Expert: Considerations of SDOH Factors Should Be Integral to Pharmacy Practice, Education

Pharmacy Times interviewed Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, assistant professor of clinical pharmacy at University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences as well as the Division of the Black Diaspora and African American Studies, on social determinants of health (SDOH) in health care. Abdul-Mutakabbir discusses what SDOH looks like and how pharmacists are the most accessible health care providers, allowing them to advocate for patients and address SDOH-related challenges. She explains that SDOH considerations should be a part of health care practices and education, and not just a separate focus.

Pharmacy Times: What will you be discussing regarding how pharmacists can help address social determinants of health (SDOH) during your keynote address at Massachusetts Society of Health-System Pharmacists (MSHP)?

Jacinda Abdul-Mutakabbir: For the keynote that I'll be giving at MSHP, I'll really be talking about SDOH, and honestly, just how I view them from my lens, and then my specialty. I'll begin with talking about systems of oppression—like racism, xenophobia, ableism, homophobia, transphobia—different elements that when combined with just the health needs that people need for survival, really can cause disparities. So, I'll talk about education and how when individuals have less access to education, how that can compromise health literacy, and then ultimately contribute to poor outcomes. I’ll then talk about socioeconomic status and how individuals that are in areas of lower socioeconomic status inevitably have less access to resources. And then I'll also talk about just access to health care and what that looks like. We're currently in a health care provider shortage, and consequently, that shortage is focused in those communities of lower socioeconomic status. About 20% to 30% of those counties that have the lowest socioeconomic status are those that are the most disparaged when we think of having access to health care providers, so, I’ll really focus a lot on that.

So that's how I'll approach SDOH, and then I'll really work to bring the listeners in into how it is I've designed my practice, my research, and how I provide education to be centered around these disparities, and how people in infectious diseases—or how [I] as an infectious disease clinician—works to address different determinants of health.

Pharmacy Times: Often SDOH is considered most relevant in the physician’s office. How might the pharmacist also have an impact on patient care in relation to SDOH?

Abdul-Mutakabbir: When I think about the pharmacist’s role in SDOH, first and foremost, I think about the community level, and the placement of community pharmacists. Pharmacists are arguably 1 of the most—if not, the most—accessible health care providers, so having a pharmacist there, oftentimes, patients because they aren't going to have the direct 1-on-1 content, we may be the ones that know what's going on with the patient first, we may understand what their socioeconomic status looks like. A lot of times community pharmacists have their real frontal view of the expense of the medications, so when it comes to being able to figure out who needs this benefit, how can we decrease the price for them, how can we make sure that they can access this medication, or do we need to put vaccines or different services into the community? While pharmacists are really able to gauge that just due to the ease of patient and pharmacist interaction, but I think about it from my standpoint, as an academician, how is it that I'm able to address SDOH. And it really comes down to [this, in order to] really know where your disparities are, you have to start with the data, you have to start with the numbers, and anybody can start with the numbers. In that case, for me, that's really been where my major focus has been, is identifying where the disparities exist in my community, and because I'm an infectious diseases person, where do they exist via infectious diseases, disease states, and once I identify those disparities, now I can have that conversation. What interventions can be put into place to mitigate these?

So, I think there are different places where pharmacists can be involved, and likely some that we don't think about, but I think that data and that community level access is a major place to start.

Pharmacy Times: What are some solutions you see before pharmacists to help address the impact on SDOH on patients?

Abdul-Mutakabbir: I think that when I consider solutions to address SDOH, I have a framework that I really go to and talk about this is how I view the actionable recommendations that we can utilize to address SDOH. I really start with first and foremost, we have to promote education about systems of oppression, biases, and different SDOH within practice settings. And then we also have to promote that across the educational spectrum for pharmacy programs. I think that before we can really say we want to address SDOH, we have to really state that inequities in SDOH real, that oppressive systems are real, and that when combined in tandem with those inequities in SDOH, we can just see that further widening of disparities. So, I think we all have to speak the same language first.

I think then after that, we have to identify where the SDOH inequities exist via our respective clinical settings. So, to identify that, I always say we have to start with the numbers, I think that's important. But when we are starting with those numbers, we have to disaggregate based upon those marginalized areas. So, a lot of times for my group, we disaggregate our data based upon race and ethnicity, or we disaggregate based upon levels of social vulnerability because it's representative of just the community that we serve. And we know that we're likely to see some type of difference there, but we have to be able to quantify that. There will be a lot of other locations, they will disaggregate based upon race, ethnicity, vulnerabilities, language status, but we have to—when we are gathering that data—be intentional about how we tried to interrogate and investigate where those disparities are in the first place. We have to start is with the disaggregation of those groups, and then, once we're able to use that data and identify where those inequities lie, then we have to think about interventions that can be implemented. But first, when we are identifying those interventions, we have to really think about who are those unnecessary decision-makers to have at the table, who's our team that we utilize to push these interventions forward, and then we have to come back and we have to measure the success, meaning that we have to determine the outcomes that we want to look at. So, we disaggregated our data, and we say [that] we want to look at differences based upon race and ethnicity. Well, then we have to go back to the data and then we have to say, based upon race and ethnicity, do we see differences when we all came together and decided on this intervention and then implement it. And then after that, we have to really just advocate for the continued uptake of these really equitable interventions, but then we also have to just advocate for addressing SDOH for providing education, about SDOH, and pharmacy education. I think that when we go silent on these matters is when we see that cessation of just continued efforts to promote the work.

Pharmacy Times: In your view, have we made much progress on addressing issues pertaining to SDOH in patient care since this became a key issue of attention in health care during the pandemic?

Abdul-Mutakabbir: So, we do have beautiful frameworks, like the Rx-HEART framework, which discusses implementing health equity and anti-racist education into curricula for pharmacy programs. So, I think that we are we are really coming into a way where it's become normalized, and it's become something that's important. [Accreditation Council for Pharmacy Education] the governing body, for pharmacy education has also made it to where health equity is something that has to be in some way integrated into a pharmacy school curriculum. And I honestly feel like that's a beautiful place for us to start. I think we have to start with educating the next workforce of pharmacists in the coming and growing workforce of pharmacists about the fact that SDOH inequities exist, but then also coupling that with what it what could be your role in identifying these inequities. So, I think that's our natural next step and I think that presentations like the 1 that I'm providing, or in the ones that other people that do this work provide will be…continuing to push the narrative forward on how we address these things.

Pharmacy Times: Closing thoughts?

Abdul-Mutakabbir: I suppose I would just like to say I hope that the conversations with SDOH continue just to become a normal course…I hope that at 1 point, we don't have to just separately have a presentation that focuses solely on SDOH, that it becomes a part of our language, that when we are doing just any general presentations, we automatically think about how it is that we're equitably serving everyone. I hope that that is what the future conversations look like the future and the way that we approach just health care and the presentations of moving forward. So, I guess that's what I have to say in closing, I hope that everyone, at least [the people] that leave my talk leaves with a nugget that they didn't have before. So that's the 1 thing that I'm hoping for.