Improving Access to Care: The Path to Health Equity, Part 3
The following is part 3 of 5 in a series of articles titled, "The Path to Health Equity" by Jason Ausili, PharmD, MSLS, Head of Pharmacy Transformation for EnlivenHealth, as well as other contributors to Ask Your Pharmacist.
Healthcare inequity can have a devastating impact on a community. Without quality healthcare, people are more likely to experience chronic diseases, preventable illnesses, and even premature death. This can lead to a decrease in the overall health and well-being of the community, as well as an increase in healthcare costs. Healthcare inequity can also have an impact on the economy and even the social stability of a community.
The good news is that a number of things can be done to address healthcare inequity. And one of the most important steps is improving access to quality healthcare. When everyone has access to quality healthcare, we can create a healthier and more equitable society for all people.
How Important Is Healthcare Access?
Access to healthcare is essential for everyone, regardless of where they live. However, people in healthcare deserts and rural areas often face significant barriers to accessing quality care.
Healthcare deserts are areas where there is a shortage of healthcare providers and facilities. This can be due to a number of factors, such as geographic isolation, poverty, and lack of economic opportunity. People living in healthcare deserts may have to travel long distances to see a doctor, which can be difficult and expensive.
Rural areas also face challenges in accessing healthcare. Rural communities often have fewer healthcare providers than urban areas, and those providers may be less specialized. Rural residents may also have to travel long distances to access specialty care or emergency services.
Lack of healthcare access can have many negative consequences for the people in these areas. In addition to increased instances of chronic disease, preventable illness, and premature death, people in healthcare deserts and rural areas are simply more likely to have poorer health outcomes than people who have better access to care. In addition, lack of access to healthcare can have a significant impact on the economy of rural communities. When people are not healthy, they are less productive at work and more likely to miss work due to illness. This can lead to decreased economic growth and increased poverty.
Improving access to healthcare for people in healthcare deserts and rural areas is essential for creating a healthier and more equitable society. But how can we improve access to these areas?
Community Pharmacies: The Nation's Most Accessible Healthcare Provider
Pharmacies are the nation's most accessible healthcare providers. They are located in every community, including healthcare deserts and rural areas. Pharmacists are also trusted healthcare professionals who are able to provide a variety of services beyond dispending medications, including but not limited to:
Providing medication therapy management (MTM) services
Offering vaccinations and other preventive care services
Performing test-and-treat services for infectious diseases
Prescribing hormonal contraceptives
Educating patients on their disease state and their medications
Screening for and referring patients to community resources
Advocating for patients' health needs
The expansion of community pharmacies into clinical care can help improve healthcare access in healthcare deserts and rural areas. Pharmacists are trained to provide a variety of clinical services, such as:
Chronic disease management
Diabetes education
Asthma management
Hypertension management
Smoking cessation counseling
Immunizations
Acute treatment of infectious disease
Minor ailments
When you expand the role of pharmacists in clinical care, you make it easier for people in healthcare deserts and rural areas to access the care they need. This can help to improve the health and well-being of these communities and reduce health disparities. By making healthcare more accessible and affordable for people in all communities, we can improve the health and well-being of all Americans.
How Community Pharmacies Can Address the Five Domains of SDOH
Not only are community pharmacies the most accessible healthcare destination, but their community reach uniquely positions pharmacy teams to address social determinants of health (SDOH). Pharmacists can work with their patients to identify and address barriers to care, such as lack of transportation, access to healthy food, and affordable housing. Pharmacists can also connect their patients with community resources that can help them to improve their health and well-being.
To review, the Five Domains of Social Determinants of Health (SDOH) are: 1) economic stability, 2) education access and quality, 3) healthcare access and quality, 4) neighborhood and built environment, and 5) social and community context.
Community pharmacies can address each of the Five Domains of SDOH in a variety of ways:
Economic Stability: Community pharmacies can partner with local businesses and organizations to provide job training and placement services to their patients.
Education Access & Quality: Community pharmacies can provide educational resources to their patients on topics such as chronic disease management, medication safety, and healthy living.
