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Hussain A, Bowen AM. Exploring Pharmacist Roles in Telepharmacy for Chronic Disease Management in New York State: A Qualitative Inquiry into Improving Implementation, Patient Communication, and Healthcare Technology Support. Cureus 2024; 16:e62982. [PMID: 39044868 PMCID: PMC11265808 DOI: 10.7759/cureus.62982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2024] [Indexed: 07/25/2024] Open
Abstract
Background This qualitative study aimed to collect information regarding pharmacists' roles in telepharmacy and chronic disease management (CDM). The literature review was conducted on historical overview, CDM overview, social determinants of health (SDOH), disparities, hospital readmissions, adverse drug events, best practices, and global implications of telepharmacy. Materials and methods Eleven licensed pharmacists from New York working in retail or hospital settings were interviewed using 16 questions. The interview covered topics such as CDM, hospital readmissions, adverse drug events, best practices, SDOH, and health disparities. The recordings of these interviews were transcribed and coded for each open-ended question, resulting in 136 different codes. Results According to the comprehensive review of interview transcripts, there is still an urgent need for communication between healthcare providers and patients, pharmacist training for telepharmacy services and SDOH, and healthcare technology support. CDM can be advanced by pharmacists by understanding patient barriers, SDOHs, health disparities, and pill burdens, as well as incorporating a multidisciplinary approach to patient care. Pharmacists must facilitate open communication, overcome technological barriers, seek support from stakeholders for telepharmacy training, and integrate new mobile applications to improve telepharmacy implementation and operations for providing interventions. Conclusion The research provides insights into the comprehensive impact of telepharmacy on healthcare delivery and its potential to transform CDM. With the expansion of telepharmacy, individuals living with chronic diseases can experience improved medication adherence and overall health outcomes.
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Affiliation(s)
- Azhar Hussain
- Pharmaceutical and Biomedical Sciences, Touro University College of Pharmacy, New York, USA
| | - Alyncia M Bowen
- Healthcare Administration, Franklin University, Columbus, USA
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2
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Parikh MA, Selvarajah S, Castora-Binkley M, Angove RSM. Engaging patients and stakeholders to identify a research agenda to support social determinants of health (SDOH) screening and intervention initiatives in community pharmacy. J Am Pharm Assoc (2003) 2024; 64:592-595.e1. [PMID: 38182002 DOI: 10.1016/j.japh.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/07/2024]
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Giron NC, Cole MB, Nguyen KH. Use of and barriers to adopting standardized social risk screening tools in federally qualified health centers during the first year of the COVID-19 pandemic. Health Serv Res 2024; 59 Suppl 1:e14232. [PMID: 37715519 PMCID: PMC10796290 DOI: 10.1111/1475-6773.14232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To describe the national rate of social risk factor screening adoption among federally qualified health centers (FQHCs), examine organizational factors associated with social risk screening adoption, and identify barriers to utilizing a standardized screening tool in 2020. DATA SOURCE 2020 Uniform Data System, a 100% sample of all US FQHCs (N = 1375). STUDY DESIGN We used multivariable linear probability models to assess the association between social risk screening adoption and key FQHC characteristics. We used descriptive statistics to describe variations in screening tool types and barriers to utilizing standardized tools. We thematically categorized open-ended responses about tools and barriers. DATA COLLECTION None. PRINCIPAL FINDINGS In 2020, 68.9% of FQHCs screened patients for any social risk factors. Characteristics associated with a greater likelihood of screening adoption included having high proportions of patients best served in a language other than English (18.8 percentage point [PP] increase, 95% CI: 6.0, 31.6) and being larger in size (10.3 PP increase, 95% CI: 0.7, 20.0). Having higher proportions of uninsured patients (14.2 PP decrease, 95% CI: -25.5, -0.3) and participating in Medicaid-managed care contracts (7.3 PP decrease, 95% CI: -14.2, -0.3) were associated with lower screening likelihood. Among screening FQHCs, the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) was the most common tool (47.1%). Among non-screening FQHCs, common barriers to using a standardized tool included lack of staff training to discuss social issues (25.2%), inability to include screening in patient intake (21.7%), and lack of funding for addressing social needs (19.2%). CONCLUSIONS Though most FQHCs screened for social risk factors in 2020, various barriers have prevented nearly 1 in 3 FQHCs from adopting a screening tool. Policies that provide FQHCs with resources to support training and workflow changes may increase screening uptake and facilitate engagement with other sectors.
