Implementation and evaluation of social determinants of health practice models within community pharmacy

Vaccination equity and the role of community pharmacy in the United States: A qualitative study

OBJECTIVES

To identify strategies community pharmacists utilized to support equitable vaccination in their communities.

STUDY DESIGN

Qualitative, descriptive design.

METHODS

Key informant interviews were conducted virtually via teleconference using a mix of purposeful and snowball sampling of Pennsylvania community pharmacy personnel who participated in COVID-19 vaccination efforts. Interviews were conducted from March until August 2022 when thematic saturation was reached. A qualitative, inductive thematic data analysis was utilized to identify major themes and strategies that emerged from the data.

RESULTS

Pharmacists utilized three philosophies: (1) prioritizing trust, (2) meeting people where they are at, and (3) building capacity within their teams and communities to create "safe spaces" for people to receive vaccinations. Nine discrete strategies used in practice exemplify how respondents implemented these philosophies: (1) Build Community Partnerships; (2) Establish Trust to Build Credibility; (3) Address Transportation Issues; (4) Provide Patient Education and Address Health Literacy Barriers; (5) Address Language Barriers; (6) Create a Safe and Accessible Space for Those with Individualized Needs; (7) Provide Patient-Centered and Culturally-Sensitive Care; (8) Train Staff on Health Equity and Patient Engagement; and (9) Advocate for Community Pharmacy Policy and Payment Reform. Definitions for these philosophies and key examples that illustrate how each strategy was employed in practice are provided.

CONCLUSION

The findings highlight unique strategies respondent community-based pharmacy teams use to contribute to equitable vaccination efforts in communities and further emphasizes the importance of their role in public health initiatives.

Experiences of goal planning in Australian community pharmacy settings for people experiencing mental illness: A qualitative study

BACKGROUND

Person-centred goal planning is increasingly being incorporated into healthcare interventions. People experiencing severe and persistent mental illnesses (SPMIs) have high levels of co-occurring health conditions, reducing their life expectancy when compared with the general population. As medications are commonly used in the treatment of SPMIs, community pharmacists are well-placed to support the health and wellbeing of this population.

OBJECTIVES

To examine pharmacists' and service users' experiences of goal planning as a component of a community pharmacy-based health intervention for people experiencing SPMIs (PharMIbridge intervention).

METHODS

This study utilised a qualitative exploratory approach with an interpretive description method. Semistructured interviews were undertaken with community pharmacists (n = 16) and service user participants (n = 26) who had participated in pharmacist support services for people experiencing SPMIs (PharMIbridge intervention).

RESULTS

Four themes relating to goal planning were identified. First, goal planning provided purpose and motivation for participation in the intervention. Planning realistic goals was important but often challenging. Both pharmacists and service users highlighted the relational aspects of goal planning and how strong relationships supported positive behaviour change and outcomes. Finally, individualised and flexible approaches were important aspects of the intervention, ensuring goals were meaningful to service users.

CONCLUSIONS

The findings from this study identified positive outcomes from the inclusion of goal-planning processes in a community pharmacy-based health intervention. Further research regarding tools, strategies or training that could support future goal-planning interventions in primary healthcare is needed.

PATIENT OR PUBLIC CONTRIBUTION

The PharMIbridge randomised controlled trial research team included lived experience members and was overseen by an expert panel that included members with a lived experience of mental illness and representatives from key organisations. The training provided to pharmacists was co-designed and co-delivered by the researchers and lived experience representatives, and pharmacists were supported by lived experience mentors. Service user participants were invited to participate in the interviews through a number of pathways (e.g., at the completion of the intervention, flyers). Those interested were provided with the full study participant information and provided with a $30 gift voucher at the conclusion of the interview.

A novel pharmacy liaison program to address health-related social needs at an urban safety-net hospital

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.

Pharmacy personnel comfort and confidence in screening for social needs: A pilot study

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.

Integrating community health workers within a pharmacy to address health-related social needs

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.