(1301) Facilitating Pharmacy-community Based Organization (CBO) Collaboration to Improve Medication Management by Addressing Social Determinants of Health

Objectives: Community-based organizations (CBOs) are non-profit organizations that can help patients manage obstacles to care associated with social determinants of health (SDOH). SDOHs are conditions in the environments where people live that affect a wide range of health and quality of life outcomes and risks. One role of community pharmacists is to promote and maintain public health, and they are an accessible health professional for all types of patients. Given their ready patient access, community pharmacies can partner with CBOs to help patients address obstacles to medication therapy that relate to SDOHs.

Objectives: 1) To develop and assess pharmacy-CBO collaborative models to address patients’ SDOH-related obstacles to medication therapy. 2) To interview CBO and pharmacy staff to identify facilitators and obstacles to developing and operating pharmacy-CBO collaborative models.

Methods: Two different models were explored in Wisconsin and Iowa. The Wisconsin model had two CBOs start an SDOH assessment process and refer patients with medication concerns/needs to a community pharmacy. The pharmacist at the community pharmacy then arranged to conduct a comprehensive medication review (CMR) with the patient, address any medication-related problems (MRPs) and follow up with the CBO about the medication action plan (MAP). In the Iowa model, pharmacists initiated an SDOH assessment process, addressed SDOH issues related to medication costs and referred patients to a service navigator at a CBO for other SDOH issues. After operating the models for 6 months, pharmacy and CBO staff members were interviewed about the collaboration processes. The interviews were recorded and transcribed. Descriptive statistics were calculated for the SDOH issues identified. A thematic analysis was conducted on the interview transcripts. The Systems Engineering Initiative for Patient Safety (SEIPS) work system domains were used to guide the rapid qualitative analysis.

Results: Of the 62 patients/clients screened, 46 (74.2%) had SDOH-related obstacles or medication concerns identified, with 40 being referred to the collaboration partner (i.e. to pharmacy in WI, to CBO in IA). Frequent SDOH issues included experiencing a lot of stress (43%), not being confident to fill out forms (36%), feeling very much overwhelmed (34%) and being unable to get food in the past year (27%). Almost 70% of patients reported more than one SDOH-related obstacle.
Themes related to patients developed from interviews were patient willingness to participate in the service, obstacles patients faced to obtain medication therapy, establishing patient trust and patients learning to advocate for themselves. Building patient trust was vital in making sure patients followed through with referrals and communicated their needs. Other obstacles included patients not having reliable telephone service and patient unfamiliarity with comprehensive medication reviews.
Themes related to the collaboration process included providing value to the partner, fitting new activities into workflow, using two-way communication, utilizing virtual technology and building trust with the partner. Providing value can help assure that time and resources will be put into the collaboration. In addition, two-way communication and building trust by keeping promises can contribute to a collaborative working relationship.

Conclusions: Both pharmacy-CBO collaboration models were effective in identifying CBO clients in need of medication management services or pharmacy patients with SDOH-related obstacles to medication optimization. Of the 62 patients/clients screened, 46 had SDOH-related obstacles identified. Limited trust between the patient and pharmacist was a key obstacle identified in this study. Developing pharmacy and CBO personal relationships is a vital key in the planning and coordination of this service. Future research is recommended on these models of collaboration.