Healthcare Access & Quality: Community pharmacies can offer a variety of clinical services, such as chronic disease management, diabetes education, and immunizations. They can also help patients to navigate the healthcare system and connect with specialists and other healthcare providers.
Neighborhood & Built Environment: Community pharmacies can partner with local organizations to improve the safety and quality of life in their neighborhoods. For example, they can support initiatives to build affordable housing, improve access to healthy food, and create safe and walkable communities.
Social & Community Context: Community pharmacies can provide social support to their patients and connect them with community resources. For example, they can offer support groups for patients with chronic diseases, and they can refer patients to food banks, job training programs, and other social services.
“Community pharmacists are in the community,” said Nicole Pezzino, PharmD, BCACP, CDES, program director of PGY1 Community Pharmacy Residency and Director of Community Outreach and Innovation at Wilkes University. “We are meeting the people and are in the community with them.”
Pezzino was a guest on a webinar hosted by pharmacy software provider EnlivenHealth titled, “Breaking Barriers: Improving Health Outcomes through SDOH Screening in Community Pharmacies.” During that webinar, Pezzino, along with Stephanie McGrath, PharmD (Executive Director of Pennsylvania Pharmacists Care Network (PPCN)) and Rachel DiPaolantonio, PharmD (PGY1 community-based pharmacy resident) shared the results of a 7-month SDOH screening program in PPCN pharmacies. During that time, 1,129 SDOH screenings were performed for PA patients, and 28.6% of those screenings resulted in a referral to address an identified gap. The full webinar was summarized in a July 2023 Pharmacy Times article.
In a recent 3-month study of nine New York pharmacies, 65% of the SDOH screenings performed by the pharmacists identified social challenges, with the most prevalent challenges being affordability of daily needs and healthcare system navigation. The successful implementation of SDOH programs in these community pharmacies connected patients in need with local resources.
The Role of Community Health Workers
A community health worker (CHW) is a trusted member of a community who provides outreach and support services to help individuals and families access and utilize health and social services. They also work to increase health knowledge and self-sufficiency through a range of activities, including outreach, community education, informal counseling, social support, and advocacy.
There is growing momentum to either include community health workers as a part of the pharmacy team or to train members of the pharmacy staff to be CHWs. One study highlights that pharmacy technicians cross-trained as CHWs can increase the utilization of this powerful resource and are seen as the “bridge that connects their communities with health and social resources.” Having CHWs as part of the community pharmacy staff would have a number of benefits, including:
Increased Access to Healthcare: CHWs can help to connect patients with healthcare services, including primary care, preventative care, and specialty care. They can also help patients navigate the healthcare system and overcome barriers to care, such as lack of insurance, transportation, and language access.
Improved Health Outcomes: CHWs can help patients to better manage their chronic conditions, take their medications as prescribed, and make healthy lifestyle choices. They can also provide support and encouragement to patients as they work to improve their health.
Reduced Healthcare Costs: CHWs can help to reduce healthcare costs by preventing unnecessary hospitalizations and ER visits. They can also help patients get the most out of their healthcare dollars by teaching the about their medications and helping them find affordable healthcare services.
Increased Patient Satisfaction: CHWs can help to improve patient satisfaction by providing personalized care and support. They can also help patients to feel more connected to their healthcare team and to the community.
Removal of SDOH Barriers: By screening patients for SDOH barriers and referring patients to community resources, CHWs can dramatically impact people’s lives.
In addition to these benefits, CHWs can also help to make pharmacies more culturally competent and responsive to the needs of the community. By working with CHWs, pharmacies can better understand the unique challenges faced by their patients and develop or recommend programs and services that meet those needs.
Making Healthcare More Accessible
Access to healthcare is essential for everyone, regardless of their income, race, ethnicity, or where they live. When people have access to quality healthcare, they are more likely to be healthy and productive members of their community.
Community pharmacies play a vital role in improving access to care. Whether through offering clinical services, addressing social determinants of health, or partnering with other healthcare providers and community organizations, pharmacists can help create a healthier and more equitable society for all.
NEXT — Part 4: Plotting the Points to Success »