INNOVATIONS in pharmacy

Pharmacist-led screening for social determinants of health and diabetes distress in an underserved ambulatory care population

Crystal Deas

Samford University, McWhorter School of Pharmacy

https://orcid.org/0000-0003-0921-5895

Gina Winslett

Cooper Green Mercy Health Services Authority

https://orcid.org/0009-0009-8358-6791

Kayla Snow

Cooper Green Mercy Health Services Authority

DOI: https://doi.org/10.24926/iip.v17i1.7186

Keywords: clinical pharmacist, ambulatory care, diabetes mellitus, type 2, social determinants of health, diabetes-related distress

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Abstract

Introduction: Social determinants of health (SDOH) significantly influence Type 2 diabetes (T2DM) outcomes but are often unaddressed in traditional care models. Diabetes-related distress (DD) also contributes to suboptimal disease control. Pharmacists in ambulatory settings are well-positioned to screen for and respond to these non-clinical barriers.

Objective: To assess the prevalence of SDOH needs and DD among patients in a pharmacist-led clinic and describe interventions provided in response.

Methods: This cross-sectional study was conducted over a seven-month period. Forty adult patients with T2DM attending in-person pharmacist-led visits were screened for SDOH and DD using validated tools. Descriptive statistics and Spearman correlations were used to analyze relationships among HbA1c, SDOH burden, and DD.

Results: The majority of patients were female (72.5%) and African American (87.5%). SDOH needs were identified in 67.5% of patients, with the most common being lack of social support (44.4%), financial strain (40.7%), and food insecurity (29.6%). Moderate to high DD (T2-DDAS CORE ≥2.0) was present in 50.0% of patients. A significant, moderate positive correlation was observed between baseline HbA1c and T2-DDAS CORE scores (Spearman ρ = 0.423, p = 0.007; R² = 0.191). Pharmacists provided a mean of 1.9 ± 0.9 interventions per patient visit, which included both routine clinical actions and screening-prompted interventions.  Routine care most commonly included medication adjustment (n=23) and diabetes self-management education and support (n=19), whereas referral to community resources were the most frequent screening-prompted interventions, driven by both SDOH (n=11) and DD (n=6) findings. The mean combined time to complete both screenings was 6.45 ± 2.32 minutes.

Conclusion: Pharmacist-led screenings identified a high prevalence of unmet SDOH needs and DD. Interventions prompted by SDOH and DD screenings were feasible to implement and may support improved diabetes management.