Pharmacists Can Help Manage Disparities in Health Care Access

Pharmacy Times spoke with Orly Vardeny, PharmD, MS, a core investigator at the Center for Care Delivery and Outcomes Research in the US Department of Veterans Affairs, about pharmacists’ roles in managing pharmacotherapy disparities.

Q: What disparities should pharmacists be aware of with regard to pharmacotherapies?

Orly Vardeny, PharmD, MS: I think it's important to recognize that medications that are FDA approved and then recommended in guidelines are not used equally in everybody. They're not prescribed equally in everybody. But we have found, and there have been several analyses and several studies that have shown, that there are certain groups that don't get access to certain medications. And that is potentially due to lack of access to health care, but it can also be due to treatment inertia. I think one example is that women, for example, are not usually on a recommended statin medication based on their cardiovascular risk. They're not offered statin, a cholesterol lowering medication, as often as men might be. So, their chances of being on a statin and a dose that's recommended by guidelines is lower. Women also discontinue this medication more frequently, and potentially experience more adverse effects. And so that's one example. Another one is in hypertension, when you think about racial and ethnic groups and differing control [levels] can affect blood pressure control treatment. Even awareness of hypertension is different in different groups. For example, blood pressure control, per AJCC guidelines, is usually lower, which means blood pressure is higher for Black individuals, for Hispanic or Latino individuals, and for Asians compared to white Americans. So that's another example where there are some disparities in treatment from several different angles for different groups.

Q: How were these disparities exacerbated by the COVID-19 pandemic?

Orly Vardeny, PharmD, MS: So, I think COVID-19 has taught us that access, and particularly access to health care, has been particularly difficult for individuals of lower socioeconomic status. [Those] are individuals that may not be able to have access to health care in person. And so, what we have found is that people have been deferring health care and waiting until things get serious or until they need to be hospitalized. And what we have found is that individuals of minority groups are more likely to be experiencing this lack of access to health care and also deferred care.