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Affiliation(s)
- Nicole C. Giron
- Department of Health Services, Policy & PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Megan B. Cole
- Department of Health Law, Policy, and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Kevin H. Nguyen
- Department of Health Law, Policy, and ManagementBoston University School of Public HealthBostonMassachusettsUSA
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Wu L, Chang C, Lo K, Butler K, Uratsu C, McCloskey J, Ranatunga D, Grant R, Deguzman L. Telephone-based social health screening by pharmacists in the nonadherent Medicare population. J Manag Care Spec Pharm 2023; 29:1184-1192. [PMID: 37889865 PMCID: PMC10778802 DOI: 10.18553/jmcp.2023.29.11.1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND: Unmet social health needs are associated with medication nonadherence. Although pharmacists are well positioned to address medication nonadherence, there is limited experience with screening for and addressing social health needs. OBJECTIVES: To compare the prevalence of social health needs among Medicare patients with higher vs lower social health risk using a predictive model. To also evaluate pre-post changes in medication adherence and health care use following a pharmacist-initiated social health screening. METHODS: A social health screening workflow was implemented into a routine pharmacist adherence program at an integrated health care delivery system. The social health screening was conducted during medication adherence outreach phone calls with Medicare members who were overdue for statin, blood pressure, or diabetes medications. We developed a social health need predictive algorithm to flag higher-risk patients and tested this algorithm against a random subset of lower-risk patients. Screening conversations were guided by a focus group that developed open-ended questions to identify social health needs. Comparisons in social health needs were made between higher- and lower-risk patients. Use and adherence outcomes were compared pre and post for patients who accepted a referral to social health resources and patients who declined a referral. RESULTS: 1,217 patients were contacted and screened for social health needs by pharmacists. Patients flagged by the social risk algorithm were more likely to report social health needs (28.7% vs 12.7% in the unflagged group; P < 0.01). Commonly reported needs included transportation (43%), finances (34%), caregiving (22%), mental health (11%), and food access (10%). 221 patients accepted a referral to a central resource website and call center that connected patients to local services. One year after screening dates, patients who did not accept a referral spent more time in the hospital (mean change +0.7 days, SD = 7.3, P < 0.01), had fewer primary care visits (mean change -0.5 visits, SD = 6.5, P < 0.01), and had a shorter length of membership (mean change -0.4 months, SD = 1.9, P < 0.01). Patients who accepted a referral had increased statin adherence (62.3% adherent pre vs 74.7% post, P = 0.02). CONCLUSIONS: We implemented a workflow for pharmacists to screen for social health needs. The social health need prediction model doubled the identification rate of patients who have needs. Intervening on social health needs during these calls may improve statin adherence and may have no adverse effect on health care utilization or health plan membership. DISCLOSURES: Social health risk predictive model development and validation was funded by the Agency for Healthcare Research and Quality (AHRQ R18HS027343).
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Affiliation(s)
| | | | - Keras Lo
- Kaiser Permanente Regional Clinical Pharmacy, Oakland, CA
- Kaiser Permanente, Oakland, CA
| | - Kerri Butler
- Kaiser Permanente Regional Clinical Pharmacy, Oakland, CA
| | - Connie Uratsu
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Jodi McCloskey
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Dilrini Ranatunga
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Richard Grant
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Lynn Deguzman
- Kaiser Permanente Regional Clinical Pharmacy, Oakland, CA
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Odugbesan O, Wright T, Jones NHY, Dei-Tutu S, Gallagher MP, DeWit E, Izquierdo RE, Desimone M, Rioles N, Ebekozien O. Increasing Social Determinants of Health Screening Rates Among Six Endocrinology Centers Across the United States: Results From the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2023; 42:49-55. [PMID: 38230332 PMCID: PMC10788654 DOI: 10.2337/cd23-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Social determinants of health (SDOH) are strongly associated with outcomes for people with type 1 diabetes. Six centers in the T1D Exchange Quality Improvement Collaborative applied quality improvement principles to design iterative Plan-Do-Study-Act cycles to develop and expand interventions to improve SDOH screening rates. The interventions tested include staff training, a social risk index, an electronic health record patient-facing portal, partnerships with community organizations, and referrals to community resources. All centers were successful in improving SDOH screening rates, with individual site improvements ranging from 41 to 70% and overall screening across the six centers increasing from a baseline of 1% to 70% in 27 months.
