Pharmacist Interventions Address Disparities in Pediatric Asthma, Diabetes in Underserved Communities

To address social determinants of health in underserved communities, Walgreens has implemented an operational response in 16 pharmacies in South Side, Chicago with interventions that could be used nationally to address gaps in care in pediatric asthma and diabetes.

“This past year has shed light on many injustices and has caused us to re-examine our approach and influence on health equity,” said Michael Taitel, PhD, senior director of health analytics, research, and reporting at Walgreens, during a session at the Pharmacy Quality Alliance 2021 Annual Conference.

Pharmacists are perfectly positioned to address health disparities because of their position as trusted, accessible community members, Taitel said. In order to begin addressing these issues in communities, he said Walgreens implemented an operational response in a Chicago store last summer, which was soon expanded to 16 other stores.

Taitel said Chicago was chosen because of the notable disparities between South Side and other neighborhoods. For example, pediatric emergency department visits due to asthma occurred in 142.8 per 10,000 people in low-income community areas of Chicago in 2017, compared to 97.7 per 10,000 people in middle- and high-income community areas. Similar disparities can be seen in diabetes-related hospitalizations and influenza- and pneumonia-related death rates, Taitel said.

Low-income neighborhoods also have lower adherence rates, Taitel explained, especially in diabetes medications, hypertension medications, and statins. The social determinants impacting these issues include discrimination; health care access; gaps in education, income, and wealth; job access; and reliable housing. Based on this knowledge, Taitel said the operational responses focused on accessibility, affordability, and providing the expertise of pharmacists in low-income communities.

Reducing delayed prescription pickup is one issue that the program focused on, with the development of a delayed pickup patient journey and protocols for when this occurs, said Walgreens Director of Patient Outcomes and Adherence Stacey Emmons, PharmD. Nine days after a prescription is filled and designated ready for pickup, it is placed on the “delayed pickup” list. Pharmacy team members then contact the patient, inform them of digital tools to help them adhere to their medications, and offer free delivery.

In the 16 locations in low-income neighborhoods, Emmons said pharmacy team members have seen significant improvements in the rates of prescription abandonment. Patients who receive digital notifications are 2.6% more adherent, she said.

Similarly, the program has aimed to address pediatric asthma by involving both the patient and their caregivers, building trust and relationships between them and the pharmacy team. The program has used data to identify patients at a high risk of asthma mismanagement, conducting high-touch consultations for pharmacists to provide education. Pharmacy teams have also provided asthma action plans for both patients and caregivers, resources on inhaler technique, and pediatric asthma activity handouts.

Finally, Taitel said the program has addressed disparities in diabetes care, which led to significant improvements in adherence, statin use, and flu vaccinations among patients with diabetes. The diabetes outreach program utilizes predictive analytics and targets patients based on their historic adherence behaviors, Taitel said. It then uses holistic interventions to remove adherence barriers and to close gaps in care.

In the intervention period, Taitel said the 16 test scores saw a 2.1% improvement in the percent of diabetes prescriptions being refilled within 2 weeks of their due date, compared to no improvement in stores that did not implement the program. Similarly, the test stores saw a 3.4% improvement in the percent of statin prescriptions refilled within 2 weeks of their due date, and a 25% improvement in the number of flu vaccinations administered at the pharmacy.

Pharmacists can play a direct role in addressing social disparities of health, Taitel concluded. Although these interventions have currently only been implemented at 16 Walgreens pharmacy locations in Chicago, he said the findings so far could have significant implications nationwide.

“Eventually, as we continue to see success in this incubator, we will take these learnings and expand it nationally,” Taitel concluded.

REFERENCE

Emmons S, and Taitel M. Pharmacies Pursuing Health Equity: Addressing Disparities Through Direct Pharmacist Intervention. Presented at: PQA 2021 Annual Conference; May 12, 2021. Accessed May 12, 2021.