Loren Bonner
The community pharmacy may be the very place where addressing social determinants of health (SDOH) can be a reality, not just a concept.
Through partnerships between community pharmacists and community health workers (CHWs), some pharmacies have been able to help close gaps that lead to poor health outcomes for the most complex patients.
“Patients are willing to discuss their social needs at the pharmacy,” said David Jacobs, PharmD, PhD, lead author of a new study in JAPhA, published January 10, 2023, that examined the feasibility of CHWs within a pharmacy to address health-related social needs.
Jacobs and his colleagues tested a CHW model in an independent community pharmacy in Buffalo, NY. Through partnerships with three community-based organizations, including one experienced in CHW programs, pharmacy staff were able to successfully screen patients for social needs and refer them to an embedded CHW within the pharmacy. The embedded CHW then assessed and referred patients to community resources and followed up as needed.
Eighty-seven social needs were identified among the patients in the study. The most common SDOH domains included issues with the neighborhood and built environment at 31%, and economic stability challenges at 30%, according to the study results. The CHW spent an average of 33 minutes per patient from initial case review through follow up.
After the intervention, patients completed a survey regarding their program experience. All respondents reported a positive perception of the program, and 70% agreed that community pharmacies should help patients with their social needs.
“There is movement toward community health workers in different settings, and this is one avenue,” said Jacobs, who is from the University at Buffalo School of Pharmacy and Pharmaceutical Sciences. “It’s feasible for a community health worker to be embedded in a pharmacy and in screening and [patient] navigation.”
The American Public Health Association defines a CHW as “a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community serviced. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.”
CHWs are credentialed through local certificate training programs, and they often share the same cultural understanding as their patients, which allows them to more easily identify barriers patients face when it comes to taking medications.
A study published March 4, 2020, in JAPhA by Segal and colleagues found that a majority of patients revealed information to a CHW of which the pharmacist wasn’t aware. The study evaluated the effect of CHWs in a community pharmacy in Florida on patient’s adherence to antihypertensive medications.
Accessing medications
To put their Buffalo, NY, CHW program in place, Jacobs and fellow researchers collaborated with Tripp Logan, PharmD, from L & S Pharmacy in Charleston, MO. Logan’s pharmacy was the first in Missouri to train CHWs through a pharmacy-based training program. His team equips their pharmacy delivery drivers with home assessments and patient assessments in order to find out if a patient should be referred to a CHW.
“This is all part of outcomes-based care, value-based care,” said Logan. “Pharmacies are in the outcomes business now, and we don’t talk about that enough. This is the secret weapon for getting into value-based care arrangements.”
In the community pharmacy setting, SDOH are the difference between a patient being able and not being able to access or manage their medications. Medication cost, literacy, transportation, and other SDOH issues all play into this.
Training
As with any new idea or model of care, there are always next steps. According to Christopher Daly, PharmD, coauthor of the JAPhA study, there are gaps to address with CHW training.
“Training requirements are different per state,” said Daly, who is from the University at Buffalo School of Pharmacy and Pharmaceutical Sciences. “There are partnerships with community-based organizations to accomplish training. Materials are adapted and pharmacy-centric to increase effectiveness.”
Pharmacy technicians can be—and have been—trained to be CHWs. Logan said they discovered that it’s easier to train a pharmacy technician in-house than hire an outside person and give them pharmacy-specific training.
Through their nationwide course, Logan’s team has trained roughly 90 pharmacy technicians in 2022 to become CHWs, and they are on track to train at least another 180 this year. ■