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Affiliation(s)
| | | | | | | | | | - Emily DeWit
- Children’s Mercy Research Institute Hospital, Kansas City, MO
| | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Khan MOF, Ried LD. Readiness of Pharmacists as Providers of Social Determinants of Health and Call to Action. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100051. [PMID: 37714653 DOI: 10.1016/j.ajpe.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 09/17/2023]
Abstract
Social determinants of health (SDOH) are defined as the conditions in the environments where people are born, live, learn, work, play, worship, and age. SDOH has an enormous impact on achieving the goals set by Healthy People 2030. With their education and training, pharmacists are in an ideal position to provide SDOH services. Community pharmacists should take innovative approaches in collaboration with the Community Pharmacy Enhanced Services Network to develop standard protocols for SDOH and reimbursements for these services. Pharmacists not being recognized nationally as healthcare providers is the major barrier to the implementation and expansion of pharmacist-provided SDOH programs. Thus, approval of the Pharmacy and Medically Underserved Areas Enhancement Act (H.R. 2759) is crucial to overcoming this barrier. This legislation is designed to increase access to pharmacists who are primary care providers for rural and underserved populations. These practice changes align well with the American Association of Colleges of Pharmacy strategic priorities 1, 3, and 4. Moreover, one of the most important recommendations in the Pharmacy Forecast 2022 is to develop standardized SDOH protocols and integrate them into the daily workflow of pharmacists and pharmacy technicians. However, are pharmacists adequately prepared and motivated to engage in practices designed to mitigate SDOH challenges that impact patients' health, functioning, and quality-of-life outcomes and risk? This commentary urges pharmacy education programs to implement curricular modifications and pharmacy practice professionals to advocate, develop and implement best practice models for providing SDOH services.
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Affiliation(s)
| | - L Douglas Ried
- College of Pharmacy, University of New Mexico, Albuquerque, NM, USA
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7
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Borden CG, Ashe EM, Buitron de la Vega P, Gast V, Saint-Phard T, Brody-Fialkin J, Power J, Wang N, Lasser KE. A novel pharmacy liaison program to address health-related social needs at an urban safety-net hospital. Am J Health Syst Pharm 2023; 80:1071-1081. [PMID: 37210728 DOI: 10.1093/ajhp/zxad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Indexed: 05/23/2023] Open
Abstract
PURPOSE Patients with unmet health-related social needs (HRSNs) often experience poor health outcomes and have high levels of healthcare utilization. We describe a program where dually trained pharmacy liaison-patient navigators (PL-PNs) screen for and address HRSNs while providing medication management services to patients with high levels of acute care utilization in a Medicaid Accountable Care Organization. We are unaware of prior studies that have described this PL-PN role. METHODS We analyzed case management spreadsheets for the 2 PL-PNs who staffed the program to identify the HRSNs that patients faced and the ways PL-PNs addressed them. We administered surveys, including an 8-item client satisfaction questionnaire (CSQ-8), to characterize patient perceptions of the program. RESULTS Initially, 182 patients (86.6% English speaking, 80.2% from a marginalized racial or ethnic group, and 63.2% with a significant medical comorbidity) were enrolled in the program. Non-English-speaking patients were more likely to receive the minimum intervention dose (completion of an HRSN screener). Case management spreadsheet data (available for 160 patients who engaged with the program) indicated that 71% of participants faced at least one HRSN, most often food insecurity (30%), lack of transportation (21%), difficulty paying for utilities (19%), and housing insecurity (19%). Forty-three participants (27%) completed the survey with an average CSQ-8 score of 27.9, indicating high levels of satisfaction with the program. Survey participants reported receiving medication management services, social needs referrals, health-system navigation assistance, and social support. CONCLUSION Integration of pharmacy medication adherence and patient navigation services is a promising approach to streamline the HRSN screening and referral process at an urban safety-net hospital.
