Conversations About SDOH Are Difficult but Vital

Stephens,Amie;

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October 30, 2024

Pharmacy Times

October 2024

Volume90

Issue 10

Conversations About SDOH Are Difficult but Vital

Author(s):

Amie Stephens, PharmD, MHA

Key Takeaways

Social determinants of health (SDOH) include income, education, and access to healthcare, impacting patient outcomes and medication adherence.
Community pharmacies, with frequent patient interactions, can effectively identify and address SDOH factors affecting health equity.
Screening tools like PRAPARE and relationship-centered communication skills facilitate sensitive SDOH discussions, improving patient trust and outcomes.
Providing actionable solutions to identified social needs is crucial to maintaining trust and enhancing health equity in communities.

Initiating such discussions can be hard, but they can greatly affect health outcomes.

Social determinants of health (SDOH) are various nonmedical factors that can influence a person’s health.¹ Another term often used interchangeably with SDOH is health equity, defined as “the principle underlying a commitment to reduce—and ultimately eliminate—disparities in health and its determinants, including social determinants.”²

Image credit: Andrii | stock.adobe.com

According to the World Health Organization (WHO), some factors that fall under health equity and SDOH are income, education, food insecurity, employment or job security, housing and environment, social inclusion and nondiscrimination, and access to affordable and decent health care services.¹ Having conversations with patients about income, health literacy, and the other sensitive topics listed above can be very challenging. These conversations can be intimidating and difficult to engage patients in but immensely impact patients’ health outcomes.

“The SDOH MTM [medication therapy management conversations] were a little daunting at first because you’re asking the customers to speak on a tough subject,” said Emilee Kennelly, PharmD, manager of adherence improvement and clinical initiatives at Rite Aid, in an interview. “Once I did my first few, though, it wasn’t a hard conversation to open up.”

About the Author

Amie Stephens, PharmD, MHSA, is director of adherence improvement and client services on the clinical services team at Rite Aid. In this role, she leads the company’s adherence and medication therapy management strategies.

SDOH factors, including medication adherence and persistence, can significantly affect a patient’s health and wellness. The National Institutes of Health (NIH) defines medication adherence as “the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen.”³ Similarly, the NIH defines medication persistence as “the duration from initiation to discontinuation of therapy.”³ All the SDOH factors can impact a patient’s medication adherence and persistence, directly affecting how well their disease states are controlled.

If a patient is not educated to understand their disease state or medications, they may never pick up their medication from the pharmacy at the outset. If a patient is unemployed or has housing or food insecurity, they may forgo their medication for periods when forced to choose between their treatment and feeding their family. Understanding how much social factors can affect a patient’s overall health makes it easy to want to pursue these SDOH conversations, but knowing where to start can be a challenge.

The easiest way to begin is with the 3 most widely used screening tools available. Using a screening tool helps to ask the right questions in the right way. The Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences (PRAPARE) has 15 core and 5 supplemental questions. In contrast, the EveryONE Project has 11 questions, and the Health-Related Social Needs Screening Tool has 10 questions.⁴ The questions in all 3 screening tools are centered around housing, food, transportation, and personal safety. Many health plans and SDOH vendors have their own version of these tools. The tools can be used in various ways, with guidance from a health care provider or pharmacy team member, or they can be self administered and submitted by the patient or patient caregiver.

Whether the provider or pharmacy team is administering the questionnaire or responding to results from a self-administered questionnaire, the conversation can be sensitive for the provider and the patient. Relationship-centered communication skills can make these conversations easier for both. These skills are focused on positive regard, active listening, and empathy and have been shown to improve patient outcomes.⁵ Being open and understanding with patients and ensuring they feel safe and supported is imperative to gaining their trust and having productive SDOH conversations.

Community pharmacy teams are well positioned to affect their patients’ health equity, as pharmacies are the most frequently visited health care locations in the US. On average, a patient visits their pharmacy 35 times per year.² Patients build long-standing, trusting relationships with the pharmacists and technicians at their local pharmacy. This enables pharmacy teams to identify potential SDOH factors contributing to nonadherence or gaps in care. In addition to having vendor partners and technology-driven SDOH tools, pharmacy teams can use their established patient relationships to read between the lines and identify various social gaps, such as transportation, food, or housing insecurity, during regular conversations.

Teams may have a trusting relationship and a productive SDOH conversation with a patient. However, trust can be lost if a social issue is identified, such as food insecurity, but the patient receives no resources or solutions. It is not enough to discuss SDOH and simply document the results. Many communities have resources to address social needs, and a quick Google search by zip code can provide options to patients with food or housing insecurities and more. Additionally, some websites offer lists of resources based on zip code.

Based on the extensive impact SDOH and health inequity can have on a patient’s health outcomes, using a preexisting screening tool, creating your own, or identifying social needs within the normal course of conversation can add value and improve health equity in our communities every day.