A presentation from the 2020 PQA Annual Meeting discussed the emerging focus on social determinants of health within the industry and how pharmacists can address the issue.
Pharmacists can play a role in influencing outcomes associated with social determinants of health (SDOHs) through effective screening and intervention methods that target medication adherence and reduce medical spend, according to a live broadcast session from the 2020 Pharmacy Quality Alliance (PQA) Annual Meeting.
Dani Markus, PharmD, MBA, vice president of quality at OutcomesMTM and Sarah Dean, PharmD, MPH, clinical program lead, quality network, at Humana, presented results from a study conducted by Humana, which assessed SDOH services by collecting data through assessment distribution. The study aimed to determine whether pharmacists were able to have effective conversations with patients about SDOH, and if intervention spurred incremental gap closures in health.
Questions included in the assessment focused on factors that often inform an individual’s health, such as housing, food, transportation, physical/emotional well-being, and school/work life:
• What is your housing situation?
• Are you worried about your housing?
• Have you worried about running out of food in the last 12 months?
• Has a lack of transportation kept you from going to medical appointments
• How often do you feel lonely or isolated?
• Do you want help finding or keeping work?
The study investigators were able to amass 9802 (56%) successful assessments from 2162 pharmacies between November 15, 2019 through December 31, 2019 from patients with chronic conditions that ranged from atrial fibrillation, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, and osteoporosis.
The most prevalent SDOHs reported were food insecurity, social isolation, and transportation; 12.5% reported challenges in making food last and being able to afford a sufficient supply of food, and 11.2% reported challenges in finding transportation in the last 12 months.
Eighteen percent of those who were assessed reported feeling either sometimes, often, or always lonely or socially isolated, according to the study.
In evaluating data through the chronic conditions present in the study, those with COPD or depression demonstrated higher reports of SDOH than other demographics. Although 13% overall were worried about running out of food, 16.5% of those with COPD and 16.2% with depression reported this concern.
Other important findings included those related to medical and pharmacy spend. According to the investigators, individuals who completed the assessment showed statistically significant decreases in medical spend, as well as non-statistically significant increase in pharmacy spend.
The investigators identified limitations related to the short study period and follow-up frame and asserted important revisions, such as working toward providing a follow-up service that facilitates action and provides resources based on the conversation individuals had with their pharmacist.
Other future recommendations involved offering best practices to help facilitate and guide conversation in a productive way. Some pharmacists in the study were successful in engaging individuals and finding helpful resources. Through the assessment, 1 pharmacist was able to determine that an individual was struggling to afford food, but not on food stamps; as a result, he was able to get his patient in touch with an agency that would help him.
Other pharmacists who participated in the study made it a priority to follow up with individuals who expressed SDOH: “We…educated the patient on the available local sources of social assistance, such as Red Cross, Salvation Army, Haven of Mercy, etc. We flagged the patient’s chart to follow up with her when she comes to the pharmacy,” 1 participant pharmacist told the investigators.
1. Markus D, Dean S. Tackling Social Determinants of Health by Leveraging Community Pharmacies in a National, Scalable Model. Presented at: 2020 Pharmacy Quality Alliance Annual Meeting; May 13-15, 2020.