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Affiliation(s)
- Caroline G Borden
- Boston Medical Center, Boston, MA
- Yale School of Medicine, New Haven, CT, USA
| | | | - Pablo Buitron de la Vega
- Section of General Internal Medicine, Boston Medical Center, Boston, MA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Vi Gast
- Takeda Pharmaceutical Company, Cambridge, MA, USA
| | | | | | - Julia Power
- Action for Boston Community Development, Inc., Boston, MA, USA
| | - Na Wang
- Boston University School of Public Health, Boston, MA, USA
| | - Karen E Lasser
- Section of General Internal Medicine, Boston Medical Center, Boston, MA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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8
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Smith CS. Applying a systems oriented ethical decision making framework to mitigating social and structural determinants of health. FRONTIERS IN ORAL HEALTH 2023; 4:1031574. [PMID: 37521174 PMCID: PMC10382250 DOI: 10.3389/froh.2023.1031574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Objectives Clinical ethical decision-making models are largely geared toward individual clinician choices and individual patient outcomes, not necessarily accounting for larger systemic issues that affect optimal patient outcomes. The purpose of this paper is to provide an ethical decision-making model, drawing upon systems orientation and ethical theory, specifically incorporating and aiding in the mitigation of social and structural determinants of health. Methods This paper presents a systems-oriented ethical decision-making framework derived from the analysis and critique of the Four-Box Method for Ethical Decision-Making by Jonsen, Siegler, and Winslade. Drawing upon both deontological and utilitarian ethical theory, the developed framework will assist providers, organizations, and health system leaders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations, who are largely impacted by social and structural determinants of health. Results The needs of underserved patients are inextricably linked to various social and structural determinants of health that, if left unaddressed, result in even poorer health outcomes, exacerbating existing health disparities. A systems-oriented ethical decision-making framework, centered on obligation, duty, and a utilitarian view of the optimal good, will aid providers, organizations, health system leaders, and community stakeholders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations. Conclusion Socioeconomic and political contexts have a significant impact on the way society is organized, how people are positioned in society, and how they will fare in terms of their health. Healthcare providers, including dentists, are largely unaware of and insensitive to the social issues that underlie the biological or psychological concerns that patients from socially disadvantaged backgrounds face. A systems-oriented ethical decision-making model will aid in mitigating social and structural determinants of health and the dental profession's obligations to the underserved.
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Affiliation(s)
- Carlos S. Smith
- Department of Dental Public Health and Policy, Virginia Commonwealth University School of Dentistry, Richmond, VA, United States
- Affiliate Faculty, Oral Health Equity Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, VA, United States
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Kiles TM, Chen C, Leibold C, Cardosi L, Hill H, Hohmeier KC. Pharmacy personnel comfort and confidence in screening for social needs: A pilot study. J Am Pharm Assoc (2003) 2023; 63:S83-S87. [PMID: 36863964 DOI: 10.1016/j.japh.2023.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Addressing social needs (such as lack of adequate housing, food, and transportation) has been shown to improve medication adherence and overall patient outcomes. However, screening for social needs during routine patient care can be challenging due to lack of knowledge of social resources and adequate training. OBJECTIVES The primary objective of this study is to explore the comfort and confidence of community pharmacy personnel in a chain community pharmacy when discussing social determinants of health (SDOH) with patients. A secondary objective of this study was to assess the impact of a targeted continuing pharmacy education program in this area. METHODS Baseline confidence and comfort were measured through a brief online survey consisting of Likert scale questions regarding various aspects of SDOH (e.g., importance and benefit, knowledge of social resources, relevant training, workflow feasibility). Subgroup analysis of respondent characteristics was conducted to examine differences between respondent demographics. A targeted training was piloted, and an optional posttraining survey was administered. RESULTS The baseline survey was completed by 157 pharmacists (n = 141, 90%) and pharmacy technicians (n = 16, 10%). Overall, the pharmacy personnel surveyed lacked confidence and comfort when conducting screenings for social needs. There was not a statistically significant difference in comfort or confidence between roles; however, subgroup analysis revealed trends and significant differences between respondent demographics. The largest gaps identified were lack of knowledge of social resources, inadequate training, and workflow concerns. Respondents of the posttraining survey (n = 38, response rate = 51%) reported significantly higher comfort and confidence than the baseline. CONCLUSION Practicing community pharmacy personnel lack confidence and comfort in screening patients for social needs at baseline. More research is needed to determine if pharmacists or technicians may be better equipped to implement social needs screenings in community pharmacy practice. Common barriers may be alleviated with targeted training programs to address these concerns.
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DiPietro Mager N, Bright D. Advancing Public Health through Community Pharmacy Practice. PHARMACY 2023; 11:pharmacy11020056. [PMID: 36961034 PMCID: PMC10037598 DOI: 10.3390/pharmacy11020056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
The overarching goal of public health is to advance the health of individuals, communities, and populations [...].
