Addressing Social Determinants of Health in Primary Care

Posted on: March 1, 2023Pittsburgh
  1. James is holding a food box.

Healthcare and convenience are two words that are hard to say in the same sentence for many.  Here in the Greater Pittsburgh area, there are over 35 hospitals that provide care for the 300 thousand-plus residents that call the area home. While these hospitals provide care, many patients find themselves navigating the healthcare system alone. From trying to figure out their next specialist appointment, what screening test they need to complete and how to do them, to trying to figure out the finances of their care, these tasks alone are hurdles. However, throwing in a job with constraining hours, language barriers, lack of insurance, and the many other barriers that patients experience leave many residents reluctant to try to figure out their individualized needs as a patient.  These barriers are furthered as many patients may face struggles from a lack of resources, like food insecurity, job insecurity, transportation, and housing. Being able to recognize and assist patients with their individualized social determinants of health and connecting them with resources has been the foundation of my service at the UPMC St. Margaret Lawrenceville Family Health Center.

As a Patient Navigator at the UPMC St. Margaret Lawrenceville Family Health Center, connecting patients to the critical resources to eliminate health disparities is at the forefront of my duties. Connecting patients to transportation resources like Medical Assistance Transportation Programs or taxi vouchers allows patients to access care no matter their location in the city. Although for some people, getting qualified for programs like these can be full of clerical diligence. Not only am I able to connect a patient with transportation services, through service I am able to connect our health center with local organizations that benefit our patients. Through a partnership with the Greater Pittsburgh Community Food Bank, we receive emergency food boxes that include non-perishable food products for patients facing food insecurity. When I first arrived in Pittsburgh, it was quite evident that grocery stores in the city are challenging to access without a vehicle. Starting this year, we have begun to acquire produce for our patients that struggle with affording healthy foods. Proudly, we have been able to provide fresh produce to over 40 patients for the last 6 months.

Though connecting patients with the resources they need is important, there is a lot more that comes with my day-to-day service.  Most of my interactions stem from outreach for preventative health screenings that include mammograms for breast cancer, colonoscopies for colorectal cancer, low-dose CT scans for lung cancer, and DXA scans for osteoporosis. The use of motivational interviewing and providing digestible education allows the ability to assist patients with their healthcare concerns. Through these conversations, the goal is to allow patients to make informed decisions that will lead to a healthier life. Being a community health center, the UPMC St. Margaret Lawrenceville Family Health Center allows patients to not only see their primary care provider, but patients also see a variety of other providers, including social workers, OBGYN, sports medicine, and dietitian services. This allows patients the ability to access care without having to go to a specialist that may be inaccessible. Using resources to assist these patients with completing their preventative health screenings allows me to not just instill change, but also provide solutions for complexities that some patients may face. Undoubtedly, my role as a Patient Navigator at the UPMC St. Margaret Lawrenceville Family Health Center has allowed me to assist patients with navigating the complexities associated with going to the doctor’s office. Through my service, I have gained tremendous passion for progressing towards an equitable healthcare system that supports all patients.

About the Author:

James Kelly

Pronouns: he/him/his

Position Title: Patient Healthcare Navigator

Where are you from? 

Philadelphia, PA

Why did you decide to join NHC?

Host Site

UPMC St. Margaret Lawrenceville Family Health Center
3937 Butler St.
Pittsburgh, PA 15201
UPMC St. Margaret Lawrenceville Family Health Center
3937 Butler St.
Pittsburgh, PA 15201