Determinantes sociales de la salud: una prioridad para la medicina interna. Documento de posicionamiento de la Sociedad Española de Medicina Interna (SEMI) y la Sociedad Portuguesa de Medicina Interna (SPMI)

Abstract

Introduction

Internal medicine, owing to its comprehensive and cross-sectional approach, is uniquely positioned to lead the integration of social determinants of health (SDOH) into clinical practice.

Methods

Based on the Delphi methodology promoted by the Spanish Society of Internal Medicine (SEMI) and the Portuguese Society of Internal Medicine (SPMI), this study explored perceptions, barriers, and strategies for integrating SDOH into hospital care. Experts from both countries participated in a two-round consultation process, followed by a consensus meeting, which resulted in a prioritized roadmap of action.

Results

Our findings show strong agreement on the relevance of SDOH for health outcomes, the need for mandatory and transversal training at all educational levels, and the importance of validated tools for systematic screening. Key barriers include lack of time, insufficient specific training, limited human resources, and the absence of structured SDOH data in electronic health records. Additionally, the results emphasize the importance of interdisciplinary teams, coordination with social services, and adapting care pathways to patients’ social contexts. Emerging determinants include population aging, mental health, climate change, and digital transformation, including artificial intelligence.

Conclusions

This decalogue provides a practical and prioritized roadmap to transform Internal Medicine care towards a more equitable, comprehensive, and SDOH-sensitive model, with training, service organization, technological resources, and collaboration as fundamental pillars.