Because I see you: Pharmacist social determinants of health as predictor of structural awareness

The contribution of social determinants of health (SDOH) to health disparities and patient outcomes is widely acknowledged. Much less has been done to characterize provider SDOH, and in particular, their effect on delivery of structurally competent care. Differing lived experiences create blind spots to the critical upstream factors contributing to health.

The primary objective of this study was to examine the association between structural awareness (SA) and SDOH when controlling for year of first licensure, primary setting of pharmacy practice, race, and gender. The secondary objective was to examine the difference in mean SA scores with 4 stand-alone predictor variables: reliance on public transportation, insurance coverage gaps, food insecurity, and housing insecurity.

This study is a cross-sectional web-based survey of 606 Minnesota pharmacists. SDOH risk and SA scores were assessed using modified versions of the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences and Cultural Competence Self-Assessment Questionnaire tools, respectively. The association of these scores was assessed using a multiple linear regression model, and the association with stand-alone variables was done using t-tests.

SDOH risk was significantly associated with SA at the 95% confidence level with a P value of 0.0016. Food and housing insecurity were also significantly associated with SA score while reliance on public transportation and insurance coverage gaps were not.

Pharmacy and other healthcare professional training programs should create opportunities for exposure to the SDOH experienced by their patients through immersive learning and/or experiential education.