Researchers found better-controlled diabetes and blood pressure in patients with social determinants of health (SDoH) barriers than those without such barriers after seeing a pharmacist for comprehensive medication management (CMM), an evidence-based, pharmacist-led clinical service designed to ensure the optimal use of medications. The Journal of Managed Care & Specialty Pharmacy published the study results in its November 2024 issue.
Following a CMM encounter, diabetes control rates increased 13.3% more among patients who faced SDoH barriers than those who did not, while the proportion of patients who achieved blood pressure control increased 7.6% more among patients with SDoH needs than those without SDoH. The patients received CMM care at one of the seven Federally Qualified Health Clinic Urban Health Network (FUHN) member clinics involved in the study by Joel Farley, PhD, a pharmacist and pharmaceutical outcomes researcher who evaluates programs and policies affecting medication use in patients with chronic health conditions, and Swetha Pradeep, PharmD, a clinical pharmacist working at several FUHN clinics who has a passion for ways pharmacists can increase health equity.
“To our knowledge, our study is the first to evaluate clinical changes from embedding SDoH screening into the delivery of CMM in patients with chronic conditions,” said Dr. Joel Farley, a University of Minnesota College of Pharmacy professor and health informatics consultant with FUHN. “The positive results, though not statistically significant given the small sample size, support the broader adoption of SDoH referral into CMM practice and the need for additional studies.”
In their research, Drs. Farley and Pradeep used a retrospective cohort design to analyze the clinical results of FUHN patients who received CMM in 2023 and a difference-in-difference approach to compare changes in outcomes over time between those who received an SDoH screening and those who did not. The research focused on the probability of achieving clinical control for blood pressure (<140 systolic/90 diastolic mm Hg) and diabetes (<9% hemoglobin A1c).
Results show greater improvement in patients with SDoH needs
Among 807 patients receiving CMM in 2023, 595 (74%) were screened for SDoH. Of the patients screened, 55.1% had 1 or more SDoH. Below are the most common barriers reported by the patients experiencing SDoH:
insurance (22.0%)
language (11.3%)
transportation (9.1%)
health behaviors (7.1%)
income/employment (5.9%)
food insecurity (5.6%).
For hypertension, the proportion of patients who were controlled at baseline was 66.3% of patients who had SDoH needs compared to 72.3% for those without. Following a CMM encounter, the proportion of patients who achieved blood pressure control increased 7.6% more among patients with SDoH needs than those without SDoH.
For diabetes, 39.0% of patients with SDoH needs were controlled at baseline compared to 75.4% of patients without. Diabetes control rates increased 13.3% more among patients who faced SDoH barriers than those who did not.
Although the results do not detect statistical significance, they suggest that patients with SDoH needs may experience larger clinical improvements in diabetes and hypertension control than patients without SDoH needs when they receive CMM. These results support the broader adoption of SDoH referral into CMM practice and the need for additional confirmatory studies using a larger sample and prospective observational or clinical trial study design
For more information about the study, see Potential benefits of incorporating social determinants of health screening on comprehensive medication management effectiveness | Journal of Managed Care & Specialty Pharmacy
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