Company Employees Joining Pieces of Jigsaw Puzzle

Addressing Health Inequalities through Trauma-Informed Care. 

The UK’s demographic complexity is evolving and becoming more diverse. Practices are facing increasing demand while ensuring quality care, which is challenging when socioeconomic, communication, and cultural barriers exist. 

Dealing with complex patients is one of the most challenging aspects of primary care. These consultations happen repeatedly and, unfortunately, lack the continuity that would best support these patients. 

Many patients from these groups face anxiety and uncertainty, particularly when navigating an unfamiliar healthcare system. Some avoid the surgery altogether because they fear their identification isn’t sufficient, or they worry their English skills aren’t good enough, or their concerns won’t be taken seriously.  

Signs of Trauma

Certain signs may indicate that trauma is influencing the patients current needs. A significant number of these patients may be dealing with the effects of trauma, which can present as various unexplained physical symptoms, anxiety, depression, PTSD, and more. Underlying causes of this include experiences of domestic violence, substance or alcohol misuse, and homelessness.  

Sideview of senior woman feeding her husband on a recovery bed, in an open space

It’s really important to remember that trauma isn’t always immediately apparent, and primary care clinicians likely encounter patients affected by trauma on a daily basis. For instance, trauma can result from heavy caregiving responsibilities, which can be equally debilitating, as well as from negative experiences with healthcare, stemming from a misdiagnosis, lack of empathy from medical staff, or feeling of being unheard. 

To address these complex issues, practices need clear strategies in place to provide holistic care. One key approach is to focus on reducing health inequalities. This involves catering to socioeconomic disparities, addressing the needs of ethnic minorities, and supporting individuals with significant vulnerabilities and mental health conditions. 

For clinicians, the pressure is immense. Consultations with trauma-affected patients often carry a heavy cognitive load, and time constraints only add to the challenge. Repeated exposure to such situations can lead to compassion fatigue and burnout. As mentioned, trauma isn’t always visible, but it is often present in daily practice, making it important for clinicians to develop coping mechanisms and support systems. 

What does Trauma-Informed Care look like?

Three priority areas in improving care are enhancing mental health services, improving care coordination, and promoting preventive health approaches. A 2015 BMJ roundtable debate on “How can we get better at providing patient-centered care?” highlighted the importance of person-centered care, measured and incentivised according to patient needs. This approach promotes self-care, encourages “patient activation,” and improves care coordination by going beyond medicine to provide holistic support. (Parish, 2015) (McShane and Mitchell, 2015) 

The Words Solution And Problem In Missing Piece Jigsaw Puzzle

Developing trauma-informed services opens doors for collaboration with local mental health, social care, and community organisations. Such partnerships can pave the way for more effective care pathways and could possibly secure additional resources or funding for trauma-related services within primary care. For practices willing to step outside their traditional roles, working with community organisations can lead to meaningful connections and opportunities for innovation. 

A quality improvement project could focus on creating better referral pathways, joint initiatives, or shared education campaigns. These efforts can maintain the independence of the respective services while ensuring individuals receive comprehensive support, both inside and outside the clinic. It is equally important that these partnerships should close the loop on communication, providing feedback on the outcomes of the collaboration, whether positive or negative. (Close et al., 2019) 

Within the practice itself, small but impactful changes can make a difference.  

Practices can start with enhancing the physical environment, using inclusive communication tools, and providing information in multiple languages to help create a welcoming atmosphere. Access to trauma-informed training is also essential. Such training should cover socioeconomic and cultural competencies to address the needs of diverse populations and reduce implicit biases in care delivery. 

Another area of change is during regular staff meetings. It’s important to allocate time to discuss challenges related to trauma-informed care.It’s great to be able to think about these things without feeling overwhelmed by daily tasks. These sessions can provide opportunities for reflection, improvement, and support, ultimately helping to reduce individual burnout

Furthermore, offering flexible appointment options, such as extended consultation slots or weekend hours, can also improve patient relationships. For those with transportation challenges, virtual consultations can be a valuable alternative. 

Collecting and analysing patient data over time is another vital strategy. By tracking demographic information (such as ethnicity, socioeconomic status, and disability), practices can identify who is using their services and uncover any gaps in care. Regular analysis of clinical outcomes, particularly for marginalised groups, can help ensure that these patients receive equitable care. 

Finally, prioritising continuity of care is key. Practices should create standardised templates that allow all staff members to easily access and understand important patient information, ensuring consistency across interactions. Encouraging patient autonomy is also critical, but for high-risk patients, clinician-initiated follow-up calls or appointments can be really valuable. (Healthpledge.co.uk, 2014)

This continuity builds trust and can help clinicians identify emerging issues before they escalate into crises. 

Overall, trauma-informed care is a comprehensive method for addressing the broader social determinants of health and reducing disparities in primary care. By creating a supportive, inclusive, and equitable approach, practices can better meet the needs of their diverse patient populations and create a more resilient healthcare environment for both patients and clinicians. 

References  

Parish, E. (2015). BMJ roundtable debate: How can we get better at providing patient centred care? BMJ, 350(feb10 14), pp.h412–h412. doi:https://doi.org/10.1136/bmj.h412. [Accessed 3rd Oct 2024] 

McShane, M. and Mitchell, E. (2015). Person centred coordinated care: where does the QOF point us? BMJ, 350(jun11 2), pp.h2540–h2540. doi:https://doi.org/10.1136/bmj.h2540. [Accessed 3rd Oct 2024] 

Close, J., Fosh, B., Byng, R., Blackwell, R., Witts, L., Hall, L. and Lloyd, H. (2019b). Evaluation of a countywide alternative to QOF, aimed at improving person-centred coordinated care. British Journal of General Practice, 69(suppl 1), p.bjgp19X702905. doi:https://doi.org/10.3399/bjgp19x702905. [Accessed 3rd Oct 2024] 

Healthpledge.co.uk. (2014). Health Pledge | Small Steps lead to Big Changes. [online] Available at: https://healthpledge.co.uk/ [Accessed 3 Oct. 2024]. 

Reflective notes from the BMJ roundtable discussion: “How can we get better at providing patient-centered care?”

Are patients interested in having their primary care clinician involved in the community, outside of their clinics?

Will patients be receptive to practices setting goals to address health issues that matter to the population that are outside the QOF indicators?

Can patients accept a negotiation around access to clinics, such as a practice reducing session hours on certain days of the week or month to engage in community outreach or quality improvement projects?

A question from one of the patient experts: How can I know how well I can be? How do you think the clinician should respond to this question?

  • Other statements/ideas made that resonated with me:

There should be a recogisable partnership of trust between patient, clinician, and system.

Patients play a crucial role in identifying what works and what doesn’t in the healthcare system, especially in terms of their own care. They share a critical position to appraise the resources needed for their care.

Healthcare is about relationships. We need to identify the barriers to these relationships and eliminate them.

No one has life completely figured out, but if you need some help, the healthcare system should be part of the solution and not make the problem worse.

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