ThoughtSpot 2021 Series: Reducing Health Disparities

Drug Topics®: Hello and thanks for listening to Over the Counter, the podcast from Drug Topics®.

This podcast series was created in partnership with AmerisourceBergen and Good Neighbor Pharmacy (GNP), as part of Drug Topics' coverage of the 2021 ThoughtSpot conference and trade show, hosted by GNP.

For more exclusive coverage of ThoughtSpot 2021, including more podcast episodes, go to DrugTopics.com.

In this episode, special guest Lonie Haynes, senior vice president and chief diversity and inclusion officer at AmerisourceBergen, will be hosting and leading the conversation on reducing health disparities and caring for underserved communities. He’ll be speaking with Ryan Marable, president of the National Pharmaceutical Association (NPhA), and Chichi Ilonzo-Momah, owner and pharmacy manager of Springfield Pharmacy.

Haynes: Hello, everyone. Thank you for tuning into today's discussion in partnership with Drug Topics. I'm Dr. Lonie Haynes, senior vice president and chief diversity and inclusion officer at AmerisourceBergen.

I'm joined today by Dr. Ryan Marable, president of the National Pharmaceutical Association, and Dr. Chichi Ilonzo Momah, owner and pharmacy manager of Springfield Pharmacy in Springfield, Pennsylvania, which is part of our Good Neighbor Pharmacy network.

Thank you both for being here. I'm excited to have the opportunity to speak with these 2 leaders in the pharmacy community on an important topic that has been exacerbated by the COVID-19 pandemic: health care disparities.

Discussions like these are critical, and they're important to AmerisourceBergen's ongoing commitment to diversity, equity and inclusion, as well as our purpose, which is creating healthier futures.

Before we dive into the conversation, I'd like to pass over the mic to Dr. Marable and Dr. Chichi to briefly introduce themselves. Dr. Marable, please take some time and introduce yourself to the audience.

Marable: Hi everyone, my name is Dr. Ryan Marable. I am a pharmacist with the drug information and medical communications team. Definitely excited to be here.

I'm currently the president of NPhA, which is the oldest Black pharmacist association with an overall mission to provide service to underserved and underrepresented populations throughout this country. So, definitely excited to be here for this very, very important topic on health inequities and health disparities and looking forward to a great discussion.

Haynes: And Dr. Chichi, if you would, share a little bit about yourself.

Ilonzo-Momah: Thank you, Dr. Haynes.

My name is Chichi Ilonzo-Momah. I am a clinical pharmacist and also the owner of Springfield Pharmacy, located here in Pennsylvania.

I have been practicing as a pharmacist for over 15 years now. I started off with the pharmaceutical industry. And for the last 10 and a half years, I have been running Springfield Pharmacy. I have a passion for helping the underserved population, and thank you for having us here.

Haynes: Thank you for those introductions. To get started, we know that community pharmacies are uniquely positioned as trusted and accessible providers with long standing community connections to create opportunities for quality care, increase prescription adherence, and, of course, reduce health disparities.

But before we start, I really want to unpack the term health disparities. We know clinically it means a difference or an outcome differentiated between different groups of people. I'd like to hear from you, Dr. Marable, your thoughts around the term health disparities, and can you discuss some of the causes and complexities in that space, from your perspective at the NPhA?

Marable: Absolutely, so, the term health disparities, it is definitely a very complex subject, but just trying to simplify it as best as possible and just get a basic understanding of what health disparities are, really in its essence, it's a situation where groups or populations of individuals have a disproportionate effect as it relates to their outcomes of their care.

You have situations where groups of individuals may experience negative outcomes as it relates to their overall health and wellness that can't necessarily be just explained by the level of care that they're receiving. So, typically, these are systematic approaches - so it's not an individualized situation where someone is experiencing a negative outcome, but you have to think about the bigger picture.

