Social determinants of health (SDOH) have become a prominent buzz word in the health care industry over the past few years. This is because conditions in which people live, learn, work, and play can affect their health risks and outcomes, making SDOH an important component in understanding patient health outcomes, according to a session at the Pharmacy Quality Alliance (PQA) 2020 Annual Meeting.

At the first educational session of the meeting on May 13, the speakers discussed pharmacists’ roles in influencing outcomes associated with SDOH in the US population through the use of screenings and interventions that target medication adherence and reduce medical spending.

In order to assess these potential outcomes, Humana collaborated with OutcomesMTM on a study intended to test SDOH screening methods, assess retail pharmacists’ ability to intervene regarding SDOH, and understand whether adherence gap closure could occur based on these interventions.

In the study, patients were asked the following questions in the screenings:
 
  1. What is your housing situation today?
  2. Are you worried about losing your housing?
  3. Within the past 12 months, have you worried that your food would run out before you got money to buy more?
  4. Within the past 12 months, did the food you buy not last when you didn’t have money to get more?
  5. Within the past 12 months, has a lack of reliable transportation kept you from medical appointments, work, or from getting things you needed for daily living?
  6. How often do you feel lonely or isolated from those around you?
  7. Do you feel physically and emotionally safe where you currently live?
  8. Do you want help finding or keeping work?
  9. Do you want help with school or training?

Based on the results, 9802 (56%) successful assessments from 2162 pharmacies were conducted between November 15, 2019, and December 31, 2019. The patients who completed the screenings had chronic conditions that included atrial fibrillation, chronic obstructive pulmonary disease (COPD), depression, diabetes, hyperlipidemia, hypertension, and osteoporosis.

Of the SDOH reported by patients, the most prevalent were food insecurity, social isolation, and transportation challenges. Additionally, 12.5% reported problems with their food supply over the past 12 months, 11.2% reported difficulties in finding transportation, and 18% reported experiencing loneliness or social isolation.

The researchers also observed that patients with COPD or depression reported greater occurrence of SDOH than other demographics. Although 12.5% of patients reported experiencing food insecurity, 16.5% of patients with COPD and 16.2% of patients with depression reported challenges with food supply.

In some cases, patients were offended when asked the screening questions by the pharmacists, although others made clear that they really needed help, according to Dani Markus, PharmD, MBA, vice president of quality at OutcomesMTM. For those who expressed this need, Humana was able to embed a health plan tool that patients could access. This tool allowed patients to search by using their zip code to find local resources available to them that could address needs associated with SDOH.

However, for the pharmacists, the question of whether patients felt physically and emotionally safe where they currently lived posed a problem. If the patients responded no, it was unclear to the pharmacists what their legal liability was in responding to this expressed need. For this reason, the researchers assessed that this question may need to be excluded in future screenings used by pharmacists to asses SDOH.

Yet, overall, the study demonstrated favorable impacts for pharmacists who provided the screening service.

“Members who completed the screening demonstrated statistically significant deductions in medical spend and an insignificant increase in pharmacy spend,” said Sarah Dean, PharmD, MPH, clinical program lead, quality network, Humana. “With these results, it’s important to remember that improved adherence will always, or often, result in higher pharmacy costs, and this is the trend that we actually do want to see. While the pharmacy cost isn’t significant, the pattern does show the right pathway. The overall reduction in medical spend was on average $1500 per member, and the increase in pharmacy spend was on average of $500 per member in the year period.”

REFERENCE
Markus D, Dean S. Tackling Social Determinants of Health by Leveraging Community Pharmacies in a National, Scalable Model. Presented at: PQA 2020 Annual Meeting; May 13-15, 2020.