Background
Social determinants of health (SDOH) are nonmedical factors that impact health outcomes. Pharmacists within integrated health system specialty pharmacies (HSSPs) are positioned to identify and address SDOH barriers.
Objective
The objective was to implement and evaluate a pharmacist-led SDOH program for HSSP patients.
Practice description
The practice innovation was implemented within 4 health systems in Michigan and Massachusetts with associated HSSPs and a standard specialty pharmacy clinical management model incorporating initial patient counseling and periodic reassessments.
Practice innovation
A SDOH screening and intervention program was developed and piloted at 4 health systems with associated HSSPs. Patients with HIV, rheumatoid arthritis (RA), and hyperlipidemia meeting pre-defined inclusion criteria were enrolled in the program from September 2023 through September 2024. After screening patients for SDOH barriers, pharmacists offered targeted interventions and structured follow-ups to ensure resolution of challenges.
Evaluation methods
Patients enrolled in the program were analyzed using data extracted from the electronic medical record and patient management platform. The primary outcome was intervention acceptance rate; secondary outcomes included intervention categories, patient-perceived value of interventions, ongoing support needs, pharmacist time spent, and clinical outcomes.
Results
Of the 50 patients (HIV: n = 6; RA: n = 27; hyperlipidemia: n = 17) enrolled, 56% completed screening and 79% of those accepted interventions. Of the 19 patients who received follow-up, 63% found the interventions beneficial, and 4 required ongoing support. The most frequent interventions included food security/nutrition (46%) and physical activity (25%). The average time per intervention was 60 min (range: 15-180 min). Patients with interventions demonstrated clinical outcomes improvements, including a mean Routine Assessment of Patient Index Data 3 score reduction of 3 points (range: 1.3-27.3) and mean low-density lipoprotein reduction of 29.8 mg/dL (range: 44-137) for RA and hyperlipidemia, respectively.
Conclusions
These pilot results suggest that a pharmacist-led SDOH program may be effective in addressing patient barriers, demonstrated by high acceptance rate and perceived benefit of interventions and improved clinical outcomes.
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