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Affiliation(s)
- Natalie DiPietro Mager
- Department of Pharmacy Practice, Raabe College of Pharmacy, Ohio Northern University, Ada, OH 45810, USA
| | - David Bright
- Department of Pharmaceutical Sciences, Ferris State University College of Pharmacy, Big Rapids, MI 49307, USA
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DiPiro JT, Allen DD, Lin A, Scott SA, Sorensen TD, Maine LL. Impact of Social Forces and Environmental Factors on Healthcare and Pharmacy Education: The Report of the 2021-2022 AACP Argus Commission. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe9452. [PMID: 36781186 PMCID: PMC10159613 DOI: 10.5688/ajpe9452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
| | - David D Allen
- University of Health Sciences and Pharmacy, St. Louis, Missouri
| | - Anne Lin
- Notre Dame of Maryland University, Baltimore, Maryland
| | - Steven A Scott
- Purdue University, College of Pharmacy, West Lafayette, Indiana
| | - Todd D Sorensen
- University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
| | - Lucinda L Maine
- American Association of Colleges of Pharmacy, Arlington, Virginia
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12
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Empowering Student Pharmacists through Social Determinants of Health Activities to Address Patient Outcomes. PHARMACY 2022; 10:pharmacy10060176. [PMID: 36548332 PMCID: PMC9786584 DOI: 10.3390/pharmacy10060176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The pharmacy education and its educators have to expose the student pharmacists to a plethora of activities regarding health disparities. It is essential for student pharmacists to be introduced to the key elements that comprise the Social Determinants of Health (SDOH) during their didactic curriculum. However, while there have been efforts made in the United States to incorporate the SDOH in the pharmacy curricula, there is limited research on student pharmacists' perspectives of how content in the didactic curriculum prepared them to provide patient care. A quantitative approach was used for this study. For the Class of 2023, activities were added to a skills-based course series and a professional development course series to introduce, apply, and illustrate how SDOH can impact pharmacist-provided care and patient health experiences. As part of the College's assessment plan, a survey is sent to the third-year student pharmacists in January prior to beginning Advanced Pharmacy Practice Experiences (APPEs). The online survey consists of 24 Likert Scale questions with five choices ranging from Strongly Agree to Strongly Disagree and not applicable. Four of the 24 questions pertained to health disparities and SDOH and were evaluated in this study. The responses were analyzed using SPSS for Windows, version 25.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics were calculated for all variables. Chi-square tests were used for all nominal data and Mann-Whitney test was used for all nonparametric numeric data. A total of 530 student pharmacists completed the survey. The mean age was 26 years and majority of the respondents identified as female (64%). More students strongly agreed that they had the ability to identify and address SDOH to improve access to or the delivery of healthcare in the class of 2023 (51.4%) compared to the class of 2022 (37.8%) and class of 2021 (35.8%). In addition, the mean survey score for the question between the class of 2023 improved significantly compared to the class of 2022 (p = 0.015) and 2021 (p = 0.004). Overall, this study suggests that longitudinal activities involving SDOH can improve student pharmacists' assessment of their abilities to interact with and care for a diverse patient population. The results suggest that the curriculum activities implemented to address a plethora of patients improve student assessment of their abilities to identify and incorporate SDOH in providing patient-centered care.
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13
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DiPietro Mager NA, Bright DR. Promising practices and pockets of excellence: Community pharmacists supporting wellness for reproductive-age women. Health Serv Res 2022; 57:1384-1389. [PMID: 36039563 PMCID: PMC9643084 DOI: 10.1111/1475-6773.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
| | - David R. Bright
- Department of Pharmaceutical SciencesFerris State University College of PharmacyBig RapidsMichiganUSA
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DiPietro Mager N, Bright D, Shipman AJ. Beyond Contraception: Pharmacist Roles to Support Maternal Health. PHARMACY 2022; 10:pharmacy10060163. [PMID: 36548319 PMCID: PMC9780787 DOI: 10.3390/pharmacy10060163] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/08/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
While contraception prescribing by pharmacists has seen rapid growth in recent years, pharmacist-provided services that can impact maternal health encompass more than just contraception. Each phase of maternal health-preconception, pregnancy, and post-pregnancy-has unique needs, and pharmacists are well equipped to provide services to meet those needs and are more accessible than other healthcare providers. While pharmacist-provided maternal health services may lead to significant savings to the healthcare system, additional research to more fully capture the value of pharmacist-provided maternal health services is needed. Robust implementation of a pharmacist-provided maternal health services program will require partnerships between providers, payers, and pharmacists. Infant and maternal mortality, preterm birth, and unintended pregnancies are significant public health issues, and pharmacists should be seen as a capable workforce who can provide needed maternal health care and serve as a gateway into the healthcare system for those capable of pregnancy.
