The Impact of Community Pharmacists on Social Determinants of Health

“Why treat people and send them back to the conditions that made them sick in the first place?”– Sir Michael Marmot.¹

Social determinants of health (SDoH) are “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes” that contribute to many of these barriers.² Healthy People 2030 include several barriers that prevent and limit people from having access to health care services.³

Some of these barriers include inadequate health insurance and limited availability of health care resources. The importance of addressing SDoH is vital and account for approximately 90% of health outcomes, whereas only 10%-15% is attributed to medical care.⁴

There is currently a physician shortage, which trickles down to longer wait times and delays in patient care. These delays in care can exacerbate health conditions, resulting in poorer health outcomes and higher medical expenditures.⁵

Ninety percent of Americans live within 5 miles of a community pharmacy and patients visited a community-based pharmacy 35 times per year compared with a primary care physician of only 4 times per year.^6,7

Community pharmacists are the most accessible health care professionals with a high level of training and extensive skillset. With that said, community pharmacists can provide clinical interventions and bridge the gap when a patient has a change in the level of care and with facilitating management of chronic diseases in collaboration with other health care providers.

Furthermore, increasing pharmacy access to opioid buprenorphine to help treat opioid addiction can provide coverage in gaps of care. Community pharmacists are in a unique position to alleviate barriers caused by SDoH and bring recognition to the importance of addressing SDoH.

Pharmacists are trained to provide patient-centric care using the model based on Pharmacists’ Patient Care Process (PPCP), which places the patient at the center of care. Pharmacists’ impact on addressing SDoH can be tremendous to promote more equitable health outcomes.⁸

The PPCP model is used as a patient-centered tool to facilitate delivery of quality care.⁹ It involves 5 elements:

1. Collect subjective and objective information about the patient.

2. Assess collected information in the context of their overall health objectives.

3. Plan patient-centered next-steps.

4. Implement the mutually agreed upon plan.

5. Follow-up with the patient to evaluate the effectiveness of the agreed plan and collaborate with health care professionals.

At the center of the PPCP process is the patient, therefore it takes into consideration several elements that include patient lifestyle, socioeconomic factors, health status, risk factors, cultural/religious background, health literacy, and medication access. These elements provide the community pharmacist with ideas to consider when developing a patient-centered care plan.

By virtue of community pharmacists being embedded in the community within local pharmacies and grocery stores, they can connect patients to community resources, facilitate care coordination, offer insight on insurance plans/340B pharmacy, and provide patient education.

With knowledge of community resources, pharmacists could provide more information based off an individual’s unique status of needs. There are many community resources and a network of other professionals, beyond health care, that many people may not be aware of.

Due to their level of accessibility in the community, pharmacists can effectively relay both medical and non-medical information to address SDoH that include:

• safe and affordable housing
• consistent transportation
• education and literacy tools
• personal safety tools
• healthy food stability
• local health services/emergency services
• interpreter services
• childcare services
• mental health services
• employment/financial tools

Community pharmacists can serve as a liaison between providers for effective care transitions, focusing on the total health care needs of a patient and providing them medical information in a way that can be understood. By providing services to streamline care coordination, community pharmacists can increase health care access and affordability for patients by leveraging their knowledge about the health care system operations and clinical knowledge.

Along with the clinical knowledge, pharmacists are also educated in insurance information and processes. Thus, when a patient comes into a community pharmacy, pharmacists can provide information regarding insurance plans in a simplistic, patient-friendly manner that allow patients to make informed decisions.

Furthermore, pharmacists have resources available to inform patients about 340B pharmacies or local programs that provide health care services and/or pharmaceutical assistance to uninsured or underinsured populations.

Pharmacists can help address SDoH and employ practical strategies that cultivate a trusting pharmacist-patient relationship to provide optimal patient care beyond medication management. Awareness of interventions community pharmacists can be involved in to improve patient outcomes is essential to demonstrate the impact pharmacists can have in public health.

Community pharmacies are generally the initial point of contact with the health infrastructure. We must ready ourselves to address social determinants of health to reach a larger patient care population.

About the Authors

Megha Gandhi, PharmD candidate, is a fourth-year pharmacy student from The Ohio State University College of Pharmacy in Columbus, OH.

Rachel Chandra, PharmD, MPH, FASHP is a Clinical Pharmacy Specialist/PGY1 Residency Program Director at the Dayton Veterans Affairs Medical Center in Dayton, OH.

References:

1. Gwede CK. Bringing a Spotlight to the Influences of Social Determinants of Health. J Cancer Educ. 2020;35(2):211-213. doi:10.1007/s13187-020-01718-0
2. Center for Disease Control. Social determinants of health: know what affects health. https://www.cdc.gov/socialdeterminants/index.htm. Accessed on September 28, 2021.
3. Healthy People 2030: https://health.gov/healthypeople/objectives-and-data/social-determinants-health. Accessed on September 28, 2021
4. Foster AA, Daly CJ, Logan T, et al. Addressing social determinants of health in community pharmacy: Innovative opportunities and practice models. J Am Pharm Assoc. 2021;61(5):e48-e54. doi:10.1016/j.japh.2021.04.022
5. Center for Disease Control. Access to Health. https://www.cdc.gov/vitalsigns/healthcareaccess/index.html. Accessed September 28, 2021.
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7. Moose J., Branham A. Pharmacists as Influencers of Patient Adherence. [(accessed on 13 April 2019)];Pharmacy Times. 2014 Aug 21; Available online: https://www.pharmacytimes.com/publications/directions-in-pharmacy/2014/august2014/pharmacists-as-influencers-of-patient-adherence-
8. Strand MA, DiPietro Mager NA, Hall L, Martin SL, Sarpong DF. Pharmacy Contributions to Improved Population Health: Expanding the Public Health Roundtable. Prev Chronic Dis. 2020;17:E113. Published 2020 Sep 24. doi:10.5888/pcd17.200350
9. Lott BE, Anderson EJ, Villa Zapata L, et al. Pharmacists' perceptions of the pharmacists' patient care process and performance in a simulated patient interaction. J Am Pharm Assoc (2003). 2020;60(6):796-803.e3. doi:10.1016/j.japh.2020.03.017
10. Joint Commission of Pharmacy Practitioners. Pharmacists’ patient care process. Available at: https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf, Accessed September 28, 2021.