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Table 2 Social Determinants of Health

From: A qualitative analysis of interprofessional healthcare team members’ perceptions of patient barriers to healthcare engagement

Theme

Quote

Uninsured: limited primary care availability and use of emergency department as primary source of care

The folks in the community who use the health center. It’s so – it takes forever. You have to go there at 5:00 in the morning or whatever and stand in line and wait hours to get your meds and some people just don’t have time for that.

They can’t go there and wait at 7:00 a.m. in the morning with the discharge instructions in hand half the morning to be seen to wonder if they’re gonna get a same day appointment or an appointment in a couple of days or so.

If you don't have insurance, you go to the emergency room and you use the emergency room as your doctor, your clinic.

Yes, and also they use the emergency room because I have found out through speaking with hundreds of people that they feel as though the emergency room have the services right there and they don’t have to wait like with a clinic you have to wait.

Difficulty applying for insurance

A fear that I have is that some people didn’t do it [enroll in ObamaCare], didn’t understand it, or even if they understood it didn’t do it the right way or what have you.

Excessive copays

I had a patient a few days ago who didn’t want a home visiting nurse to come out to check his incision because he couldn’t afford the co-pay.

So what I’ve seen is there are very few options to a person without insurance and one of them being the health centers in Philadelphia… But often what I’ve seen with people without health insurance is also they can’t go to the health care center because it’s a sliding scale so it’s you pay to be seen and that doesn’t work for many people.

Impact of mental health and substance abuse

There’s no next, there’s no future… There’s no consequence all.

Transportation logistics

I find that logistics is the biggest issue with transportation… Thinking of new amputees living in [neighborhood] row homes, even getting up four steps is sometimes, it just can’t be done. And insurance companies don’t pay for a stretcher transport, so then you kind of have to coordinate with the entire family who can meet so-and-so at their front door and carry them up four steps to get in or out.

Unpredictability

I think most of us who are here today have a life that’s been somewhat organized and predictable and a lot of our individuals’ lives that we’re caring for has been anything but organized and predictable. And they are grateful to be awake and, you know, it hurts and you’ve no – you’ve no experience of what pain is manageable and what is not manageable.

When you dig just a little deep and you open up the flood gates of what’s going on in their lives, its just mind boggling. So someone is perhaps not able to buy their insulin because they need to have 10 percent to get their son’s bail – to set the bail… I’m just saying that the problems are so pervasive from violence to depression to living in situations that are just – there isn’t any one service that’s gonna fix all this.

[Primary care provider] implies stability. A [primary care provider] implies that the rest of your life has some degree of continuity. Sometimes you can’t – you can’t even control it.

…so they feel that’s their life. It’s constant crisis and so that’s how they treat it. That’s why they go through the [emergency departments], the health centers… And I feel like even having continuity is so foreign in general because it’s never been in any pattern of their life in any area. So having one doctor follow you for 20 years—once in a while you get patients like that too, but—