One of the main areas as it relates to health disparities can be impacted by groups of individuals, their overall socioeconomic status. You can have gender disparities; you can have disabilities as it relates to sexual orientation; you have situations where access and availability to care and medications can create impact. And there's so many different areas that can lead to health disparities.

But I feel like some of the more important ways, as pharmacists who are interfacing with these with patients, and other health providers in the community, is to just take time throughout your professional journey and to educate yourself, because things do continue to change, sometimes for good, sometimes for bad. But at the essence of it all, as long as you're continuing to educate yourself, that's one way that we can continue to address these health disparities and try to break down some of those barriers that we just mentioned previously.

Haynes: Thank you, Dr. Marable. Dr. Momah, you have that unique position of not only being a clinician, but also a practitioner with boots on the ground. And you support many different patient populations in Springfield, PA and throughout the Delaware County. Can you describe some of the disparities that you experience and those barriers that you've seen in the patient population you happen to serve?

Momah: Absolutely. We are fortunate and blessed to be located in Springfield, where it's almost like in the middle of Delaware County, where we can reach the underserved, as well as a lot of people that are experiencing health care disparities.

One of the major things that I've noticed is accessibility. A lot of patients are not able to have access to a certain level of care that should be easy to get. And most of them are due to, some people might say ignorance, some people might say hesitancy, but it comes down to education and communication.

And I've seen a lot of language barriers, where people, we just assume people understand English or can read English, but because they can't understand or read, they're not able to be served what they need.

And we've also noticed fear. A lot of people are afraid to ask questions. A lot of people are afraid to admit that they don't know some information. And that causes a lot of gaps in our system. And as pharmacists on the front line, we are the liaison between other providers and these patients, so we have to be able to - some people might say dumb it down - but it is what it is. We have to be able to speak the language that they understand and meet them where they are to explain it to them better.

And being able to empathize with this patient and be approachable. Being able to be accessible to them is important and the pharmacy is the place where you can walk in without really making an appointment. We are training our staff to be more empathetic, so that when the patient sees you, they're not afraid to even talk.

We’ve had situations where patients can come in with a problem, but are afraid to even voice out the problem because of fear of being judged, fear of not being understood, or the fact that they don't see anybody that look like them in the pharmacies.

I am very passionate about patients I serve. I'm going to give you an example. We ran a COVID-19 clinic, where everybody there spoke Spanish and I do not speak Spanish. Being able to have an interpreter say some of these medical terms in Spanish, but in a very easy and understandable way, so I can communicate with this patient and tell them, ‘You're going to be okay. Are you having any symptoms?’ Explaining it to them in their language so that they can feel comfortable in their own skin to express how they feel.

Haynes: Excellent. As you were speaking, Dr. Momah, I did think about what is coined as cultural competency. Being able to, to your point, speak the language for those patients, whether it is a different language, whether it's sign language, if you're dealing with deaf individuals, or whether, as you said earlier, the LGBTQ population. Race, ethnicity, gender - all these are critical when engaging with patients.

And Dr. Marable, I wanted to ask you if you could describe some actionable ways that pharmacists can address these disparities, and also how to best engage with a diverse patient population and within their own communities?

Marable: Yes. With pharmacists, we're uniquely positioned to really create positive change and to interact with patients from diverse backgrounds, communities, and socioeconomic backgrounds. I always am a champion of pharmacists to be able to really put our best foot forward and to try to address these various barriers and try to break them down.

So just a few unique ways to accomplish that is to try to engage with other like-minded organizations in your area to try to create unique partnerships and to build off of each other. You have various organizations in whatever respective community that you're in: you have religious organizations, you have public health and public safety organizations. It will be in your best interest, as a health care professional and leader within the community, to really try to align with them and see what services that they offer that could assist you and how you interact with your patients, and vice versa, because you have a professional level of service - from immunizations, to medication counseling, point of care (POC) testing - all of these different services you already have readily available, but you may not have that unique connection with those patients.