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Affiliation(s)
- Natalie DiPietro Mager
- Department of Pharmacy Practice, Raabe College of Pharmacy, Ohio Northern University, Ada, OH 45810, USA
| | - David Bright
- Department of Pharmaceutical Sciences, Ferris State University College of Pharmacy, Big Rapids, MI 49307, USA
| | - Allie Jo Shipman
- National Alliance of State Pharmacy Associations, Richmond, VA 23235, USA
- Correspondence:
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Implementation of a Health Risk Assessment into Workflow of the Appointment-Based Model at an Independent Community Pharmacy. PHARMACY 2022; 10:pharmacy10060148. [PMID: 36412824 PMCID: PMC9680318 DOI: 10.3390/pharmacy10060148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Health risk assessments (HRAs) are tools used to collect information on patients' current health conditions, personal and family medical history, and lifestyle factors that can impact their overall health. The objectives of this pilot project were to implement an HRA as part of the appointment-based model workflow and to assess the resulting pharmacy-patient-care service opportunities. Sixteen HRA questions from a single health plan were incorporated into the appointment-based model workflow at an independent community pharmacy. Questions were administered either telephonically or in person over two patient encounters. Pharmacy staff were trained on how to administer the HRA, what to do if patients needed immediate assistance, how to provide referrals, and how to document of responses. Forty-nine patients were contacted and 38 (77.6%) completed the HRA. The median time for HRA completion was 19 min and the identified opportunities were vaccination (49), smoking cessation (15), diabetes prevention program (14), asthma control assessments (8), and substance use disorder screening and referral (3). This pilot project demonstrates that community pharmacies can implement HRAs and utilize the results to identify new pharmacy-patient-care service opportunities that can contribute to improved patient care and practice sustainability.
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Expanding comprehensive medication management considerations to include responses to the social determinants of health within the
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Helping Build Healthy Communities Program. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Foster AA, Daly CJ, Logan T, Logan R, Jarvis H, Croce J, Jalal Z, Trygstad T, Jacobs DM. Implementation and evaluation of social determinants of health practice models within community pharmacy. J Am Pharm Assoc (2003) 2022; 62:1407-1416. [PMID: 35256284 DOI: 10.1016/j.japh.2022.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/26/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND While community pharmacies are an ideal setting for social needs screening and referral programs, information on social risk assessment within pharmacy practice is limited. OBJECTIVES Our primary objective was to describe 2 social determinant of health (SDOH) practice models implemented within community pharmacies. The secondary objective was to evaluate implementation practices utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. PRACTICE DESCRIPTION Two pharmacy groups participated in a 3-month study, one in New York (9 pharmacies) and another in Missouri (1 pharmacy). The New York pharmacies implemented an SDOH specialist practice model, in which pharmacy staff members facilitate the program. The Missouri pharmacy implemented a community health worker (CHW) model by cross training their technicians. Each pharmacy developed their program using the Community Pharmacy Enhanced Services Network Care Model. PRACTICE INNOVATION Both programs expanded the technician role to take on additional responsibilities. The SDOH specialist model partnered with a local independent practice association to create a social needs referral program using a technology platform for closed-loop communication. All workflow steps of the self-contained CHW program were completed within the pharmacy, placing additional responsibility on the CHW and pharmacy staff. EVALUATION METHODS RE-AIM framework dimensions of Reach, Effectiveness, and Adoption. RESULTS Social challenges were identified in 49 of 76 (65%) generated SDOH screenings. The most prevalent social needs reported were affordability of daily needs (33%) and health care system navigation (15%). While most pharmacy staff indicated that workflow steps were clearly defined, assessments and referral tools were identified as potential gaps. While approximately 50% of pharmacy staff were comfortable with their assigned roles and in addressing SDOH challenges, physical and mental health concerns required additional education for intervention. CONCLUSION The successful implementation of community pharmacy SDOH programs connected patients with local resources. Community pharmacies are ideally positioned to expand their public health footprint through SDOH interactions that consequently improve patient care.
