Pharmacists Play Valuable Role in Addressing Social Determinants of Health

Through screening and interventions that target medication adherence and reduce medical spend, pharmacists can help influence outcomes associated with social determinants of health (SDOH), according to a live broadcast session from the 2020 Pharmacy Quality Alliance Annual Meeting.

Dani Markus, PharmD, MBA, vice president of quality at OutcomesMTM, and Sarah Dean, PharmD, MPH, clinical program lead, quality network, at Humana, presented results from a study conducted by Humana, which evaluated SDOH services by collecting data through assessments distributed to pharmacies. The investigators aimed to determine whether pharmacists were able to have effective conversations with patients about SDOH and if intervention spurred changes in the patients’ health-related behavior.

Assessment questions focused on factors that often inform an individual’s health, such as housing, food, transportation, physical/emotional well-being, and school/work life and included the following:

• What is your housing situation?

• Are you worried about your housing?

• Have you worried about running out of food in the last 12 months?

• Has a lack of transportation kept you from going to medical appointments?

• How often do you feel lonely or isolated?

• Do you want help finding or keeping work?

The investigators amassed 9802 (56%) successful assessments from 2162 pharmacies from November 15 to December 31, 2019, which included patients with chronic conditions including atrial fibrillation, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, and osteoporosis.

The most prevalent SDOH reported were food insecurity, social isolation, and transportation, with 12.5% of participants reporting challenges in making food last and affording a sufficient supply and 11.2% reporting challenges in finding transportation in the past 12 months. In addition, 18% reported sometimes, often, or always feeling lonely or socially isolated.

In evaluating data according to the chronic conditions present in the study, those with COPD or depression demonstrated higher reports of SDOH than other demographics did. Although 13% overall said they worried about running out of food, 16.5% of those with COPD and 16.2% with depression reported this concern. According to the investigators, individuals who completed the assessment also showed statistically significant decreases in medical spend.

The investigators identified limitations related to the short study period and follow-up frame and suggested important revisions, such as working toward offering a follow-up service that facilitates action and provides resources based on the conversation between an individual and a pharmacist.

Future recommendations involved offering best practices to facilitate productive conversations. Some pharmacists in the study were successful in engaging individuals and finding helpful resources. Through the assessment, 1 pharmacist determined that an individual was struggling to afford food but not on food stamps; as a result, he put his patient in touch with an agency to help.

Other participants made it a priority to follow up with individuals who expressed SDOH: “We...educated the patient on the available local sources of social assistance, such as Red Cross, Salvation Army, Haven of Mercy, etc. We flagged the patient’s chart to follow up with her when she comes to the pharmacy,” a participating pharmacist told the investigators.