And by aligning with those organizations, that can help facilitate those relationships. Really being able to build relationships with the individuals within your community, that is more than half of the battle. And if you can accomplish that, that will help you in delivering the best level of care that you can and create those positive outcomes in the health and wellness lives of the patients that you serve.

Haynes: Dr. Marable, you mentioned some great points. And as you were discussing that, I thought of one of the most challenging populations that we're facing as a country and when it comes to health care and would like if you could expound a bit on our elderly population, especially in urban communities.

Marable: Yeah, absolutely. During this COVID-19 pandemic, I feel like this has been an exposing moment for everyone that's involved, most specifically with our elderly patients.

Having a background and working in community pharmacy and interacting with patients who come from that elderly population - it can be situations where they have limited access to come into your pharmacy, they may have situations where they may not understand their full regimen of their medications.

The benefit previously, before the pandemic, was you would be able to communicate with them in person and to be able to interact with them face to face. But now, we're in a situation where those opportunities can be few and far between.

So, being able to utilize resources that you have at your disposal is going to be critical. Not only using them for yourself, but also ensuring that those patients have the understanding and ability to use those as well, because if they're not engaged in their health, and they don't have that interaction with their health professionals, with their physicians, with their nurse practitioners, then the likelihood of them disengaging and not fully understanding their care increases.

That puts them in the position where they're already a part of a vulnerable population, and that makes the situation compounded to be even worse. As pharmacists, we have the ability to utilize technology and our resources to best interact with our patients who come from that elderly population to make sure that their care is kept that priority number 1.

Haynes: Thanks for that, Dr. Marable. Dr. Ilonzo-Momah, can you share with the audience things you're doing within your pharmacy to better understand the patients? And if you could describe some recent experiences during COVID-19, during George Floyd, where that engagement and interaction really stood out?

Ilonzo-Momah: Absolutely. So, in our pharmacy, like I said earlier, we have a diverse population in our area. So, employing a diverse staff is something that I was very intentional about in the last few years because you want the customer to walk in and see somebody that does look like them.

And like Dr. Marable was talking about the elderly patients, for example, we have to start an adherence program where we put it in blatant packaging for the elderly. And they don't pay for it. It's free. But we noticed that some of them can't even read the label to know how many medications you're supposed to take at a given time, so we put it in these packages, and all they have to do is pop one in the morning and pop one at nighttime, and we explain it to them.

And then we COVID as well, we increase our delivery radius to give people more access to their care because of a pandemic. They're not able to maybe take public transportation or get somebody else to pick it up or bring them to the pharmacy.

Other things that we're doing - we are visiting the patient more often. Especially during COVID, most of the patients are not able to come to our pharmacy to get their vaccines. So, we do home calls for a lot of elderly patients or home-bound patients. Or it might just be a mom that had 4 kids that she can’t bring out with her to come pick up a prescription, so we take it to them. These are little things that we do in the pharmacy.

And for example, you brought up George Floyd. During the George Floyd incident - it was a very emotional time in our pharmacy, because some places might not address the situation, but in our pharmacy, I said we have to talk about it. We have to talk about how the staff is feeling about it.

Because if you talk about how you feel, and everybody talks about what they think about the situation, a lot of people will get educated on what is going on. Because a patient might come in, and is Black, and has a family member that is going through what is going on in the media. When my staff doesn’t understand the why - they don't understand why the Black Lives Matter, or why there's a movement going on now, they will not be able to understand the pain that the patient is feeling. They will not be able to empathize with a patient. They will not be able to serve the patient better. They will not be able to meet the patient where the patient currently is at that moment emotionally.

Haynes: That's great. Thank you for that. And I know, as part of our discussion, we've talked about the challenges that you face on the ground and how to best address some of those. I'm curious, and as we go into the last part of this, would love to hear your thoughts about how we as an organization at Amerisourcebergen, our Good Neighbor Pharmacies, and how the National Pharmaceutical Association, how we both can increase diverse representation within the pharmacy space.