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Roman YM. COVID-19 pandemic: the role of community-based pharmacy practice in health equity. Int J Clin Pharm 2022; 44:1211-1215. [PMID: 35764850 PMCID: PMC9244246 DOI: 10.1007/s11096-022-01440-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/04/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic disrupted the landscape of primary care practice, creating new gaps in chronic disease management and worsening existing health disparities. Community-based pharmacy practices have played a critical role in responding to the pandemic; however, their role in promoting health equity and addressing existing health disparities has not been fully characterized. The objective of this commentary is to highlight some of the challenges and opportunities to cultivate an equitable plain field for communities to overcome significant health crises. Moreover, this commentary underscores the potential role of integrating community-based pharmacies into the public health infrastructure. It is uncommon to find an individual or an organization that has not been impacted by the pandemic. As painful as it has been to lose so many lives due to COVID-19 infection, it is critical to dedicate the time to reflect on how we arrived at this point. Compounding this global health crisis, the pandemic did not weigh equally on all community members, but rather some population groups carried the brunt of the pandemic more than others. The disproportionate burden of COVID-19 has uncovered significant gaps in our healthcare system and the global public health response. Understanding how we arrived at that point in the pandemic is a crucial first step toward achieving health equity. While many factors have led us onto the pandemic path, using national and global health frameworks to address health disparities and monitor health inequalities are worth discussing to delineate a roadmap to optimal population health. As these pandemic lessons challenge the status quo throughout communities, facing these new realities allows us to envision a roadmap for social justice, health equity, and innovative models to optimize health. Leveraging community-based pharmacy services could promote health equity, close growing health gaps, increase access to health care, and rapidly detect and respond to public health threats.
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Affiliation(s)
- Youssef M Roman
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, 23298, USA.
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19
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Stewart V, McMillan SS, Wheeler AJ. The development of a taxonomy to support goal setting between mental health consumers and community pharmacists. Res Social Adm Pharm 2022; 18:4003-4008. [PMID: 35717529 DOI: 10.1016/j.sapharm.2022.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/10/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Goal setting is widely used in mental healthcare, yet there is limited information about goal development between community pharmacists and people experiencing mental health conditions. OBJECTIVES i) To review goals developed in partnership between Australian community pharmacists and people experiencing depression/anxiety, and ii) categorize goals and develop a taxonomy. METHODS Community pharmacists (n = 142) who had completed a mental health training program provided an individualized medication support service and documented goal planning for 350 people experiencing anxiety and/or depression. Goals were reviewed using a general inductive content analysis to develop themes which were then grouped, categorized, and coded. This involved three researchers in different phases of the coding, repeated review and redrafting of the taxonomy, and inter-rater reliability consistency checks. RESULTS The goals (n = 749) represented a diverse range of health behaviors and outcomes (e.g., medication adherence, relationships, leisure activities). The resulting taxonomy involved five overarching domains: improved health; satisfaction with life; manage physical illnesses; manage mental health; and use of medicines. CONCLUSIONS Pharmacists have a role in providing person-centered care and addressing social determinants of health by considering factors that contribute to a person's overall wellbeing. While further testing is necessary, the taxonomy is valuable for pharmacists unfamiliar with supporting goal development with people experiencing anxiety and/or depression.
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Affiliation(s)
- Victoria Stewart
- School of Health Sciences and Social Work, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia.
