Address Health Disparities Through Pharmacist-Led Initiatives in Underserved Communities

Health disparities are preventable gaps in health outcomes that disproportionately burden individuals facing social, economic, or environmental barriers—most often affecting racial and ethnic minorities and individuals with lower socioeconomic status.¹ They can be seen in health care access, use, quality, and delivery of clinical care as well as the incidence and mortality from conditions, diseases, and disorders. Disparities can also be observed in the risks, incidence, and problems associated with certain behaviors. Health disparities stem from socioeconomic status, race and ethnicity, geographic location, and language barriers.

The unmatched accessibility of community pharmacists can be used as a critical asset in the fight against health care disparities, especially in medically underserved areas. By maximizing this inherent accessibility and expanding our clinical roles, pharmacists can reduce health inequalities and improve outcomes for vulnerable populations.

Pharmacist-led initiatives, including targeted patient care, community outreach, and policy advocacy, are ideal for mitigating health care disparities and promoting health equity.

Disparities in Pharmacy Practice

Health disparities underscore the influence of social determinants of health on patient well-being. Factors include geographic and access barriers, medication nonadherence, suboptimal prescribing, and cost- and insurance-related barriers.

Some populations may face significant geographic barriers to accessing essential pharmacy services, such as the approximately 16 million individuals in the United States who live in areas without adequate access to pharmacies.^2,3 Pharmacy deserts disproportionately affect low-income areas, certain racial and ethnic minority neighborhoods, and small rural communities. Unfortunately, pharmacy deserts are often paired with food deserts, compounding the burden on residents and contributing to poor health outcomes.

Racial and ethnic minority populations also show lower rates of medication adherence for chronic conditions than White populations. These disparities are driven by issues that go beyond cost, including lack of trust in the health care system, language barriers, and lower health literacy rates.^4,5

Suboptimal prescribing is an umbrella term encompassing a range of indicators that may increase the risk of medication-related harm, such as polypharmacy, underprescribing, and prescribing potentially inappropriate medications. In health care deserts, this is often a result of limited access to medical resources and providers, resulting in inadequate medication management and poor patient outcomes.⁶

Cost and insurance issues can also significantly impact medication access for vulnerable populations. High out-of-pocket costs can contribute to nonadherence, and insurance plans vary widely in their coverage of medications, leading to gaps in access.⁷

Pharmacist-Led Initiatives and Interventions

Pharmacists consistently demonstrate a positive impact on patient outcomes through initiatives that go beyond dispensing. By leveraging the accessibility and trusted position of community pharmacies, pharmacists can deliver targeted clinical services and public health interventions that combat health disparities.⁸

For instance, pharmacists can provide chronic disease state management for conditions such as hypertension, diabetes, and heart disease through consistent monitoring, education, and medication optimization. This has been shown to improve patient outcomes in underserved populations.⁸

Pharmacists’ expertise in medication management and patient education also allows them to provide a wide range of services that prevent the onset or progression of diseases. These services can include immunizations, health screenings, patient education, lifestyle and wellness counseling, and referrals and coordination of care.⁹

Social determinants of health (SDOH) are conceptually similar to health disparities. Pharmacists play a crucial role in addressing SDOH, which are economic and social conditions that influence individual and group differences in health status. By assessing a patient’s social factors, such as income, education, health literacy, and access to health care, pharmacists can tailor their communications in a way that empowers patients to make informed health decisions. This leads to more equitable health outcomes, particularly in vulnerable populations.¹⁰

Another vital role for pharmacists is culturally competent outreach, which involves integrating the cultural beliefs, attitudes, and behaviors of diverse populations into community engagement. To achieve this, pharmacists must understand and respect diverse cultural backgrounds, use clear and respectful communication that accommodates language barriers and varying levels of health literacy, and demonstrate empathy and patience. By doing this, pharmacists increase trust and enhance their outreach efforts, thereby contributing to improved health outcomes.¹¹

Finally, pharmacy technology plays an important role in improving access to health care. Telepharmacy services provide remote consultations and medication management while also reducing travel barriers and wait times. Mobile health applications enhance patient education and adherence by offering medication reminders and health tracking. Community outreach programs identify and engage underserved populations by offering health screenings and education. These programs also collect data to help identify specific health needs of communities.¹²

Barriers

Despite the effectiveness of these initiatives, significant barriers exist and must be addressed for pharmacists to reach their full potential in improving health equity. Perhaps most notably, the reimbursement models for pharmacists are insufficient. This stems from a lack of provider status in many regions and from inadequate fees for service that do not appropriately compensate for time-intensive patient care.

Additionally, legal limitations on a pharmacist’s scope of practice, which vary by region, are restrictive, and collaborative practice agreement regulations contain burdensome administrative requirements. This prevents pharmacists from fully engaging in the patient care process and using their expertise as part of the health care team.

Lack of access to electronic medical records and exclusion from the formal health care team reduce care coordination and limit the pharmacist’s ability to provide comprehensive patient care. These 2 conditions conspire to fragment care coordination, decrease opportunities for preventive care, and reduce patient trust and awareness.

Time constraints in pharmacy are a significant limiting factor. High prescription volumes and copious operational demands, coupled with inadequate staffing, reduce time for patient counseling and clinical services, especially in underserved communities.

Finally, there is often limited access to educational materials tailored to diverse populations. Without clear, culturally relevant resources, pharmacists may struggle to communicate effectively with patients whose language, background, or health beliefs differ from those typically represented in standard materials. This gap can hinder counseling, reduce patient engagement, and ultimately make it harder for pharmacists to help close existing health disparities.

Conclusion

Health disparities in underserved communities persist, underscoring the need for innovative, pharmacist-led initiatives. Improving health equity through pharmacist-led care is a collective necessity requiring a multifaceted, collaborative approach. Advocating for sustainable reimbursement and expanded scopes of practice requires simultaneous action from policy makers, health care leaders, and the pharmacy profession.

About the Author

Kathleen Kenny, PharmD, RPh, earned her doctoral degree from the University of Colorado Health Sciences Center. She has over 30 years of experience as a community pharmacist and works as a clinical medical writer based in Albuquerque, New Mexico.

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