Public Health Strategies for Pharmacists to Improve Health for People With Chronic Disease

Community-based pharmacists have the geographic proximity, easy accessibility, and strong understanding of the community's local, social, economic, and cultural dynamics. This can allow pharmacists to screen for and address various social, economic, and environmental factors. Critical factors are those that affect the health of people in the community who have disproportionately higher rates of chronic disease.

Patients interact more often with their pharmacists than their primary care clinicians, as pharmacies are often located within a patient's community. In addition, pharmacies typically operate for extended hours, including evenings and weekends, and usually do not require appointments. Moreover, patients with chronic disease visit pharmacies routinely for medications. All of these factors offer pharmacists the opportunity to provide health-related social needs, screenings, and referrals.

Pharmacists can begin by screening patients for barriers, such as limited medication and health care access, transportation challenges, and food insecurity. Pharmacists can then refer patients to services and community organizations that can address needs, improve health outcomes, and lower medical costs. Pharmacists can help address individualized needs through tailored pharmacy-based interventions and cost-lowering strategies. These efforts help with medication adherence and affordability.

Addressing medication adherence challenges can include:

1. Counseling patients using clear, simple language.
2. Ensuring that patients understand how to take their medications properly as well as potential side effects of each medication.
3. Addressing concerns or misunderstandings about medications—to dispel myths and clarify the benefits of medication adherence.
4. Offering blister packaging or pill organizers, 90-day prescription fills, technology to provide refill reminders, and delivery services.

Addressing medication affordability challenges can include:

1. Recommending lower cost options to patients' prescribing clinicians.
2. Assessing eligibility for prescription discounts and assistance programs.
3. Offering sliding fee scales for 340B entities such as Federally Qualified Health Centers, rural health centers, and community-based rehabilitation centers.

Pharmacists can try to understand patients' needs in a variety of ways. Examples are being active and engaged community members and fostering relationships with community-based organizations. These actions can inform pharmacists about:

• Priority topics and needs of the community members.
• Disparities in the burden of chronic disease in the community.

It is important to work with community leaders and partners to tailor initiatives that best fit patients' needs and preferences. Programs can also be tailored to address the specific factors that affect health within a community.

In addition to working with local organizations, pharmacists can better understand community needs by becoming members of local health advisory boards. All of these actions offer pharmacists options for helping develop and implement programs that address disparities and improve health.

Medical mistrust from ethnic and minority groups—particularly African American/Black, Hispanic, and American Indian and Alaska Native persons—can impede a trusting relationship between pharmacists and patients. Pharmacists can provide culturally competent care to better serve patients from racial and ethnic minority populations. Pharmacists with a foundation in cultural competence can optimize medication adherence by:

• Improving patient communication.
• Better understanding patients' cultural and religious beliefs about medication use.

Pharmacists can consider developing communication products and other efforts that adapt to the cultural, linguistic, environmental, and historical situation of each population they serve.

Pharmacists' efforts to reduce medical mistrust and provide culturally competent care can include:

1. Using translators as needed.
2. Working with trusted local community organizations and leaders such as community centers, barbershops, and faith-based organizations. The goal is to offer programs that provide education and patient care services.
3. Partnering with community health workers (CHWs) for community outreach.

States' scope of practice laws and collaborative practice agreements may help expand the services that pharmacists provide to address patients' needs. A collaborative practice agreement creates a formal relationship wherein specific patient care services are delegated to the pharmacist by the collaborating clinician.10 These agreements enable pharmacists to provide services such as:

• Chronic disease management.
• Care transition interventions.
• Medication therapy management.

See a story from the field of a collaborative practice agreement in a community-based setting.

Pharmacy data, such as prescription fill and pick-up information, are vital to improving patient care, program planning, implementation. Such data also help address health disparities. Pharmacists have access to pharmacy data systems, which enables them to:

• Partner with clinicians to identify gaps in medication adherence.
• Develop initiatives that address health disparities in chronic disease outcomes and medication affordability. This is especially helpful among people with lower incomes and those facing health-related social needs.

Grants can help pharmacies develop and use initiatives that address health disparities. Pharmacists can obtain resources through grant funding for programs that offer services or resources at no cost to patients. See a story from the field of a pharmacist-led, grant-supported intervention to improve hypertension control.

• CHWs can be a bridge between the pharmacy and the community, ensuring that people have access to necessary medications and health services.
• Outreach programs organized by CHWs can educate the community on the importance of regular health check-ups and medication adherence.

• CHWs can offer health education sessions along with pharmacists to promote preventive care, disease management, and healthy lifestyles.
• Pharmacists can provide information on medication management and potential side effects. This helps ensure patients have a complete understanding of their treatment plans.

• CHWs often have deep insights into the cultural and social nuances of the community they serve. Pharmacists who work with CHWs can provide more culturally competent care, considering the diverse backgrounds of their patients.
• CHWs can identify and address barriers to health care, such as navigating public transportation options. Other examples include translating materials into a person's native language and finding affordable health insurance.
• Pharmacists can work with CHWs to overcome these barriers and ensure patients receive the care they need.

• CHWs can help pharmacists monitor patients' progress and help patients navigate the complexities of long-term medication use.

• CHWs can provide reminders, education, and support to patients to ensure they take their medications as prescribed.
• Pharmacists can work with CHWs to track and assess adherence, adjusting interventions as needed.

• CHWs, working with pharmacists, can help organize health screenings and early detection campaigns—to identify health issues at an early stage.
• Pharmacists can contribute by offering advice on appropriate over-the-counter medications and preventive measures.

• CHWs can facilitate referrals between pharmacists and other health care professionals, ensuring a seamless continuum of care.
• Pharmacists can work with CHWs to monitor patient outcomes and adjust care plans accordingly.