Redefining the Patient Experience: The Critical Role of Pharmacists and Patient Data in Addressing SDOH

Depictions of the patient experience in the health care system in popular television would have people believe that this experience consists of a patient and a physician with a God complex navigating the health care system together, explained Richard Martin, MD, MPH, medical director for health equity and community engagement, Tennessee Oncology, during a panel discussion at the 2024 Advanced Topics for Oncology Pharmacy Professionals (ATOPP) Summit in St Louis, Missouri. However, the reality is quite different, especially in the current health care landscape, according to Martin.

“In reality, often I'm not even at the forefront of understanding some of the hang ups around [pharmacy benefit managers], prior authorizations, and copay accumulators. Often, it's actually the pharmacists and the people who work on our drug authorization committee, and I'm not even aware [of these challenges],” Martin said.

Martin explained that he feels quite fortunate to not have to go through the headaches of dealing with these types of issues while working with patients, which allows him to focus on providing care for the patient instead. However, he noted that he is also not the only member of the care team focusing on this patient care piece.

“The reality is that while I may have a shared decision making point with my patient, any number of other people in our health care team—our infusion nurses, administrators, social workers, even family caregivers—their social support is stepping in to make the difference,” Martin said. “There's a role for each of them to do something in social determinants of health [SDOH] and [health-related social needs], and also just for our standard medical care and medical practices. I hope that you know, when you really, truly reflect on your touchpoints with patients and patient care experiences, realize there's absolutely a critical role for you [as pharmacists].”

Panelist Sabrina Meyers, PharmD, senior director, Medical Sciences Oncology, Gilead Sciences, noted that, as a pharmacist, early in her career she would often find herself advocating for her role as a clinician and for her expertise and knowledge of therapeutics within a multidisciplinary team.

“But it really is not a competition. We all play a unique role in treating patients,” Meyers said. “I think pharmacists have a unique perspective, because of how we're engaging with patients, and also the knowledge that we have of the reimbursement space. So I definitely think that there's room for pharmacists in [managing SDOH].”

Panelist Emily Touloukian, DO, medical oncologist at Coastal Cancer Center, explained that in her experience, that role also does not need to be broad, but can sometimes be quite specific. For example, Touloukian said that at her practice, there have been cases where she will prescribe a medication that requires multiple visits, and the patient will go to the pharmacy and tell the pharmacist that they are not able to make that many visits that many days in a row. If the pharmacist then brings this information back to Touloukian, this has helped address this SDOH for this patient.

“It doesn't have to be a big, structured program,” Touloukian said. “It can be a tiny little bite that helps the patient get the care that they need.”

Martin explained that, as a physician, he also believes there is a need for physicians to take time to interface with pharmacists and listen to their perceived gaps in care or barriers to care.

“Pharmacists are the experts in some of these areas, whether it's directly related to our pharmaceuticals, indirectly with some of our care flows, or other types of initiatives or even state level advocacy or national level advocacy things that they'd like to see championed as solutions,” Martin said.

Additionally, Martin posited that another way pharmacists might be able to help address SDOH for patients may be by substituting drug for something else, such as food or transportation.

“Could you substitute drug, or whatever the service may be, with something else? It's still your same role, still your same action, but apply that to food or transportation or gift cards or something else,” Martin said. “We've been able to successfully launch that with food by partnering with Second Harvest Food Bank, where instead of drug, we're delivering food boxes to patients that qualify for food insecurity.”

Martin explained that, just as a pharmacist might have delivered oral oncolytics to clinics, they can courier a food box to patients who qualify and provide them with longitudinal food.

“It's just taking a creative mindset and making sure you have buy-in across your organization. Those are the types of things that, I think, if you just sit down and think creatively, you can align it with what you’re already doing,” Martin said.

However, panelist Amogh Rajan, MA, MS, product lead – US Solutions, BroadReach, explained that food is just one SDOH that pharmacists can help address. There are other areas as well where pharmacists can provide significant support, such as education.

“Patient education is a big thing. If patients have questions about a drug, they come to you [the pharmacist], and you speak to them about it. That's addressing health literacy, which is an SDOH,” Rajan said. “You're already doing that work today. And the best thing is, as of 2024, you can get paid for doing that work and bill for it.”

Rajan explained further that currently, one of the challenges facing the SDOH space is that SDOH spans beyond the scope of current health data and into other areas, such as consumer data. Specifically, Rajan explained that a predictive model of health used by a health plan in California showed that the healthiest population of people in the state are those who not only had a visit with their primary care provider (PCP) within the past 12 months, but also are those who drive a Toyota or Honda, live within 2 to 5 miles of a bike trail or hiking trail, and own a dog.

Rajan explained further that currently, one of the challenges facing the SDOH space is that SDOH spans beyond the scope of current health data and into other areas, such as consumer data. Image Credit: © Justlight - stock.adobe.com

“Based on this predictive model that people use for a health plan in California, these were the most predictive indicators of health,” Rajan said. “Just one [predictor] was directly related to health care--that was on the PCP [visit]. Everything else was not related to health care.”

Additionally, Rajan explained that patients are transient and may not stay with the same health care practice or payer, so it is valuable for their health care data to follow them.

“It needs to make sense no matter where they go,” Rajan said. “That's why data needs to be structured for that precise reason. We have codes for that precise reason, and SDOH is no different.”

Rajan explained further that to more deeply understand the patient’s context and potential health care resource utilization, different sources of data beyond health care alone are needed.

“If you really want to understand the patient's context, we need to overlay the health care data with different sources of data that are out there,” Rajan said. “These could be reported by the patient, but also you can purchase that data externally through data vendors, and that's when we really get a whole person view on what is going on with the patient.”

REFERENCE
Meyers S, Martin R, Rajan A, Touloukian E. General Session: From Words to Action: Practical Steps for Applying Social Determinants of Health in Oncology Pharmacy Practice. 2024 ATOPP Summit; St Louis, Missouri; June 27-29, 2024.