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Blakely M, Sherbeny F, Hastings T, Boyd L, Adeoye-Olatunde O. Exploratory analysis of medication adherence and social determinants of health among older adults with diabetes. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100371. [PMID: 38058361 PMCID: PMC10696385 DOI: 10.1016/j.rcsop.2023.100371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
Background Diabetes is the fifth leading cause of death in the United States (US), affecting approximately 27%, or 15.9 million adults 65 years of age and older. Diabetes is the most expensive chronic condition in the US and accounts for the second largest avoidable healthcare cost. Adherence to long-term medication treatment plans is crucial among patients with diabetes because it decreases risk of developing comorbid conditions and improves quality of life. Greater exposure to adverse social determinants of health (SDOH) over an individual's lifespan can result in worse health outcomes. Hence, it is important to obtain a better understanding of how social determinants of health (SDOH) influence patients' behaviors and affect medication adherence among older adults with diabetes. Objectives Identify and prioritize SDOH associated with medication adherence among a nationally representative sample of older adults with diabetes. Secondary objectives were to characterize SDOH, estimate medication adherence, and explain implications for health disparity populations among older adults in the US who have been diagnosed with diabetes. Methods This study used a cross-sectional secondary data analysis to examine the National Health and Nutrition Examination Survey database, identifying associations between SDOH and medication adherence among older adults with diabetes in the US. Results A total of 1807 respondents' data were included in the analyses. Nearly three-quarters (73.9%) of patients were considered adherent to their oral diabetes medications. Multivariable analysis revealed significant differences in medication adherence based on disability status (p = 0.016), household balanced meals (p = 0.033), and interview language (p = 0.008). Conclusions Results revealed those with a disability, those who could not afford a balanced meal, and/or those who spoke English were associated with a higher likelihood of being nonadherent to their diabetes medications in comparison to individuals not in these groups. These findings can assist in developing SDOH-centered medication adherence strategies for pharmacists to implement with older patients with diabetes.
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Affiliation(s)
- M.L. Blakely
- University of Wyoming, School of Pharmacy, Department of Pharmaceutical Sciences, United States of America
| | - F. Sherbeny
- Florida A&M University, College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health. Economic, Social, and Administrative Pharmacy Division, United States of America
| | - T.J. Hastings
- University of South Carolina College of Pharmacy, Department of Clinical Pharmacy and Outcomes Sciences, United States of America
| | - L. Boyd
- Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Department of Biostatistics and Health Data Science, United States of America
| | - O.A. Adeoye-Olatunde
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, Department of Pharmacy Practice, United States of America
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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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Davis VH, Dainty KN, Dhalla IA, Sheehan KA, Wong BM, Pinto AD. "Addressing the bigger picture": A qualitative study of internal medicine patients' perspectives on social needs data collection and use. PLoS One 2023; 18:e0285795. [PMID: 37285324 DOI: 10.1371/journal.pone.0285795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/29/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND There is increasing interest in collecting sociodemographic and social needs data in hospital settings to inform patient care and health equity. However, few studies have examined inpatients' views on this data collection and what should be done to address social needs. This study describes internal medicine inpatients' perspectives on the collection and use of sociodemographic and social needs information. METHODS A qualitative interpretive description methodology was used. Semi-structured interviews were conducted with 18 patients admitted to a large academic hospital in Toronto, Canada. Participants were recruited using maximum variation sampling for diverse genders, races, and those with and without social needs. Interviews were coded using a predominantly inductive approach and a thematic analysis was conducted. RESULTS Patients expressed that sociodemographic and social needs data collection is important to offer actionable solutions to address their needs. Patients described a gap between their ideal care which would attend to social needs, versus the reality that hospital-based teams are faced with competing priorities and pressures that make it unfeasible to provide such care. They also believed that this data collection could facilitate more holistic, integrated care. Patients conveyed a need to have a trusting and transparent relationship with their provider to alleviate concerns surrounding bias, discrimination, and confidentiality. Lastly, they indicated that sociodemographic and social needs data could be useful to inform care, support research to inspire social change, and assist them with navigating community resources or creating in-hospital programs to address unmet social needs. CONCLUSIONS While the collection of sociodemographic and social needs information in hospital settings is generally acceptable, there were varied views on whether hospital staff should intervene, as their priority is medical care. The results can inform the implementation of social data collection and interventions in hospital settings.
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Affiliation(s)
- Victoria H Davis
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Katie N Dainty
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Irfan A Dhalla
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen A Sheehan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Brian M Wong
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Foster AA, Daly CJ, Leong R, Stoll J, Butler M, Jacobs DM. Integrating community health workers within a pharmacy to address health-related social needs. J Am Pharm Assoc (2003) 2023; 63:799-806.e3. [PMID: 36710147 PMCID: PMC10198812 DOI: 10.1016/j.japh.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Community pharmacies in the United States are beginning to serve as patient care service destinations addressing both clinical and health-related social needs (HRSN). Although there is support for integrating social determinant of health (SDoH) activities into community pharmacy practice, the literature remains sparse on optimal pharmacy roles and practice models. OBJECTIVE To assess the feasibility of a community pharmacy HRSN screening and referral program adapted from a community health worker (CHW) model and evaluate participant perceptions and attitudes toward the program. METHODS This feasibility study was conducted from January 2022 to April 2022 at an independent pharmacy in Buffalo, NY. Collaborative relationships were developed with 3 community-based organizations including one experienced in implementing CHW programs. An HRSN screening and referral intervention was developed and implemented applying a CHW practice model. Pharmacy staff screened subjects for social needs and referred to an embedded CHW, who assessed and referred subjects to community resources with as-needed follow-up. Post intervention, subjects completed a survey regarding their program experience. Descriptive statistics were used to report demographics, screening form, and survey responses. RESULTS Eighty-six subjects completed screening and 21 (24.4%) an intervention and referral. Most participants utilized Medicaid (57%) and lived within a ZIP Code associated with the lowest estimated quartile for median household income (66%). Eighty-seven social needs were identified among the intervention subjects, with neighborhood and built environment (31%) and economic stability challenges (30%) being the most common SDoH domains. The CHW spent an average of 33 minutes per patient from initial case review through follow-up. All respondents had a positive perception of the program, and the majority agreed that community pharmacies should help patients with their social needs (70%). CONCLUSIONS This feasibility study demonstrated that embedding a CHW into a community pharmacy setting can successfully address HRSN and that participants have a positive perception toward these activities.
