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Listen closely and ask clarifying questions to best address patient challenges.
Health equity, health disparities, and social determinants of health (SDOH) are all trendy buzzwords in the health care industry, but what do they really mean? At a glance, they are just various factors that affect a person’s health that are not medical in nature. Pharmacy teams may not know it, but they can have an enormous impact on a patient’s SDOH.
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To position themselves to have this impact, pharmacists and technicians alike should do what they are best at: building strong, trusting relationships with their patients so they can learn about their unique situation and intervene when appropriate. To be successful, pharmacists and their teams should get comfortable with being uncomfortable, because the truth is that some conversations about SDOH are sensitive in nature. However, the most important thing to remember is that a simple conversation could change someone’s life.
SDOH and health equity go hand in hand. SDOH are nonmedical factors that influence health outcomes.1 According to Healthy People 2030’s SDOH Workgroup, these include but are not limited to access to quality education, access to quality health care, income, social status, and the strength of an individual’s community.2 In turn, these SDOH factors drive health equity, which is defined as “the principle underlying a commitment to reduce—and ultimately eliminate—disparities in health and its determinants, including social determinants.”3
Community pharmacies are in a unique position to address their patients’ SDOH needs for 2 reasons. First, they see their patients, on average, 35 times per year,4 and that number is even more notable when compared with how often patients see their primary care physician, which is just a few times per year or fewer. The second reason is that pharmacists continue to be one of the most trusted professions in the United States, according to results from a 2023 Gallup poll.5 This trust also
extends to our pharmacy technicians, who tend to have more conversations with patients and have the opportunity to build personal relationships as well. This is why these conversations should not be limited to just pharmacists but rather embraced by the entire team.
Amie Stephens, PharmD, MHA, is the director of adherence improvement and client services on the clinical services team at Rite Aid. In this role, she leads the company’s adherence and medication therapy management strategies. She lives in Erie, Pennsylvania, with her husband and 3 daughters.
SDOH conversations can seem daunting, but they may already be occurring in the regular course of business; pharmacy teams just need to listen closely and ask clarifying questions to best utilize these conversations. Imagine Mrs Smith comes in and tells the pharmacist that she has to wait for her lisinopril to be filled because her neighbor brought her here and she doesn’t know whether she can bring her back. Asking clarifying questions such as “Do you have a car, or are you able to drive?” can help you ascertain whether Mrs Smith has a long-term transportation issue. Outside the course of regular conversation, there are also resources provided by health plans and medication therapy management (MTM) vendors that help identify patients at risk and provide questionnaires and tools to help drive these conversations.
Pharmacies can partner with their vendors to have these conversations and best use the data gleaned from these discussions. For instance, in the past 5 years, Rite Aid has partnered with the MTM vendor partner OutcomesMTM to run 2 SDOH pilots. In the first pilot, the focus was on asking SDOH questions and providing the details back to the health plans. Although this pilot saw great success, the feedback from pharmacy teams was that they felt their hands were tied once they identified a patient with a social need, such as transportation or housing.
In the second pilot, OutcomesMTM redesigned its offering to pull in localized resources based on the answers to the SDOH questions. The success with this second pilot was incredible. Pharmacists and technicians reported feeling more confident and comfortable having the conversations because they could close the gap once a need was identified. As an example, one patient told their pharmacist that it was somewhat difficult for them to pay for food, housing, and medical needs every month. The pharmacy team was able to provide them with a detailed resource list that included local community resources for food provision and counseling for overcoming barriers to food security. In total, issues were identified and resource support was provided to 460 patients.
In this pilot, a vendor was providing the social resources based on the identified risk area, although community pharmacies without these vendors and tools can still find and provide the appropriate resources for their patients. Emilee Kennelly, PharmD, a Rite Aid pharmacist and manager of adherence improvement and clinical initiatives, works with her patients on their social risk factors and said it is easy to ask patients what city or county they live in and do a quick Google search for food banks or housing assistance in their area. Other great resources include county-level human services offices, which often have lists of resources to provide.
Many health plans are starting to realize the need for and the benefits of running an SDOH program. As these programs become more prevalent, community pharmacies can take steps to be ready to engage with their patients regarding their SDOH. Some ways to prepare include getting comfortable with uncomfortable conversations, utilizing technicians as trusted community members, and becoming familiar with local resources in order to provide them to patients.
Although SDOH conversations are sometimes difficult for both the patient and pharmacist, they can make very large and lasting impacts on a patient’s life. Pharmacists who prioritize SDOH conversations are filling an important gap in their patient’s overall health care, as these conversations may not be happening anywhere else.
