SDOH Framework Highlights Role of Health System Specialty Pharmacists

A recently developed social determinants of health (SDOH) framework developed by clinicians at Shields Health Solutions demonstrates that health system specialty pharmacies (HSSPs) can have tailored, effective interventions.

Integrated HSSPs are well-positioned to identify and address SDOH, defined as non-medical factors that impact patients’ medication use and health outcomes. However, there is a lack of published data measuring and supporting the impact of SDOH programs in HSSPs. Findings from the new framework were presented in a poster at the Pharmacy Quality Alliance Annual Meeting in Baltimore, Maryland, on May 15, 2024.

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“Basically, what we did here is we created an integrated framework whereby we could screen our patients for SDOH primarily in 3 disease states: [rheumatoid arthritis], hyperlipidemia, and HIV,” explained presenter Andrea Idusuyi, PharmD, in an interview with Pharmacy Times.

A standardized workflow for the SDOH framework was developed and pharmacists completed interventions with patients who had identified barriers. Patients were included if they were actively filling medications for HIV with a viral load >200 copies/ml, rheumatoid arthritis with a RAPID3 score indicating high disease activity, or hyperlipidemia with low-density lipoprotein (LDL) >100 mg/dL. Metrics for screening categories and acceptance rate, intervention acceptance, and pharmacist intervention time were collected from September through December 2023. The framework was piloted at 4 health systems with 50 patients.

The workflow involved 5 steps: engage, intervene, coordinate, enhance, and renew. First, a clinical pharmacist was alerted if a patient was not meeting disease-specific goals. They then performed a SDOH screening and initiated an intervention, when appropriate. During the coordinate phase, the pharmacist performed routine follow-up with the patient to assess the impact of the intervention and/or initiate additional intervention(s). One year after the intervention, the disease-specific outcome and SDOH data were reanalyzed to further refine the program, and screening needs were reassessed on a routine basis.

“What ended up happening is that 79% of patients accepted the pharmacists’ recommendations after we screened them, and we found [which] SDOH we could actually intervene on,” Idusuyi said. “And overall, what we were able to discover is that the patients really did benefit from the intervention services that we provided.”

Of the 50 patients enrolled, 28 (56%) completed screening, 14 (28%) declined, and 8 (16%) were unable to be reached. Of the 28 patients screened, 79% accepted and 21% declined the pharmacists’ recommendations.

The most frequent SDOH screening categories included food insecurity, physical activity, housing, utilities, social support, transportation, and preventive care screening, which were documented using Z-codes. The mean pharmacist intervention time was 60 minutes per patient (range: 15-180 minutes). The population of patients was primarily White, non-Hispanic women with a mean age of 56 years and with comorbidities, Medicare insurance, and an average of 2.1 interventions before screening.

The investigators concluded that their framework highlights the significant potential role for HSSPs in addressing SDOH barriers. The poster said future potential directions include measuring the impact of clinical pharmacist interventions on referral utility, disease-specific clinical outcomes, patient satisfaction, medication adherence, and absenteeism.

“What was really great is that we were able to take the time to really dig into these patients, see what they needed, and provide a meaningful intervention for them to ultimately change the outcomes of whatever the disease state that we were screening [for],” Idusuyi said. So, we’re looking forward as we continue to do this, to be able to provide more interventions in the future.”

Reference

Idusuyi A, Lakada I, Nguyen O, et al. Evaluation of a Social Determinants of Health Screening and Intervention Framework within an Integrated Health System Specialty Pharmacy Care Model. Poster presented at: PQA 2024 Annual Meeting. Baltimore, MD; May 14-16, 2024.