Pharmacists Can Play a Key Role in Addressing Health Disparities
by Victoria Green, Doctor of Pharmacy Candidate (2024)
According to the Centers for Disease Control and Prevention (CDC), health disparities are preventable differences in disease burden and access to optimal healthcare.1 These differences are most common among socially disadvantaged groups subject to prejudice or stigma and occur across a wide array of ages, genders, socioeconomic statuses, and sexual identities.1 Examples of health disparities include African Americans being 30% more likely to die from heart disease than non-Hispanic whites, patients living in rural areas having higher rates of smoking, hypertension, and obesity when compared to those living in urban areas, and transgender people experiencing higher rates of mental illness.2,3,4 Health disparities lead to negative consequences such as increased costs, decreased quality of life, reduced functional status, and higher rates of mortality.1 Healthcare professionals can and should play a critical role in recognizing and addressing the socioeconomic factors that are the root cause of many health disparities.
Social determinants of health (SDOH) are nonmedical factors (e.g., conditions in which people are born, grow, work, live, and age) that influence health outcomes.5 These factors include education, income, employment, access to food, transportation, social support systems, housing, and access to affordable health care.5 Health professionals can’t address all of these needs but can help improve health literacy, increase access to affordable health care, and advocate for public policies that address these factors.
It can be challenging to identify patients negatively impacted by SDOH. A physical examination and laboratory studies won’t reveal these important factors. While direct questioning the patient is helpful, it’s time-consuming, and many patients may be reluctant to reveal things about their lives when directly asked by a health professional.
Consider using a self-administered screening tool such as the:
- National Association of Community Health Centers’ Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) screening tool6
- American Academy of Family Physicians Social Needs Screening Tool,7 or
- Centers for Medicare and Medicaid Services Accountable Health Communities’ Health-Related Social Needs Screening Tool (AHC-HRSN).8
These screening tools are designed to identify which factors a patient is most impacted by and if they would like assistance in addressing those factors. Healthy People 2030, which is a 10-year plan with national health objectives, mentions addressing SDOH as one of the top goals. Specifically, to “create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”9
There are several ways that pharmacists can address SDOH, particularly in community practice settings. In a recently published Call to Action, the authors describe the opportunities for pharmacists to become aware of and address SDOH. Although many social determinants of health are not directly related to medication use, pharmacists are in an ideal position to have an impact because they are the most accessible health professionals and often practice in underserved communities.10 Through community partnerships, pharmacists can guide patients and refer them to local services as needed. For example, for patients who do not have health insurance, pharmacists can assist by referring them to receive free care at the Jackson Free Clinic. Being aware of which factors impact a patient helps the pharmacist assess the risk of poor health outcomes, including poor adherence to medication or unsafe storage of medications. Pharmacists can also help patients apply for drug assistance programs.10 One successful practice model addressing SDOH integrated community health workers in community pharmacies. Patients were screened and referred to local programs to address their needs.11 Another way to increase awareness is through interprofessional education and the important role each professional discipline can play.12
Health professionals play an important role in recognizing and addressing health disparities, commonly resulting from social factors. Pharmacists should regularly use screening tools in their practice, consider how social factors may negatively impact access and adherence to medications, and refer patients to local services that can help address their needs.
References:
1. Centers for Disease Control and Prevention. Health Disparities. https://www.cdc.gov. Accessed September 22, 2023.
2. United States Department of Health and Human Services Office of Minority Health. Heart Disease and African Americans. https://www.minorityhealth.hhs.gov. Accessed September 22, 2023.
3. Centers for Disease Control and Prevention. Rural Health. https://www.cdc.gov. Accessed September 22, 2023.
4. Wanta JW, Niforatos JD, Durbak E, Viguera A, Altinay M. Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgend Health. 2019;4(1):313-315.
5. World Health Organization. Social Determinants of Health. https://www.who.int. Accessed September 22, 2023.
6. National Association of Community Health Centers. Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences Tool. https://www. prapare.org. Accessed September 22, 2023.
7. American Academy of Family Physicians. Social Needs Screening Tool. https://www.aafp.org. Accessed September 22, 2023.
8. Centers for Medicare and Medicaid Services. Accountable Health Communities’ Health-Related Social Needs Screening Tool. https://www.cms.gov. Accessed September 22, 2023.
9. United States Department of Health and Human Services. Healthy People 2030. https://www.health.gov. Accessed September 22, 2023.
10. Kalabalik-Hoganson J, Ozdener-Poyraz AE, Rizzolo D. Call to Action: Addressing Social Determinants of Health in Pharmacy Practice. Ann Pharmacother. 2022;56(6):740-745.
11. Foster AA, Daly CJ, Logan T, et al. Implementation and evaluation of social determinants of health practice models within community pharmacy. J Am Pharm Assoc (2003). 2022;62(4):1407-1416.
12. Crowl AN, Wellner Z, Levy M, et al. Determining the impact of an interprofessional simulation focused on social determinants of health among pharmacy students. Curr Pharm Teach Learn. 2021;13(7):779-783.