Whole health: How pharmacists are working to bridge health disparities

By Krista Roberts

Dr. Annesha White

 

Even as pharmacists help patients fight COVID-19, they are looking for ways to solve health disparities – a societal ill that plagues communities nationwide.

Every day pharmacists are helping patients with COVID-19 and the delta variant, through therapies and medicines that can help them survive.

Pharmacists can be found at COVID-19 testing and vaccine sites. They interact with patients at community pharmacies, outpatient clinics, hospitals and long-term-care facilities where they can also identify health disparities.

“Pharmacists are integral members of the health care team due to their expertise in pharmacotherapy and their accessibility,” said Annesha White, PharmD, MS, PhD, Associate Professor and Associate Dean for Assessment in the HSC College of Pharmacy. “People see their pharmacists more than their primary care physicians, and they can see health equity issues daily.”

The HSC College of Pharmacy is putting health disparities in the forefront through practice, research and education with an eye on being part of the solution. This effort is helping prepare upcoming generations of pharmacists to better address the health needs of vulnerable communities.

The College is also helping pharmacists and other health professionals specialize their skills in health outcomes research with new online certificate and Master of Science programs. This is another example of how the College is better preparing future pharmacists.

Experts note that pharmacists can see the issues that get in the way of people getting health care. These hurdles are known as Social Determinants of Health (SDOH). These include demographic information such as where a person was born, where a person lives, and where a person works.

“Perhaps a patient has food insecurity, limited access to health care services, limited health literacy, a language barrier, and a lack of social support – these are all issues that are routinely seen by pharmacists,” Dr. White said.

Pharmacists are also documenting or identifying health inequities in quality and access to health care to better address solutions as they prevent the spread of COVID-19 and the delta variant.

“As vital members of their communities, pharmacists are in a position to help address needs of patients experiencing challenges due to Social Determinants of Health,” she said.

For example, pharmacists can help patients figure out if they qualify for patient assistance and suggest a sliding-scale fee so they can afford medication. Pharmacists often refer patients to various services and programs, including behavioral health services and chronic disease education resources.

A patient’s whole health

Clinical pharmacist Megan Wesling, PharmD, Assistant Professor of Pharmacotherapy, often encounters patients with food insecurity, low access to community safety, exposure to trauma, and lack of health literacy.

“Pharmacists can impact health disparities through many facets,” said Dr. Wesling, who is also an ambulatory care pharmacist at HSC Health family medicine clinic. “This can include starting from the top, with a comprehensive medication assessment, to ensuring access to quality health care and day-to-day needs, such as durable medical equipment, medications and diagnostics.”

Dr. Wesling said pharmacists have a unique skillset, offering a whole health approach to patient care. They can conduct extensive medication reviews, provide patient education, and recommend solutions to medication access that may address chronic conditions and remove barriers to treatment plans.

Andre Castaneda, a fourth-year pharmacy student, said they regularly discuss how socioeconomic status, race or ethnicity, and disability, can predispose people to worse health outcomes.

“Our PharmD program is highly focused on molding students into pharmacists that have the knowledge and ability to help close the gap on health disparities,” said Castaneda. “Students learn tools to communicate effectively with people from different countries and backgrounds and how to provide financial help to our patients who may not have the ability to pay for life-saving medicine.”

Cultural sensitivity training, which is a required component of pharmacy education, is included in the HSC College of Pharmacy’s curriculum.

Students participate in an interprofessional cultural sensitivity session as part of their academics. As part of PHAR 7263 IPT Special Populations course, students hear first-hand from real patients about their personal challenges and barriers to quality health care.

Dr. White also helped to coordinate and assess the patient-led Cultural Sensitivity Panel as it was integrated into the curriculum. This tool helps better understand personal cultural competence and the impact on pharmacy students’ perceptions.

“More than 95% of students agreed or strongly agreed that a cultural sensitivity panel is a worthwhile experience, and that the panel would help them change behaviors that may be culturally insensitive,” Dr. White said.

The exercise elevates students’ self-awareness and offers insight into their own cultural biases, leading to more compassionate, patient-centered care.

In the clinical setting, students learn to assess patient risk and identify SDOH by using the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool.

“They also learn to identify barriers to optimal medication use, solve medication adherence barriers and learn strategies to addressing medication access and formulary management situations,” Dr. Wesling said.

“There are various factors that have been linked to health disparities across the nation, such as racial inequality and poverty, and it is our responsibility as future health care providers to address these issues and find ways to resolve them,” said Jessica Obioma, a third-year pharmacy student.

Obioma said she has gained a new perspective through her experiences with the HOME clinic program, which allows pharmacy students to partner with students for Texas College of Osteopathic Medicine (TCOM) to help homeless people with their health and medication questions.

“This experience opened my eyes to a population that I never explored,” Obioma said. “Unfortunately, the homeless population is on the rise.”

Obioma said the prevalence of drugs and disease make medications necessary for survival.

“It was a rewarding experience to talk one-on-one with people who have lived and experienced a life so different from my own and hear what struggles they face every day,” she said.

Looking for solutions in the data

Health economics outcomes research (HEOR) has a significant impact on global health.

Usha Sambamoorthi, PhD, Professor and Associate Dean for Health Outcomes Research in the College of Pharmacy, uses data-driven intelligence to provide a comprehensive view of what factors affect the health of individuals and populations. She also looks for various pathways to improve population health.

Dr. Sambamoorthi works with large datasets using advanced statistical methods and machine learning algorithms in the areas of disease burden and determinants of access to health care, quality, costs and outcomes. Some areas of disease burden are diabetes, depression, cancer, and heart disease.

She said there is a “need for disaggregated data on healthcare of different racial/ethnic groups.”

“My research tries to answer questions related to differences (often known as disparities) in health among specific population groups,” she said.

To address this issue, Dr. Sambamoorthi recently studied the impact COVID-19 had on Asian Indians living in the United States. The study highlighted low-vaccine hesitancy, but high COVID-19 related mental health burden among Asian Indians.

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