Pharmacy Staff, Community Health Care Workers Can Team Up to Address Social Determinants of Health

Tripp Logan, PharmD, vice president at SEMO Rx Pharmacies and Logan & Seiler Inc discusses how pharmacy staff and community health care workers can work together to address social determinants of health.

Q: What are some ways that you and your pharmacy network have targeted social determinants of health?

Tripp Logan: Social determinants of health are those situations that people deal with every day of their life that may impact their health, and so in our area, it's really no different than anybody else's area, what we do is we just look at local need. With our patients, locally, we just target the things that are of importance to them, and our approach has been to cross-train our pharmacy technicians as community health workers, so that always fall on the pharmacist, so that we can make sure that our staff is well equipped to fill the needs of the people in the community that we serve every day.

Q: Can you discuss how social determinants of health have a significant impact on the health outcomes of underserved patient populations?

Tripp Logan: Social determinants of health have a big impact negatively on patients’ lives. It makes sense if you think about it because if you're if you've got a patient with diabetes, and hypertension, and heart failure, they may see their specialist a couple of hours a year, they may see their primary care a few hours a year, they may see my delivery driver a few hours a year, and that equals 10 total hours of the year that they've got access to health care professionals are their representatives.

That’s great. But every other hour of the year is life, and sometimes life gets in the way of health care. If you can't afford insulin, or your insulin gets warm, because you don't have a refrigerator that works properly or freezes your insulin, it's hard to do diabetes education, or expect somebody to have a reduction in their hemoglobin A1C.

So the first thing to solve a problem like that is to give them access to an appropriate refrigerator or insulin they can afford. All social determinants of health, not clinical. Each patient's journeys a little bit different and targeting social determinants of health means we just try to help them navigate not only their health, but make sure that life's not getting in the way of better health.

Q: For pharmacists who want to address social determinants of health in their communities, what kind of organizations should they partner with to help?

Tripp Logan: In my experience, local public health, like if you feel like your community pharmacists like me, and you're on an island, some days you just feel like I'm out here by myself, then what you need to do is go down your local public health department and see like they're even on more of an island than you are.

So that's, that's what my number 1 recommendation is: if you don't know who the director is of the local Department of Health or who works down there, set an appointment, go talk about their needs and your needs, and it could be a cross referral destination. That's the first step. I think it's easy, and usually it's a welcome conversation because not every day, does local public health get somebody like a pharmacist coming in and saying, “Hey, how can I help you make your metrics better in the in the county and make the overall population health improve?” And that's something that pharmacy can often do with local public health departments.

Q: How should pharmacists team up with community health care workers to address the gaps in patients’ social needs?

Tripp Logan: Community health workers are kind of like a hot topic, whether that's through the CDC or whether through state governments. What we found is that community health workers are local peer-to-peer liaisons that help people navigate the health care system locally. Peer-to-Peer, people that look like talk like come from the same neighborhood, so that white coat syndrome of dealing with a clinician or dealing with somebody from a call center that barriers let down.

So community health workers, in my experience, we have 9 on-staff technicians that are cross trained as community health workers, and their specialty is pharmacy and health care. The value they bring is when they're helping patients overcome barriers, they've got a pharmacist that's real close. Also, they work with community outreach, health workers, and health work community health workers that that work at nonprofits, who have specialty in maybe neighborhood or community organization or other things. It's really cool to see how the community health workers in the community often refer to the community health workers in the pharmacy because they have different skill sets.

Q: How can pharmacists work with underserved patient populations to address social determinants of health?

Tripp Logan: I usually start with quality metrics, and so if you look at a community and you see that it's a high tobacco use area, or the infant mortality rates high, or it's a high prevalence of diabetes, then there's obviously a need and so how can pharmacy fit that need and close those gaps and fill a void.

A lot of times there are state appropriated federal funds, or local public health funds, even health plan related dollars that are targeting those diabetes or whatever it is in that community. By pharmacy recognizing what the needs are in the community and having resources like maybe a community health worker or technician that's trained up on social determinants of health, how to identify and solve problems, it puts the pharmacy in a really good position to help support those and usually there's some sort of payment or funding to support the pharmacies effort help close those local gaps.

Q: Anything else you would like to add?

Tripp Logan: I would like to touch on one thing, which is just the value of the community health worker. This is my 21st year of community pharmacy practice, and I grew up in this watching my dad work in the community pharmacy and the most exciting and innovative thing that we've worked on is this community health worker project.

I've seen lives changed. I've seen lives saved by deploying community health workers to help vulnerable patients navigate the healthcare system. I really firmly believe that this is a solution to the small percentage of patients that have the poorest outcomes and cost the most money to the system. I think it's a unique solution to solve for that and to make people better in the local community, and it's a great service opportunity for service-driven pharmacies.