Identifying and Addressing Social Determinants of Health: A Health System Specialty Pharmacy Approach

OBJECTIVES: To describe the findings of two health system specialty pharmacy (HSSP) social determinants of health (SDOH) screening and referral initiatives.

METHODS: This is an interim analysis through December 2023 of an ongoing prospective, observational study. In August 2023, SDOH screening pilot programs were implemented at two client-managed HSSPs. At site one, people living with human immunodeficiency virus (PLWH) were eligible for screening. Eligible patients at site two included individuals with a diagnosis of type 2 diabetes mellitus (T2DM) who were new to the clinic or were an existing patient with uncontrolled T2DM (defined as an A1c ≥ 10%). During routine clinic visits or during patient calls, the HSSP teams invited eligible patients to complete a social needs questionnaire utilizing a ten-question tool adapted from the Health Leads Screening Toolkit. If a social need was identified (screen positive), resources and/or a referral to social services was/were offered and facilitated by pharmacists. Baseline demographics, comorbidities, and screening outcomes were analyzed. Medians were calculated for continuous variables and frequencies and percentages for categorical variables.

RESULTS: The HSSP teams screened 59 patients (44 PLWH, 15 diagnosed with T2DM): 56% male, 63% white, with a median age of 54 years. One patient declined screening. Comorbid hypertension (49%) and/or hyperlipidemia (47%) were common. The screen positive rate was 59% (n=35) of which 57% reported two or more social needs. Challenges related to food (49%), transportation (43%), utilities (31%), and housing (31%) were reported most frequently. Among those who screened positive, 80% (n=28) requested assistance. Pharmacists provided resources and/or social services referrals to 29 patients, of whom 1 did not screen positive.

CONCLUSIONS: HSSP teams can play a significant role in identifying and addressing patients' unmet social needs. This comprehensive, personalized care aims to advance health equity and improve overall health outcomes.