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

Advancing social care integration in health systems with community health workers: an implementation evaluation based in Bronx, New York

BACKGROUND

In recent years, health systems have expanded the focus on health equity to include health-related social needs (HRSNs) screening. Community health workers (CHWs) are positioned to address HRSNs by serving as linkages between health systems, social services, and the community. This study describes a health system's 12-month experience integrating CHWs to navigate HRSNs among primary care patients in Bronx County, NY.

METHODS

We organized process and outcome measures using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) implementation framework domains to evaluate a CHW intervention of the Community Health Worker Institute (CHWI). We used descriptive and inferential statistics to assess RE-AIM outcomes and socio-demographic characteristics of patients who self-reported at least 1 HRSN and were referred to and contacted by CHWs between October 2022 and September 2023.

RESULTS

There were 4,420 patients who self-reported HRSNs in the standardized screening tool between October 2022 and September 2023. Of these patients, 1,245 were referred to a CHW who completed the first outreach attempt during the study period. An additional 1,559 patients self-reported HRSNs directly to a clinician or CHW without being screened and were referred to and contacted by a CHW. Of the 2,804 total patients referred, 1,939 (69.2%) were successfully contacted and consented to work with a CHW for HRSN navigation. Overall, 78.1% (n = 1,515) of patients reported receiving social services. Adoption of the CHW clinician champion varied by clinical team (median 22.2%; IQR 13.3-39.0%); however, there was no difference in referral rates between those with and without a clinician champion (p = 0.50). Implementation of CHW referrals via an electronic referral order appeared successful (73.2%) and timely (median 11 days; IQR 2-26 days) compared to standard CHWI practices. Median annual cost per household per CHW for the intervention was determined to be $184.02 (IQR $134.72 - $202.12).

CONCLUSIONS

We observed a significant proportion of patients reporting successful receipt of social services following engagement with an integrated CHW model. There are additional implementation factors that require further inquiry and research to understand barriers and enabling factors to integrate CHWs within clinical teams.

From refugee to pharmacist: Insights for better care

PURPOSE

This reflection utilizing Gibb's model offers insight into the lived experience of a Vietnamese child refugee who, many years later, found herself working as a pharmacist with Afghan refugees.

DESCRIPTION

Through this piece, the author describes her childhood experience with the United States (US) healthcare system as a refugee, her experience as a pharmacist caring for refugees, and explores her thoughts and feelings about the experience.

ANALYSIS/INTERPRETATION

The author evaluates the positive and negative aspects of the situation and analyzes the experience to make sense of the situation.

CONCLUSIONS

After reflecting on what she learned through her experience combined with findings in the literature, the author offers recommendations to pharmacists as they care for refugees, emphasizing the need for trauma-informed care for refugees with limited English language skills who are trying to navigate the complex US healthcare system.

IMPLICATIONS

This piece offers insights for pharmacists caring for refugees on how to offer better care.