I would love to hear your thoughts around that, first Dr. Marable, and then, of course, Dr. Ilonzo-Momah, I'd love to hear your thoughts, especially, again, as a practitioner on the ground.

Marable: Yes, so the National Pharmaceutical Association, our mission, of course, is service to the underserved. But one of our main aims and values is upholding the highest level of standards within the practice of pharmacy.

One area that we continually address is developing our students that are within the student National Pharmaceutical Association. We have over 5000 students nationwide, chapters present on pretty much every campus around this country, and some of our main focuses even on just African American students in the colleges of pharmacy, but all students who have a desire to provide service to the underserved.

Not only are we performing ongoing leadership development, but we also have a scholarship program in which we have an endowment that has been established. And we have been able to deliver over $35,000 in the form of scholarships to students since the year 2001.

It's been an amazing journey to see the development of our students, who will then go on to transition as pharmacists and will be able to serve within communities from coast to coast. It's an amazing situation for all parties involved. Many of the funds are raised privately by our members, but we also have many corporate partners, one being AmerisourceBergen, so that's something that we are very excited about that we just connected with this past year. It's something that we are looking forward to as it relates to developing the next generation of pharmacists who are looking to address and break down those barriers of those health disparities, so definitely an exciting point.

Haynes: Thanks, Dr. Marable. And Dr. Ilonzo-Momah, as I said, you have boots on the ground, you're there on at the front line. And I think as you mentioned earlier, you're the first face that patients see when they arrive in the pharmacy when trying to get prescriptions filled or just wanting advice or consultation from a clinician. Can you please share your thoughts and perspective on how we can best increase diverse representation in the profession?

Ilonzo-Momah: Sure. Just over the last year or 2, we partnered with local colleges to give a chance to some of the minority students that attend pharmacy school.

And another example that I have is that we got a grant from the Pennsylvania Pharmacy Association to hire an intern for about 10 to 12 weeks this summer, just to give them the opportunity to grow in the practice of pharmacy. And we were able to pick a student from the student National Pharmacy Association from Temple University.

And this kid, he's very smart. But he would have been able to fall through the cracks, and nobody would have been able to give him this opportunity to learn, to network, and to grow and see other sides of pharmacy.

He was able to work with people in government this summer. He was able to work with other local universities and colleges, and it really empowered him. This is what we would love for, not just my pharmacy to continue, but other pharmacies and other organizations to empower these young, brilliant minds from these historically Black colleges and universities (HBCU) and give them access to be able to bridge the gap and help drive awareness to their communities. In African American communities, in Latinx communities, whatever it is, just to be able to drive awareness in these communities.

We can sit here and talk about it, but we have to do something about it. Empowering these kids through internship, and I know Dr. Marable’s organization helps these students to be able to form organizations and network, but we have to be able to help give them access so that they can pass on the torch to the next generation.

Haynes: Wonderful. I just want to thank you both for taking time to really delve into this topic, and for our audience to understand the importance of health disparities, having the ability to address health disparities with a diverse patients in their communities.

And this should not only be viewed as altruism or something that is the right thing to do. There's a good business sense of this. And if the audience is aware that in the next 25 years, this will be a majority minority country, where you’ll have diversity in rural areas and urban areas, small towns and big cities. And it's critical that we as an organization, as we strive to create healthier futures for everyone, understand health disparity.

So, I want to thank the 2 of you again for sharing your time sharing your perspective, and we look forward to continued partnership to create healthier futures for everyone.

Drug Topics®: Thanks so much to Lonie, Ryan, and Chichi for taking the time to have a conversation about this important topic, and thank you to AmerisourceBergen and Good Neighbor Pharmacy for partnering with Drug Topics on this podcast series.

And thank you for listening to Over the Counter, we hope you enjoyed this episode. If you did, take a minute to subscribe and share with your pharmacy friends. We’ll see you next time at the counter.