Pharmacists Can Make Small Interventions to Help Patients Impacted by Social Determinants of Health

Pharmacy Times® interviewed Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP, dean and professor at the Loma Linda University School of Pharmacy in California, on his keynote address at the APhA 2023 Annual Meeting & Exposition titled “Keynote: Small Things. Big Impact.”

Pharmacy Times: How can social determinants of health impact patient outcomes?

Michael D. Hogue, PharmD, FAPhA, FNAP, FFIP: I think that we all inherently kind of understand that there's more things that impact our patients’ health and wellbeing than just the medicines they take and the health care they receive from their primary care provider. There's lots of things that impact our health decision-making. Things like how safe our environment is, whether or not there are sidewalks in our environment which makes it easy for us to walk in our neighborhoods if you're in an urban area, whether or not you have transportation—maybe you can't afford a car or you don't have easy access to a bus station—transportation can affect that greatly, and then just simply also whether or not there's a supportive environment around you where people value health and other individuals value what you have.

Then there's other things that are social determinants of health that are out there that impact our health and wellbeing overall, air quality and pollution being one of the biggest ones that really impacts patient outcomes. And so what we're suggesting is that social determinants of health are something that just simply can't be ignored. And, whether you're a pharmacist or a physician or a nurse practitioner or a physician assistant or whatever your discipline is, we have to take into account that these other factors that are perhaps not biologic factors but environmental factors impact the way that our patients approach health care, and impact the way that they seek health care, and impact the way that they engage on a regular basis or are disengaged on a regular basis. And all of that information then helps a pharmacist think more carefully about how they need to work in their community to better meet their patients’ needs and ensure that we have appropriate outcomes from therapy.

Pharmacy Times®: What are some ways that pharmacists can identify a patient who may be in need of support due to social determinants of health?

Hogue: Yeah, so pharmacists in local communities are the pillars of their communities, and they have wonderful relationships with the patients in their communities. And we just encourage that continued relationship-building. Relationships are really where it's all at. And we recognize that not every pharmacist has the staffing support around them, or has the support, perhaps a corporation, necessarily, but many do. And many pharmacists do pride themselves in knowing the names of their patients and knowing about their patients and the lives of their patients. So, awareness is the number one thing that pharmacists need to do in order to be able to know about and identify what the issues are in a community, what the factors may be in a person being able to access health care services, whether it's at the pharmacy or somewhere else. So, pharmacists just need to listen to little cues.

Oftentimes, patients will talk about—will give you clues of things that may impact food security, for example. They may make comments off the cuff about, oh, yeah, I haven't had breakfast yet. Well, maybe they don't regularly eat breakfast. So we need to ask questions about meal habits. And that might be important depending on the medication they're taking. Because, if a medication has to be taken with food and a person's not able to actually eat 3 meals a day because they don't have the financial resources to have food 3 meals a day, we might have to get creative about how we help the individual find food pantries in the community. We might be have to connect them with a local social services support or faith-based organizations, such as churches and others, that might have food pantries, or provide those resources so that patients can be able to get the best out of their medicines, because medicine may need to be taken with food. So those are just little things. But really, it's just listening to your patients and listening to the challenges that they're facing in their everyday life, and being aware of the community around us. And most community pharmacists know well what's going on in their local community, and just through good active listening and questioning, we can identify ways that we can support our patients in the things that may not be around their medicines, particularly, but around their community and their ability to be impacted or take their medications correctly.

Pharmacy Times®: What are some of the small interventions that pharmacists can take to help patients who are impacted by social determinants of health?

Hogue: Well, I think a lot of this really depends on where you're located and what your community resources are. I mean, the first thing pharmacists can do is actually just put together a one pager, even if it's just used as a handout, but a one pager of local community resources. Now, many people in community just may not have awareness about what is available around them that could potentially help them in accessing social services or accessing the resources they need. There's a lot of great community-facing organizations out there that help with transportation that can give people rides at no cost to get to the pharmacy, to get back and forth to the pharmacy. Your pharmacy can offer delivery service. You may think that everyone knows that you offer delivery service, but that may not be true. Patients may not be aware that they can actually have their medicines delivered to their home. And so, for a patient that’s having transportation issues, that little bitty thing, just getting medicines delivered to the home, can be a game changer for them. And so we think it's no big deal. Patients think it's a really big deal. And we shouldn't assume that patients know what's there.

And the other thing I just like to mention to pharmacists, particularly those of you who work in an urban area, is that there's a group of health care professionals springing up that didn't exist a few years back. But now they are really growing in numbers, and they're called community health workers. Community health workers are individuals who have some basic underlying training in health behaviors and health change. And community health workers are boots on the ground in local communities, working with social workers and other community health agencies to try to improve the health and wellbeing of local communities. They might be working with your state Medicaid agency. They might be working with your county health department. Community health care workers might be connected to large academic health science centers. But if you can identify whether or not there's a community health worker serving your area, that would really be helpful because they can then mobilize social service support features that can help individual patients out. So, these are just easy ways. What I call this, frankly, is connecting the dots. Pharmacists can be—a simple thing pharmacists can do is just simply connect the dots for patients: help patients connect between the pharmacy, the social services that they might need, and their primary care provider. And making that connection will enhance and ensure that those patients are getting optimal health and optimal health care.

Pharmacy Times®: What are some of the tools and resources available to pharmacists to support patients with barriers to care?

Hogue: Well, the big thing here is partnerships. And I've said this before, but I really think it's important for pharmacists to be connected. We don't have to do everything, although I do believe that pharmacists provide a more comprehensive range of services in their local community oftentimes than any other health care providers are able to provide, just simply because, in many communities, pharmacists are the only health care providers. So, the breadth of services that pharmacists offer is pretty wide. But I would just say, this is one of those times where being connected in the local community and knowing exactly where to refer a patient is probably the most time efficient and effective thing that can be done. Knowing where in your local community someone can get assistance with any—you name it—whatever the service is the patient needs is really important.

And then the other thing I would just say is volunteerism is really a very, very vital part of each of our lives. And I can tell you even busy pharmacists in busy stores, perhaps exhausted from the work that they're doing which is just real in health care these days and real in pharmacy, pharmacists love to give back and the heart of pharmacists shines through. And so, consider engaging with volunteer organizations in your local communities that can really help individuals in the community access health care and access health resources. There's a lot of small things that we can do that don't have to be time consuming. It just has to be from the heart and pharmacists really impacting social determinants is a heart thing. It's not a labor thing, and if we will just let our heart shine through, generally speaking, we can make a huge impact on our patients.