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Strategies aimed at improving patient access and adherence.
As key members of the patient care team, pharmacists have a unique opportunity to address the disparities in healthcare that have been exacerbated by the ongoing COVID-19 pandemic. Although the current public health crisis has highlighted the extent to which multiple populations experience increased incidence of illness, morbidity, and death, the differences in access, usage, quality, and outcomes have been building for decades. The US has historically seen differences in health outcomes among certain socioeconomic, racial, and ethnic groups.
The reasons for these disparities can be traced back to several factors, including social disadvantages that impact health outcomes and the corresponding failure of health systems to respond to these needs; poor access to affordable, high-quality healthcare; lack of transportation and high out-of-pocket specialist costs that lead to constrained decision-making; racial, ethnic, and implicit bias; and differences among healthcare organizations, geographic areas, and providers.1 Since the onset of the pandemic, these factors have continued to have an even greater influence on patient outcomes, especially those related to social disadvantages.
A significant driver of COVID-19 disparities is the disproportionate number of racial and ethnic minorities who are essential workers in grocery and retail stores, healthcare facilities, factories, restaurants, public transportation, and farms. These employees often work in close contact with the public and other workers, are unable to work from home, and frequently have no access to sick leave benefits, putting this population at significant exposure to the virus. Because of lower high school completion rates and unequal access to high-quality education and college, these groups have also been affected by the unstable job market and have less flexibility to leave jobs that carry high risk of COVID-19 exposure, increased financial pressure to work when sick, and higher reliance on public transportation.
Minority populations also face disparities outside of the workplace. Racial and ethnic minorities currently face disproportionate rates of unemployment, leading to eviction and shared housing, both of which result in crowded living conditions that may challenge isolation and social distancing.2-4
While the responsibility of responding to these needs reaches across the entire healthcare system, Pharmacy Times Continuing Education™ (PTCE) believes that pharmacists have an important role to play in addressing the disparities that impact so many Americans. More than 90% of people in the US live within five miles of a community pharmacy and visit their pharmacists 12 times more frequently than their primary care physician,3 placing pharmacists on the frontlines of patient care. This position offers pharmacists the ability to impact the racial and socioeconomic groups disproportionately affected by the COVID-19 pandemic through strategies aimed at improving access and adherence.
Pharmacies can offer many services, including dedicated private computer access outside of the pharmacy to increase the availability of telehealth; delivery and curbside or drive-thru pick-up for easier access to prescriptions; and drive-thru and curbside COVID-19 testing, vaccinations, and point-of-care testing. Pharmacists can coach patients toward better adherence by recommending simplified medication regimens and deprescribing when appropriate; implementing 90-day supplies, setting up refill alerts and medication synchronization processes; and with education on diet and exercise routines.5,6
At PTCE, we understand the challenges pharmacists are facing as they address the many disparities that affect their patients. We are continually seeking ways to support learners through the education that we provide. In the coming months, we will introduce a COVID-19 curriculum to support pharmacists in administering the vaccine, while empowering them to improve outcomes and ensure health equity for at-risk populations.
1. Fiscella K, Sanders MR. Racial and Ethnic Disparities in the Quality of Health Care. Annu Rev Public Health. 2016;37:375-394.
2. Health Equity Considerations and Racial and Ethnic Minority Groups. CDC. cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
3. Double Jeopardy: COVID-19 and Behavioral Health Disparities for Black and Latino Communities in the US. SAMHSA. samhsa.gov/sites/default/files/covid19-behavioral-health-disparities-black-latino-communities.pdf
4. McNeely CL, et al. Social Determinants and COVID‐19 Disparities: Differential Pandemic Effects and Dynamics. World Medical and Health Policy. 2020;12(3):206-217.
5. Kennedy A. COVID-19 Pandemic and Adherence to Therapy: What Can Pharmacists Do? pharmacytimes.com/news/covid-19-pandemic-and-adherence-to-therapy-what-can-pharmacists-do
6. Strand MA, et al. Community Pharmacists’ Contributions to Disease Management During the COVID-19 Pandemic. Prev Chronic Dis. 2020;17:E69.
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