By: Sabree Burbage & Jordana Levitt
COVID-19 continues to have a devastating impact on our economy, our healthcare system, and the well-being of our citizens. It has become increasingly apparent that COVID-19 not only strains the existing healthcare infrastructure, but also exacerbates health disparities across America. Social determinants of health (SDOH) “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes,” contribute to many of those disparities. SDOH impact wellness and health outcomes and are particularly important to address for vulnerable patients including racial and ethnic minorities, low-income and unhoused families, older persons, rural area resident and those otherwise disadvantaged, who are disproportionately impacted by COVID. SDOH reflect the “relationship between how population groups experience ‘place’ and the impact of ‘place’ on health” and have the ability to negatively or positively impact an individual’s health outcomes and quality of life. As more stakeholders in the health care arena look for innovative ways to improve patient outcomes and value in care, interventions targeting SDOH are increasing.
For patients at risk, the introduction to and use of telehealth services “can provide an effective means to conduct appointments and check on at-risk individuals, while keeping them safe in their homes and limiting their risk of exposure”. Telehealth services are a flexible means to meet the patient where they are via telephone and video chat and is especially useful in rural and underserved communities. In an effort to protect vulnerable citizens of North Carolina, especially those with complex chronic conditions, the pharmacists in the Comprehensive Medication Management (CMM) Telepharmacy project expanded medication management services to include SDOH support for patients with uncontrolled diabetes. As one of the most accessible health care providers, pharmacists are in a unique position to alleviate a number of patient burdens attributed to SDOH that have been intensified or worsened due to COVID-19.
In the CMM Telepharmacy Project, clinical pharmacist used a SDOH screener to identify patients’ broader social needs prompted by the pandemic. Over the 4 months of implementation, the pharmacist conducted 200 visits with 66 patients, screening all patients for COVID-prompted concerns. With over one third of the patients experiencing one or more SDOH, it is clear that a focus on these factors should be a necessary part of patient care and service delivery to identify root problems. Upon identification of SDOH concerns, the pharmacist provided brief interventions to address these needs including: connecting the patients with community resources (i.e. providing options to order groceries to their door online, providing patients coupons to make medications more affordable), care coordination to increase access and affordability of medications with the clinic or community pharmacy (i.e. switching patients to pharmacies that deliver, switching to 340b pharmacy when applicable) and providing education (i.e. educating on precautions to take while at work, break room etiquette). To learn more about the role of the clinical pharmacist’s impact on SDOH, read CMO’s recent publication in Exploratory Research in Clinical and Social Pharmacy.
With sustained support, pharmacists can continue to address current population health gaps in collaboration with other members of the healthcare team to combat results of persistent SDOH impacted by COVID-19.
 Relias. The relationship between social determinants of health and COVID-19. https://www.relias.com/blog/social-determinants-of-health-and-covid-19 Published August 31, 2020. Accessed on March 9, 2021.
 Office of Disease Prevention and Health Promotion. Healthy People 2020 topics & objectives. Social determinants of health. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health Accessed on March 9, 2021.
 Journal of American Health Information Management Association. Addressing social determinants of health with technology during public health emergencies. https://journal.ahima.org/addressing-social-determinants-of-health-with-technology-during-public-health-emergencies/ Published June 1, 2020. Accessed on March 9, 2021.
 Livet, M., Levitt, JM., Lee, A., & Easter, J. The pharmacist as a public health resource: Expanding telepharmacy services to address social determinants of health during the COVID-19 pandemic. Explor Res Clin Soc Pharm. 2021;2:100032. https://doi.org/10.1016/j.rcsop.2021.100032.