Using Health Equity-Informed Eligibility Criteria to Improve Access to Pharmacists for Comprehensive Medication Management

Posted on July 29, 2024 by Alicia Zagel

This entry is part 3 of 4 in the series CVD Prevention 2

Cultivating relationships among comprehensive medication management pharmacists and patients with greater social disadvantage who are at risk of cardiovascular events may improve health outcomes and connect patients to essential resources.

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Despite vast efforts to reduce the burden of cardiovascular disease (CVD) within the United States, disparities in quality and accessibility of cardiovascular care and related outcomes remain stubbornly wide. Social determinants of health (SDOH) are important predictors of poor CVD outcomes, thus collaboration among healthcare teams is needed to better address both the medical and social needs of patients to manage CVD, from prevention tactics to addressing downstream conditions, in order to create more equitable outcomes. In “The impact of health equity-informed eligibility criteria to increase the delivery of pharmacist-delivered comprehensive medication management services for patients with high blood pressure,” we discuss a collaborative intervention within primary and specialty care clinics in socially disadvantaged neighborhoods that links patients at risk for poor CVD outcomes to comprehensive medication management pharmacists.

Comprehensive medication management (CMM) is a pharmacist-led service that partners patients with pharmacists to personalize care pathways through tailoring a patient’s medications to best meet their personal needs and experiences. This includes addressing adverse medication events and improving medication adherence, enhancing health education and improving health literacy, making referrals to healthcare and ancillary services, and working toward individualized health goals. The CMM pharmacist care model has numerous benefits such as improving patient experiences and health outcomes, reducing overall healthcare costs, increasing access to care, and even improving physician satisfaction through reducing their workload while increasing the quality of patient care. It is possible that proactively providing access to CMM services may aid in promoting health equity and, ultimately, reducing disparities in downstream CVD outcomes for patients and communities.

Proactive CMM Pharmacist Intervention

This work occurred in partnership between a large academic health system, M Health Fairview, and the Minnesota Department of Health. It focused on adult patients who had high blood pressure or high cholesterol and were treated within 13 health clinics in the Minneapolis-St. Paul metropolitan located within socially disadvantaged neighborhoods, as determined by the Centers for Disease Control and Prevention’s Social Vulnerability Index. Ultimately, we aimed to reduce health disparities of patients receiving CMM care. CMM pharmacists were given lists of eligible patients approximately quarterly, and executed chart reviews to determine appropriate outreach and services needed. For patients who were thought to benefit from CMM services, pharmacists worked to recruit patients via telephone, and aimed to follow them within the usual care model.

Findings

The CMM intervention enabled a more diverse population to access pharmacist-led care within the targeted clinics overall. For example, greater proportions of underrepresented racial and ethnic groups, Minnesota Health Care program (including Medicaid) beneficiaries, and those needing interpreters received at least one CMM visit following the intervention’s start. While patients received fewer physician office visits following the intervention compared to the year prior to the intervention (likely due to the timing of the COVID-19 pandemic), they received more CMM visits following the intervention, which highlights the valuable role of the CMM pharmacist in care, especially when other clinicians are less available.

Among patients directly eligible for the CVD CMM intervention:

Those who saw pharmacists tended to be older, less likely to be non-Hispanic white, more likely to use interpreters, and more likely to live in socially vulnerable neighborhoods compared to those who did not meet with CMM pharmacists.
Patients who were cared for by CMM pharmacists were also more likely to use other health system resources such as social workers, diabetes educators, and medical specialty clinicians.
Patients receiving CMM care were more likely to meet blood pressure and statin use health goals compared to patients who did not see CMM pharmacists.

Health systems have an obligation to work toward providing equitable health outcomes, and partnering with state and local public health leaders allows a more comprehensive view of important issues and their creative and multifaceted solutions to address community health. Our article, “The impact of health equity-informed eligibility criteria to increase the delivery of pharmacist-delivered comprehensive medication management services for patients with high blood pressure,” evaluates one such partnership that aimed to improve care for patients with CVD who received healthcare within socially disadvantaged neighborhoods. We were able to provide CMM pharmacist care to patients within sociodemographic groups that had been underserved in the past. CMM care was associated with greater connection to resources and providers within the health system and improved health outcomes, which is likely due to improved health literacy and the promotion of team-based care models. People who are subjected to negative SDOH are at the highest risk for poor health outcomes; thus, promoting CMM pharmacist care for patients seeking care in socially vulnerable neighborhoods may be crucial for creating more equitable care delivery, promoting better health outcomes, and improving community health.

Acknowledgements

We extend our gratitude and acknowledge the valuable insight and subject matter expertise of our co-authors from Fairview Pharmacy Services, including Dr. Amanda Brummel and Ms. May O’Donnell, and the Minnesota Department of Health, including Dr. James Peacock, Ms. Megan Chacon, and Ms. Emily Styles. Their dedication to this project allowed us to improve the reach of our care model and work toward achieving greater health outcomes for our patients. Further, we acknowledge and thank the CMM pharmacists who continuously work to provide quality patient care, and whose time and commitment to this intervention drove its success

About the Author

Alicia Zagel: Alicia Zagel, PhD, MPH, is the health outcomes manager for Fairview Pharmacy Services. She works within ambulatory pharmacy services to promote quality patient care and improve health outcomes around the M Health Fairview System and beyond.