Implementation and evaluation of social determinants of health practice models within community pharmacy

Background: While community pharmacies are an ideal setting for social needs screening and referral programs, information on social risk assessment within pharmacy practice is limited. Objectives: Our primary objective was to describe 2 social determinant of health (SDoH) practice models implemented within community pharmacies. The secondary objective was to evaluate implementation practices utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Practice description: Two pharmacy groups participated in a 3-month study, one in New York (9 pharmacies) and another in Missouri (1 pharmacy). The New York pharmacies implemented an SDoH specialist practice model, in which pharmacy staff members facilitate the program. The Missouri pharmacy implemented a community health worker (CHW) model by cross training their technicians. Each pharmacy developed their program using the Community Pharmacy Enhanced Services Network Care Model. Practice innovation: Both programs expanded the technician role to take on additional responsibilities. The SDoH specialist model partnered with a local independent practice association to create a social needs referral program using a technology platform for closed-loop communication. All workflow steps of the self-contained CHW program were completed within the pharmacy, placing additional responsibility on the CHW and pharmacy staff. Evaluation methods: RE-AIM framework dimensions of Reach, Effectiveness, and Adoption. Results: Social challenges were identified in 49 of 76 (65%) generated SDoH screenings. The most prevalent social needs reported were affordability of daily needs (33%) and health care system navigation (15%). While most pharmacy staff indicated that workflow steps were clearly defined, assessments and referral tools were identified as potential gaps. While approximately 50% of pharmacy staff were comfortable with their assigned roles and in addressing SDoH challenges, physical and mental health concerns required additional education for intervention. Conclusion: The successful implementation of community pharmacy SDoH programs connected patients with local resources. Community pharmacies are ideally positioned to expand their public health footprint through SDoH interactions that consequently improve patient care.