The ASHP Foundation recently released its annual Pharmacy Forecast for 2022, and this year’s report focused heavily on social determinants of health. It’s a topic being given increasing attention by the healthcare industry, especially since the onset of the COVID-19 pandemic.
We also see similar emphasis from the federal government. The Department of Health and Human Services’ fiscal 2023 budget request notes several areas focused on social determinants of health incorporating maternal health, Medicare and Medicaid, along with digital healthcare, data strategies and technology.
Social determinants of health, shortened to SDOH, are loosely defined as the conditions in which people live, work and play that significantly shape their health and well-being. They encompass socioeconomic status, race and ethnicity, access to healthcare and nutritious food, and living in adequate housing within a safe neighborhood, among other factors. While it’s difficult to quantify the effect these have on someone’s health and well-being, it’s not hard to see how they influence costly chronic conditions such as diabetes and heart disease.
“The ongoing COVID-19 pandemic has placed a spotlight on the racial disparities in health outcomes in America, as well as the underlying socioeconomic factors that give rise to them,” reads a 2021 report from the Brookings Institution. “Even though the largest declines in U.S. life expectancy caused by COVID-19 may be behind us, health disparities caused by the social determinants… will continue to manifest themselves unless they are addressed.”
While many SDOH lie well beyond the influence of pharmacists or other clinicians, we recognize the opportunity to make better use of SDOH data in optimizing medication use.
The biases of data analytics
This year’s forecast reflects responses from 311 pharmacy leaders nationwide. However, only half said pharmacists and pharmacy technicians systematically screen for SDOH.
Accordingly, the report states that screening for SDOH “has demonstrated value in improving patient outcomes, decreasing medical expenditures, and improving medication optimization,” citing two studies. But they add that pharmacists need training and guidance to adequately screen for social determinants of health. Also, 73% of respondents believe that health systems will use advanced data analytics to address healthcare disparities such as a population’s cultural preferences, the digital divide, and preventive measures.
“Data analytics should be considered part of the overall approach to health disparities,” the authors write. “However, analytic algorithms are not usually created with health equity and may not take into consideration diverse patient populations. Hence, data analytics has the potential to create biases that could exacerbate existing health disparities. Health systems need to ensure that data retrieved from these types of advanced models are inclusive of all populations.”
The challenge is that no one has determined practical ways to advance healthcare delivery to address the role of SDOH in patient outcomes. For example, factors like poor diet, lack of exercise, and stressful, unsafe living conditions may outweigh any positive effects from the clinical intervention for a patient with cardiovascular disease. However, if pharmacists play increasingly important roles in preventive care for patients, as the survey suggests they do, they need much more SDOH data much earlier on. Information is the key to designing interventions that can enhance access to care and medication or increase the awareness of patient assistance programs.
Analytics could play a more prominent role. For example, Trisus Medication Compare (formerly CRCA P&T), our longitudinal, real-world pharmacy database, could easily be configured to incorporate data highlighting key SDOH affecting individual patients or a patient population. Running analytics would be beneficial in designing and constructing more targeted, evidence-based care pathways. Currently, pharmacists and other clinicians are providing care for many patients without a view of what is or isn’t working.
The big question is, how can we consistently incorporate this data into existing applications to unlock the power of data?
Restricted access to data
Healthcare lags far behind industries, such as retail, in collecting and sharing data. That’s partly due to the heightened sensitivity, and strict rules, around patient privacy. As a result, health systems typically don’t have access to, or are restricted from, using the kinds of data that Amazon readily scoops up about their customers, or that political candidates gather about constituents to target their voter outreach efforts.
For example, using Compare today, you can view data about a patient’s age and gender. The healthcare of tomorrow will include race, ethnicity, and socioeconomic status, all of which could inform pharmacy leaders about potential health disparities or increased risk for certain diseases.
This disparity in access to SDOH data is doubly interesting now that Amazon is expanding into the pharmacy world with Amazon Care. It highlights the dilemma: Healthcare isn’t explicitly barred from collecting SDOH data from patients, it’s just restricted in the ability to disclose or share such information. Another factor complicating the continuum of care is hoarding patient data, which health systems often view as a competitive advantage.
The challenge before us is establishing a reliable platform for data exchange that protects the privacy of individual patients while providing clinicians with accurate information, so patients can have affordable and convenient access to care that improves their health. We need federal funding from HHS and government oversight to build better policy.
The lack of healthcare information exchange should not be a social determinant of health. We are encouraged by continued research by HHS and agencies like the Agency for Healthcare Research and Quality into unlocking the power of SDOH data. We must build a better path forward. Otherwise, we’re simply throwing darts at a board and hoping our therapeutic strategies are effective.