A descriptive analysis of social determinant of health needs and medication therapy problems in a comprehensive...

Comprehensive medication management (CMM) pharmacists routinely care for patients with uncontrolled chronic conditions, optimizing medications regimens and collaborating to improve patient outcomes and reduce health care costs. Social determinants of health (SDOH) needs are associated with chronic disease burden, medication nonadherence, and higher health care expenditures. Many CMM patients have unmet SDOH needs, but little is known about their prevalences or associations with medication therapy problems (MTPs).

To describe how SDOH needs are associated with CMM service utilization and MTPs identified within the course of CMM pharmacist care.

This retrospective, descriptive analysis included patients with uncontrolled chronic conditions from a CMM registry within a large health system. Patients were compared by CMM visit completion following registry inclusion. CMM patients were then described by presence of self-reported SDOH needs, and initial-visit MTPs. Chi-squared tests assessed group differences.

Of 23,654 registry patients, 8% completed a CMM visit. Provider referrals were associated with CMM visit completion (CMM visit: 59% vs. no CMM visit: 8%, P < 0.0001). Patients completing CMM visits were more likely to report SDOH needs (25% vs. 17%, P < 0.0001) and have ≥3 chronic physical diagnoses (55% vs. 22%, P < 0.0001) compared to those without CMM visits. Among CMM patients, those reporting SDOH needs had similar rates of any MTP at the first CMM visit compared to those without SDOH needs (76% vs. 74%, P = 0.33). Adherence-related MTPs were more common among patients with SDOH needs (25% vs. 20%, P = 0.0026), while other MTP types did not differ (P > 0.05 for all).

Patients meeting CMM registry criteria who completed CMM visits had high rates of SDOH needs, which may warrant different interventions, such as referrals or education by CMM pharmacists. Including SDOH needs evaluations into CMM referral and care prioritization processes may provide an opportunity to promote health equity and positive health outcomes.