Patients, Pharmacists Tackle SDOH, With Surprising Insights

What is the business case for social determinants of health (SDOH), and what would incentivize payers to support these initiatives?

At the Pharmacy Quality Alliance (PQA) 2022 Annual Meeting Wednesday, participants heard about some unexpected insights arising from a workshop held right before the conference began between patients and pharmacists who have been working together to create a patient-centered outcomes research agenda focused on addressing SDOH in the community pharmacy setting.

During the session, 2 PQA staff members—DeBran Tarver, PhD, MPH, a qualitative research analyst, and Megha Parikh, PhD, MS, a senior research scientist—described the overall structure and goals of the project, which is funded by a Patient-Centered Outcomes Research Institute (PCORI) Eugene Washington PCORI Engagement Award. Announced in November 2021, the project is being managed by PQA and the Patient Advocate Foundation (PAF).

The project brings together 6 patients and 3 pharmacists in a planning committee to create a patient-centered research agenda. They were guided by a gap analysis, which identified 5 key SDOH areas that have an impact on patients in community pharmacy settings: transportation, housing, health literacy, food insecurity, and medication cost.

In addition, the gap analysis identified patient preferences and experiences in SDOH in pharmacy settings and identified resources issues relevant to the pharmacy perspective, said Parikh.

Last month, the group met over Zoom to refine their research list and share stories about what each side has experienced, said Parikh. For example, patients shared how they could not afford medication or did not understand certain things about side effects.

“It was helpful for patients and pharmacy stakeholders to understand each others’ perspectives,” said Parikh.

They conducted some polling among themselves to decide on the most important issues that should be worked on in order to implement SDOH initiatives, and in breakout groups, there was a lot of discussion around patient-pharmacist communication, appropriate screening tools, and pharmacy infrastructure. There was further prioritization of research topics ahead of the in-person meeting held this week right before the PQA conference began in Baltimore, Maryland.

Then, she said, “They went a little bit rogue and they added a topic that was not on our list.”

For the group, their top priority turned out to be making a business case for SDOH and understanding their value and clarifying reimbursement issues.

Other important issues that came out of the in-person session included better training for pharmacists and pharmacy staff, including technicians and clerks, on topics such as implicit bias, empathy, and discussing sensitive subjects.

There also needs to be a better way to identify and connect patients to resources, the group decided.

Patients had other insights as well, such as pointing out that they see a pharmacist more often than they see their primary care provider and that they would like it if pharmacies could be “more accessible and inviting,” said Parikh.

From the pharmacists’ perspective, the main takeaway is that “they don’t believe the system as it currently is; [it] does not fit into their current workflow or objectives."

"You can have as many tools and checklists as you’d like, but if you don’t have enegagement from pharmcists, or reimbursement, realistically, SDOH screening and initiatives on a large scale is not going to happen," summed up Parikh.

The group will meet again in June for a final workshop.