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Stewart de Ramirez S, Shallat J, McClure K, Foulger R, Barenblat L. Screening for Social Determinants of Health: Active and Passive Information Retrieval Methods. Popul Health Manag 2022; 25:781-788. [PMID: 36454231 DOI: 10.1089/pop.2022.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Screening for social determinants of health (SDOH) is recommended, but numerous barriers exist to implementing SDOH screening in clinical spaces. In this study, the authors identified how both active and passive information retrieval methods may be used in clinical spaces to screen for SDOH and meet patient needs. The authors conducted a retrospective sequential cohort analysis comparing the active identification of SDOH through a patient-led digital manual screening process completed in primary care offices from September 2019 to January 2020 and passive identification of SDOH through natural language processing (NLP) from September 2016 to August 2018, among 1735 patients at a large midwestern tertiary referral hospital system and its associated outlying primary care and outpatient facilities. The percent of patients identified by both the passive and active identification methods as experiencing SDOH varied from 0.3% to 4.7%. The active identification method identified social integration, domestic safety, financial resources, food insecurity, transportation, housing, and stress in proportions ranging from 5% to 36%. The passive method contributed to the identification of financial resource issues and stress, identifying 9.6% and 3% of patients to be experiencing these issues, respectively. SDOH documentation varied by provider type. The combination of passive and active SDOH screening methods can provide a more comprehensive picture by leveraging historic patient interactions, while also eliciting current patient needs. Using passive, NLP-based methods to screen for SDOH will also help providers overcome barriers that have historically prevented screening.
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Affiliation(s)
- Sarah Stewart de Ramirez
- Department of Population Health Services, OSF HealthCare System, Peoria, Illinois, USA.,Department of Emergency Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Jaclyn Shallat
- Department of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Keaton McClure
- University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Roopa Foulger
- Department of Health Care Analytics, OSF HealthCare System, Peoria, Illinois, USA.,Department of OSF OnCall, OSF Healthcare System, Peoria, Illinois, USA
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Steeves-Reece AL, Nicolaidis C, Richardson DM, Frangie M, Gomez-Arboleda K, Barnes C, Kang M, Goldberg B, Lindner SR, Davis MM. "It Made Me Feel like Things Are Starting to Change in Society:" A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12668. [PMID: 36231967 PMCID: PMC9566653 DOI: 10.3390/ijerph191912668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Many healthcare organizations are screening patients for health-related social needs (HRSN) to improve healthcare quality and outcomes. Due to both the COVID-19 pandemic and limited time during clinical visits, much of this screening is now happening by phone. To promote healing and avoid harm, it is vital to understand patient experiences and recommendations regarding these activities. We conducted a pragmatic qualitative study with patients who had participated in a HRSN intervention. We applied maximum variation sampling, completed recruitment and interviews by phone, and carried out an inductive reflexive thematic analysis. From August to November 2021 we interviewed 34 patients, developed 6 themes, and used these themes to create a framework for generating positive patient experiences during phone-based HRSN interventions. First, we found patients were likely to have initial skepticism or reservations about the intervention. Second, we identified 4 positive intervention components regarding patient experience: transparency and respect for patient autonomy; kind demeanor; genuine intention to help; and attentiveness and responsiveness to patients' situations. Finally, we found patients could be left with feelings of appreciation or hope, regardless of whether they connected with HRSN resources. Healthcare organizations can incorporate our framework into trainings for team members carrying out phone-based HRSN interventions.
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Affiliation(s)
- Anna L. Steeves-Reece
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, OR 97201, USA
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Dawn M. Richardson
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
| | - Melissa Frangie
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Katherin Gomez-Arboleda
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Chrystal Barnes
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Minnie Kang
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Bruce Goldberg
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Stephan R. Lindner
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Melinda M. Davis
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
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Wallington SF, Noel A. Communicating with Community: Health Disparities and Health Equity Considerations. Med Clin North Am 2022; 106:715-726. [PMID: 35725236 DOI: 10.1016/j.mcna.2022.03.007] [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] [Indexed: 11/19/2022]
Abstract
This article explores why communicating with communities is important to the health of individuals as well as public health, and best practices of how. We outline the use of relevant theoretic frameworks, understanding the role of technological contextual changes, trust despite misinformation, health and digital literacy skills, and working with the community for effective reciprocal communication. Strategies for developing community communication are also enumerated and applied to addressing health disparities.
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Affiliation(s)
- Sherrie Flynt Wallington
- George Washington University, School of Nursing, 1919 Pennsylvania Avenue, Suite 500, Washington, DC 20048, USA.
| | - Annecie Noel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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