The importance of addressing social determinants of health (SDH) in clinical practice is widely acknowledged. However, managing SDH becomes particularly challenging when patients exhibit psychological deficits and behavioral disorders. The present case involved a woman in her 80s who lived on public assistance and exhibited multiple co-morbidities. Following the initiation of home medical care, her condition deteriorated due to an interruption in necessary medical treatment after the electricity in her house was disconnected for nonpayment. The patient had strained relationships with the public assistance officer and other support personnel. As her primary physician, I convened all relevant parties to address the situation, evaluated her psychological and behavioral issues, and provided financial management support. Within six months, she paid her overdue electricity bill, following which her symptoms showed notable improvement. This report details the challenges healthcare workers face while addressing multiple SDHs such as the patient's financial hardship and severed connections with social resources. Our findings suggest that interventions tailored to a patient's psychological and behavioral needs improve their health.

Introduction: This study assessed the changes in outpatient visits during the COVID-19 pandemic.Methods: Subjects were patients who visited the outpatient clinic of the Family Medicine Centre at Kanai Hospital between April and May in 2019 and 2020. We compared the number of outpatients, their age, and their reasons for encounter (RFEs) classified according to the International Classification of Primary Care, 2nd Edition between 2019 and 2020.Results: A total of 1159 patients in 2019 and 859 patients in 2020 were evaluated. There were 553 male patients in 2019 and 452 in 2020 (P =0.029). The mean age of the patients was 48.4 years in 2019 and 52.4 years in 2020 (P =0.010). The mean number of patients per day was 25.2 in 2019 and 17.9 in 2020 (P < 0.001), with a significant reduction in patients aged 0-4 years in 2020 relative to 2019 (3.64 in 2019 vs.1.02 in 2020; P < 0.001). On evaluation of RFEs classified by organic system, the proportion of respiratory RFEs decreased from 45.3% in 2019 to 31.6% in 2020 (P =0.026), and gastrointestinal RFEs decreased from 17.9% to 5.3% (P =0.003) among children. Among adults, the proportion of respiratory RFEs decreased from 22.6% in 2019 to 15.6% in 2020 (P < 0.001) and skin RFEs decreased from 20.1% in 2019 to 15.3% in 2020 (P =0.011).Conclusion: The number of outpatients decreased during the COVID-19 pandemic. There were differences in the proportion of RFEs between the two periods.