USE OF SOCIAL DETERMINANTS OF HEALTH DATA IN PHARMACY PRACTICE

To encourage the use of patient and community social determinants of health (SDoH) data in pharmacy practice to optimize patient care services and improve healthcare access; further,

To educate the pharmacy workforce and learners about SDoH domains, including their impact on patient care delivery and health outcomes; further,

To encourage research to identify methods, use, and evaluation of SDoH data to positively influence key quality measures and patient outcomes.

Rationale

Social determinants of health (SDoH) are defined by the Centers for Disease Control and Prevention (CDC) as the “conditions in the environments where people are born, live, learn, work, play, worship and age.” These conditions can have a significant impact on healthcare outcomes and quality of life for individuals and communities. SDoH have been found to account for 80-90% of modifiable contributors to health outcomes. From a third-party payer perspective, the recent shift of many organizations from fee-for-service to value-based reimbursement models places more emphasis on SDoH, screening, and evidence-based decision-making to prioritize long-term health outcomes. Healthy People 2030, a national program developed by the Office of Disease Prevention and Health Promotion within the U.S. Department of Health and Human Services, includes 355 measurable, data-driven, national objectives to improve the health and well-being of the American public by the year 2030. Health People 2030 recognizes five distinct SDoH domains: Economic Stability, Education Access and Quality, Healthcare Access and Quality, Neighborhood and Built Environment, and Social and Community Context. Patient screenings and data collection from multiple data sources to ascertain SDoH would be optimized through the use of standardized codes (e.g., ICD-10-CM Z codes, SNOMED-CT value sets) that are consistent, discrete data elements that are reportable and can be shared with other technologies, leading to actionable intelligence to enhance quality improvement initiatives. To support this goal, there is a need for broader implementation of SDoH health information technology (IT) tools into general practice and development of policies for how to appropriately use SDoH in clinical decision-making. The Office of the National Coordinator for Health Information Technology has identified four priority areas for advancing interoperability and use of SDoH data: standards and data, infrastructure, policy, and implementation. Many health IT and electronic health record (EHR) vendors have invested significant resources in development of SDoH tools and products. Among these products are screening tools, population health metrics, referral and care transition tools, and analytic and reporting tools. Health systems must have access to appropriate technology-based platforms to exchange SDoH data and make referrals for patients at discharge or transfer to another institution. Lack of standardization of data and reporting across health systems makes sharing of best practices and metric goal-setting difficult.

Efforts to address SDoH through pharmacy practice have varied. A 2018 survey of postgraduate pharmacy residents and their program directors found that only 1% of residents and 4% of residency program directors stated they had received education and training on Healthy People 2020. (Chandra RN. Pharmacists’ knowledge of social determinants of health in post-graduate pharmacy residency programs. Wright State University; Dayton, OH; 2018.) The pharmacy workforce has opportunities to advance the use of SDoH in pharmacy practice (e.g., consults, medication reconciliation, patient assistance programs) to improve health outcomes.

Tools available within some EHR platforms include those measuring quality of life, suicidal ideation rating, community service referral capabilities, and use of secondary survey data in conjunction with the CDC/ATSDR social vulnerability index to further evaluate population health at a community level. SDoH tools can be categorized as either single domain, such as the Hunger Vital Sign tool to evaluate food insecurity, or multiple domain, such as the WE CARE survey to evaluate education, employment/income, food insecurity, and housing/utility domains. The validity of each tool should be considered before implementing into practice, and more research is needed to determine the utility of specific tools in pharmacy practice. The Pharmacy Quality Alliance (PQA) has developed a Medication Access Framework for Quality Measurement and is evaluating a pharmacy measure concept to address the social determinants of health that hinder patient medication access and contribute to poor health outcomes.