Implementation and outcomes of a pharmacist-led social determinants of health screening and intervention program in an integrated health system specialty pharmacy model

BACKGROUND: Social determinants of health (SDOH) are non-medical factors that impact health outcomes. Pharmacists within integrated health system specialty pharmacies (HSSPs) are positioned to identify and address SDOH barriers. 

OBJECTIVE: The objective was to implement and evaluate a pharmacist-led SDOH program for HSSP patients. 

PRACTICE DESCRIPTION: The practice innovation was implemented within four health systems in Michigan and Massachusetts with associated HSSPs and a standard specialty pharmacy clinical management model incorporating initial patient counseling and periodic reassessments. 

PRACTICE INNOVATION: A SDOH screening and intervention program was developed and piloted at four health systems with associated HSSPs. Patients with HIV, rheumatoid arthritis (RA), and hyperlipidemia meeting pre-defined inclusion criteria were enrolled in the program from September 2023 through September 2024. After screening patients for SDOH barriers, pharmacists offered targeted interventions and structured follow-ups to ensure resolution of challenges. 

EVALUATION METHODS: Patients enrolled in the program were analyzed using data extracted from the electronic medical record and patient management platform. The primary outcome was intervention acceptance rate; secondary outcomes included intervention categories, patient-perceived value of interventions, ongoing support needs, pharmacist time spent, and clinical outcomes. 

RESULTS: Of the 50 patients (HIV: n=6; RA: n=27; hyperlipidemia: n=17) enrolled, 56% completed screening and 79% of those accepted interventions. Of the 19 patients who received follow-up, 63% found the interventions beneficial, and 4 required ongoing support. The most frequent interventions included food security/nutrition (46%) and physical activity (25%). The average time per intervention was 60 minutes (range: 15-180 minutes). Patients with interventions demonstrated clinical outcomes improvements, including a mean RAPID3 score reduction of 3 points (range: 1.3-27.3) and mean LDL reduction of 29.75 mg/dL (range: 44-137) for RA and hyperlipidemia, respectively. 

CONCLUSIONS: These pilot results suggest that a pharmacist-led SDOH program may be effective in addressing patient barriers, demonstrated by high acceptance rate and perceived benefit of interventions and improved clinical outcomes.