Table 1.

Summary of Key Tasks and Challenges in Care for Socially disadvantaged Patients

KEY TASKS	CHALLENGES
Exchange of Information
Obtaining history	Higher disease burden, psychological distress and social problems16,28,32,159,160
Eliciting patients expectations, beliefs, values, perspective	Cross-cultural and educational differences between physician and patient (Social distance)161
Behavioral risk factor counseling	Higher rates of behavioral risk factors (e.g. poor diet, physical inactivity, smoking)16,162,163
More intensive and/or complex Treatment	Greater number of symptoms and illnesses 25,28,159,160
Primary care mental health counseling	More emotional distress and less access to mental health treatment 16,160,164
Physical Examination
More time to explain procedures	Lower health literacy47,48 and language barriers21,46
Detailed examination	Greater morbidity28
More time needed to complete examination	Higher levels of functional disability28
Special equipment to accommodate disabilities	Higher levels of functional disability28
Patient-Centered Communication
Establishing rapport and trust	Social and cultural distance and mistrust31,62,161
Negotiating a visit agenda	Greater number of concerns to be addressed, lower health literacy 28,32
Understanding patient social and family context	Physician bias and misunderstandings more likely, greater need to tailor care to patient's context70,165
Understanding patients’ beliefs, expectations, preferences	Social and cultural distance and patient skepticism of patient's health beliefs161,166,167
Establishing shared understanding of problem and treatment	Social and cultural distance; prerequisite to patient activation161
Confirming patient understanding	Differences in language, culture, and health literacy45,168,169
Assessing and addressing adherence barriers	Financial, cultural, education, social, and logistical barriers53,54
Non-Reimbursed Care
Pre-visit planning	More complex visits28,32
Post-visit planning	Need to confirm patient understanding and address barriers to plan45
Language translation	Lower rates of English proficiency 168
Care coordination by physician (referrals, correspondence, etc.)	Greater illness burden and psychosocial problems, more access barriers28,32,130
Assisting high risk patients in navigating the system	Higher rates of HIV, cancer, diabetes, asthma86
Establishment and maintenance of tracking registry	Worse control of chronic disease170,171
Improving access to care	Greater need for patient outreach86
Patient self management training	Greater need for outreach to patients in need of care172-174
Form completion	Higher rates of disability, involvement with social services, criminal justice system, drug treatment programs28,175,176