| | - Sara S McMillan
- Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia
| | - Amanda J Wheeler
- Menzies Health Institute Queensland, Griffith University, Australia; School of Pharmacy and Medical Sciences, Griffith University, Australia; Faculty of Health and Behavioural Sciences, University of Auckland, New Zealand
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Irwin AN, Munar MY, Olstad S, Braden‐Suchy N. Student Pharmacists’ Perspectives on Health Equity Following a Co‐Curricular Activity. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kiles TM, Cernasev A, Leibold C, Hohmeier K. Patient perspectives of discussing social determinants of health with community pharmacists. J Am Pharm Assoc (2003) 2022; 62:826-833. [PMID: 35115261 DOI: 10.1016/j.japh.2022.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Social determinants of health (SDOH) have a considerable impact on the lives and health outcomes of Black communities. Although the implementation of social needs screening in various clinical settings has been studied, the patient perspective of discussing SDOH with health care providers has not been thoroughly investigated. There is an opportunity for community pharmacists to help identify social risk factors and address social needs, particularly in minoritized communities. OBJECTIVES The objectives of this project were to (1) characterize the perspectives of Black patients regarding social risk discussions with community pharmacists and (2) to develop a framework for community pharmacists to engage in conversations with patients about social risk factors. METHODS A qualitative study was conducted using principles of grounded theory. Patient perspectives regarding discussions of 5 key determinants of health (economic stability, education, social and community context, health and health care, and neighborhood and built environment) were elicited through semistructured interviews. Data analysis included interpretation of interview transcripts from 14 Black adults living in medically underserved areas in Memphis, TN. Charmaz's approach to theory development was followed. RESULTS Three themes emerged to characterize the needs and expectations for patients in discussing social risk factors with community pharmacists. The themes of rationale, relationship, and resources were compiled to construct the newly developed Social Determinants of Health Patient Communication Framework. This framework describes the key factors that affected the patient receptiveness and willingness to discuss their social needs. CONCLUSION Although patients are open to sharing social issues with community pharmacists, they may be reluctant to discuss social factors if initial understanding, personal connection, or resources are not present. This proposed, novel framework is a step toward improving the assessment of SDOH for underserved Black patients within community pharmacies. This framework can also be used for future education of pharmacists and other health care providers.
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22
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Kiles TM, Peroulas D, Borja-Hart N. Defining the role of pharmacists in addressing the social determinants of health. Res Social Adm Pharm 2022; 18:3699-3703. [DOI: 10.1016/j.sapharm.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 11/27/2022]
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Schooley TR, DiPietro Mager NA. Food for thought: Can community pharmacists help patients living in food deserts? J Am Pharm Assoc (2003) 2021; 62:1369-1373. [PMID: 35063368 DOI: 10.1016/j.japh.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Community pharmacists can play an important role in helping patients who live in food deserts through screening, adjusting therapeutic recommendations and counseling practices, and making referrals to community resources. However, literature regarding community pharmacists' knowledge, practices, and attitudes regarding food deserts is scant. OBJECTIVES The primary objective of this study was to assess Ohio community pharmacists' knowledge regarding food deserts. Secondary objectives included determining their attitudes, practices, and perceived barriers related to this topic. METHODS An anonymous 26-question survey was created and distributed to a random sample of 500 licensed community pharmacists in Ohio. Participants were granted 3 weeks to complete the survey and were offered a link to free Accreditation Council for Pharmacy Education-approved continuing pharmacy education as an incentive. The survey was deemed exempt by the Institutional Review Board. RESULTS The survey was successfully delivered to 491 pharmacists; 72 participated (14.7% response rate). About 43% of respondents were familiar with the term "food desert," and less than one-third (31.9%) reported being aware of community resources. Of those who thought that some of their patients lived in food deserts, the majority indicated that they did not consider it in patient interactions (65.1%) and "never" adjusted their counseling practices (65.1%). Barriers that prevented them from referring patients included lack of knowledge and confidence as well as workflow constraints. About 68% of respondents somewhat or strongly agreed that pharmacists could help patients living in food deserts, and 65.3% were interested in learning more information about food deserts. CONCLUSION Deficiencies in knowledge regarding food deserts and available resources were found among Ohio community pharmacists, but they showed interest in learning more information. Efforts should be made to educate community pharmacists about food deserts and to determine how to optimize their ability to assist patients as needed.
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Kalabalik-Hoganson J, Ozdener-Poyraz AE, Rizzolo D. Call to Action: Addressing Social Determinants of Health in Pharmacy Practice. Ann Pharmacother 2021; 56:740-745. [PMID: 34541883 DOI: 10.1177/10600280211040895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Social determinants of health (SDOH) are conditions in which individuals are born, live, work, learn, play, and age that affect health, risks, functioning, and outcomes. SDOH are recognized barriers to care, risk factors for certain diseases, and associated with poorer health outcomes. Screening for SDOH in physician practices and hospitals is reportedly low. The accessibility of pharmacists and established relationships with patients make pharmacy settings ideal for identifying and mitigating social needs. An evaluation of the impact of SDOH on health outcomes and opportunities for pharmacists to embed screening into practice is warranted.
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