Walk A Mile In My Shoes
According to the Centers of Disease Control and Prevention (CDC), Social Determinants of Health (SDOH) are the conditions in the environment where people are born, live, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks. The World Health Organization has a similar definition of SDOH but adds that these circumstances are further shaped by the distribution of money, power, and resources on a global, national, and local level.
Certain elements of SDOH guide the health behaviors of many pharmacy patients and once we understand that we can make a plan and move to help them.
How much do we know about the life of our patients? What’s going on in their homes, with them or their families, that might affect their health behaviors? Walking a mile in their shoes can help with that understanding.
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Effects of socio-economic class: Our diabetes patients who worry every day about how to make the next rent payment or buy food for their family probably won’t focus on our conversations about eating healthy foods, being active, and taking their medicine as prescribed. Even without the COVID-19 pandemic, its accompanying economic chaos, and the situational poverty it has created, we have families in our communities who live under constant financial stress. Those who are victims of generational poverty, defined as having lived in poverty for at least two generations, are mired in a situation where they can see no remedy. We need to understand these people and practice the correct patient centered techniques to help them along.
Social Isolation: Being alone carries its own set of psychological maladies due to lack of social interaction. However, this also includes the loss of support for activities of daily living.
Transportation: In Big Sky Country, everything is a long way off so, for some folks, going to the pharmacy is not a quick and easy task. Inability to get to the pharmacy creates a “pharmacy desert” scenario where non-adherence is commonplace. In addition patients, especially during the COVID-19 crisis, have deferred needed medical care because of transportation problems.
Food insecurity: Defined as “the lack of consistent access to enough food for an active and healthy life” affects up to one in four families in the United States. That reflects a two-fold increase since the beginning of the pandemic. Hungry people are mostly worried about food so healthcare behaviors may be way down the list of important things in life.
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“It occurred to me that who got sick and who didn’t and what happened to them and their interactions were not just biological phenomena; they were social, political, and racial phenomena."
Dr. H Jack Geiger was a pioneer in the field of social medicine, the philosophy that doctors had the moral obligation to treat the social as well as the medical conditions that adversely affect patient’s health. Hence the concept of Social Determinants of Health.
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Pharmacy's Role
Although the term Social Determinants of Health and the elements therein have been formally recognized since the early 2000s, the pharmacy profession has only recently begun to find its pace in addressing the issue. There is a push for increased awareness of the health inequities existing in our patient populations and for pharmacists and staff to learn more about how to help with solutions.
Some of us may have encountered the Outcomes MTM program that, in conjunction with a large insurer, sought to identify at risk patients by utilizing a SDOH screening tool and documenting the results. The pharmacists were paid a small fee to complete the patient surveys either by phone or in person. They completed over 9800 screenings with patients identified as having one or more chronic medical conditions, including diabetes. The results showed that the most prevalent SDOH were food insecurity, social isolation, and transportation challenges. The health plan sponsor was able to link patients in need to a site where they could search their zip code to find local resources available to help address their stated needs. It appears that there will be a time when our pharmacies will have SDOH data for at risk patients and be given the opportunity to act on it.
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Pharmacists, as one of the most trusted members of the health care team, can take an active part in resolving some of these SDOH issues. We can be that resource that guides our patients in need of support. In order to do that we might consider these and other activities:
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Identify resources in your community such as community health workers to assist patients in addressing SDOH
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Educate yourself and staff about SDOH so that they can be more sensitive to patient needs
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Use motivational interviewing techniques to identify and address patient needs in culturally competent and patient centric manner
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Become familiar with the SDOH survey questions and address questions in a culturally appropriate and unbiased manner.
- If you have delivery services educate the delivery person in SDOH. The delivery person sometimes knows more about the patient than the pharmacist
- Now more than ever increase your telephone outreach to check on your patients
- Use CONNECT, the free, bi-directional referral system to link your patients to resources they need.
James Bennett RPh, BCGP, CDCES
Bozeman MT
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