Community Pharmacists Can Better Understand, Implement Social Determinants of Health

In a webinar titled “Breaking Barriers: Improving Health Outcomes through SDOH Screening in Community Pharmacies,” 3 expert panelists discussed the use of social determinants of health (SDOH) in community pharmacy practice, with a focus on screenings and referrals.

Host and moderator Jason Ausili, PharmD, MSLS, head of pharmacy transformation at EnlivenHealth, described the importance of outreach in community pharmacies. Ausili emphasized that pharmacies are positioned at the epicenter of care.

Food pantry | Image credit: Drazen - stock.adobe.com

Community pharmacies provide various resources, starting with accessibility. More than 90% of the population live within 5 miles of a pharmacy, making it the most accessible health care destination. As a result, community pharmacies can provide more guidance and support when medical care facilities are difficult to reach or access.

In a report from the Association of American Medical Colleges (AAMC), experts predicted a shortage of 17,800 to 48,000 primary care physicians (PCPs) by 2034. Because of this looming challenge, pharmacies are providing high-touch care as research suggest that patients visit their pharmacies at least 2 to 9 times more than their PCP. The study, conducted by Klepser et al., found that 38.7% of patients utilize the pharmacy outside of the normal office hours and 34.6% of patients reported not having a PCP.

With all the benefits provided by community pharmacies, the panelists acknowledged that there are opportunities to expand their clinical service. Some of these opportunities include chronic disease management, point of care testing, wellness and preventative services, robust vaccination programs, working with physicians, test and treat, and—perhaps most importantly—SDOH screenings and referrals.

“We help patients get better while more affordable health care is closer to home. SDOH is the center of all of this,” Ausili said during the discussion. “If the patient is struggling, they will not be able to achieve optimal health.”

Opening the discussion on the topic of SDOH, Stephanie McGrath, PharmD, Executive Director of the Pennsylvania Pharmacists Care Network (PPCN), the CPESN network of Pennsylvania, provided the definition of Social Determinants of Health. According to the US Department of Health and Human Services Office of Disease Prevention and Health Promotion, SDOH are defined as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks.

According to McGrath, SDOH can be broken into 5 domains: economic stability, education access and quality, health care access and quality, neighborhood and built environments, and social and community context.

“There are a lot of evidence that shows that 45% to 60% of health outcomes are due to social determinants,” McGrath said.

Nicole Pezzino, PharmD, BCACP, CDES, program director of PGYI Community Pharmacy Residency and director of community outreach and innovation at Wilkes University, discussed the role community pharmacies have with SDOH.

“Community pharmacists are in the community. We are meeting the people and are in the community with them,” Pezzino said.

According to Pezzino, patients will visit a pharmacy roughly 35 times a year, allowing pharmacists to create a strong relationship with them. Importantly, everyone pharmacy staff member who interacts with the patients can play a part in building this relationship, including delivery drivers, cashiers, and technicians. Pezzino said there is a community right there in the pharmacy center.

Community health partners are great assets for these pharmacies in order to give patients more information on benefits and resources. In one PPCN community pharmacy, McGrath said a 63-year-old woman who had limited access to resources needed aid. She only had 1 more bus ticket and needed to decide whether to use it to get to the food bank or a medical appointment. At home she only had 1 can of chili, 1 bag of popcorn, and 1 cup of coffee to last her until she could get to the food bank.

McGrath explained that this woman did have benefits, but she could not access them. A community health worker was able to communicate options and benefits to the woman and how she can use them to be able to get to both the food bank and medical appointment, along with other assistance options for the future.

McGrath explained that the woman is not usually very open to communication, but McGrath said she was grateful that the pharmacy was able to help.

“[The pharmacy was grateful to have] this opportunity with her. She just needed the help, and many are not able to ask for help,” McGrath said.

Such services have impacted many individuals and the expert panelists said they have been able to see the impacts firsthand.

Rachel DiPaolantonio, PharmD, a PGYI community-based pharmacy resident at Wilkes University, described the time she helped a 24-year-old male that she connected with on a cold call, when she brought up SDOH. During their phone call, the man told DiPaolantonio that he was in a car accident the day prior outside of the pharmacy. It was a tough situation because he had post-traumatic stress disorder from driving in the past. He now was worried about how he was going to get to work and get to medical appointments due to a major surgery necessary after the accident. He also had pain medication waiting for him at the pharmacy that he would have to walk to get because the pharmacy did not offer a delivery service.

DiPaolantonio was touched by his situation and reached out to a community partner to ask if they could provide help with transportation. A medical case manager was put into contact with the man, and he now has a car and can get to appointments.

McGrath shared a similar story in which another PPCN pharmacy was able to provide someone with the assistance to receive Section 8 housing. Once patients have resources, she said the goal is to check in with patients with how they are doing, so they can eventually become more independent and less reliant on such programs.

“I cannot believe pharmacists are [triaging SDOH needs], but they are and are making a great impact,” McGrath said.

According to McGrath, PPCN has made significant efforts to collect data on SDOH. They now have 7 months of data between August 2022 and March 2023. Throughout those 7 months, 1,100 screenings occurred. In the early program results, the Pennsylvania Pharmacists Care Network found that most of the referrals were for financial strain, utilities, food insecurity, health care affordability, and clothing.

The assessment used for the screenings includes 4 questions and is a patient-friendly format to ensure that the questions are answered accurately.

The panelists said they have experienced various challenges with SDOH screenings and referrals. Pezzino shared that during one phone call, a woman hung up on her saying she did not need assistance. The patient later called back, explaining that she was in a public space and did not want to discuss SDOH-related issues there. Because of this, Pezzino said she realized that private locations are more ideal and can make patients feel more comfortable to express what they need.

When discussing how to bring up the idea of SDOH to patients, DiPoalantonio described how she learned the difference between being perfect and being prepared. She originally took the time to write the perfect pitch, but later realized all she needed was to prepare herself about the resources available. This preparation allowed her to connect more patients with the resources they needed.

Reference

Ausili J, McGrath S, Pezzino N, DiPoalantonio R. Breaking Barriers: Improving Health Outcomes through SDOH Screening in Community Pharmacies. June 21, 2023. https://omnicell.registration.goldcast.io/events/14e648ed-7f30-43cd-b438-5f662f333c3d