So, good afternoon. Thank you for joining us for the Social Determinants of Health in People Living with Psychiatric Disorders, the Role of Pharmacists. I'm very excited today to be joined by Dr. Aloma Atta to present on this very important topic. Next slide, please. As many of us are aware, SMI Advisor, the Clinical Support System for Serious Mental Illness, is a Substance Abuse and Mental Health Services Administration, SAMHSA-funded initiative implemented by the American Psychiatric Association. Next slide, please. Today, we have three opportunities for continuing education credit, physician, pharmacist, and nursing. Next slide. There are handouts available today. You will see that those were just posted in the chat. Please head over there and select on the link to view the handouts. Next slide. If you need to turn on captions, there is a captions button available in your bar at the bottom of the Zoom screen. Click the Show Captions at the bottom and the arrow and select Full View Transcript to open the captions in a side window. Next slide. If you'd like to participate in the question and answer, please feel free to submit your questions throughout the presentation by typing them into the questionnaire found in the lower portion of the control panel. We'll reserve 10 to 15 minutes at the end of the presentation for questions and answers. Next slide. So, I am very excited to introduce Dr. Aloma. She's going to be presenting today on Social Determinants of Health. She is a Collaborative Drug Therapy Management Clinical Pharmacist at New York Health and Hospitals King County Hospital in Brooklyn, New York. She also practices intermittently as a clinical pharmacist for the New York Disaster Medical Assistance Team under the U.S. Department of Health and Human Services. So please welcome Dr. Aloma today to give us some insight into her practice, and I'll turn it over to you. Thank you so much for that introduction. I'm very excited to be giving this talk today. I have a few slides moving forward, the first couple with disclosures, so I don't have any financial relationships or conflict of interest to disclose on the subject matter. The ideas, opinions, and comments that are expressed in this presentation are strictly my own and they do not represent any of my work affiliations. The presentation will include an off-label discussion of a medication, and I will also be discussing topics from a paper that I co-authored. I'd like to also take a moment to acknowledge a few individuals and groups, so I wish to sincerely express my appreciation and gratitude for the co-authors of the paper that I was part of regarding social determinants of health and the role of pharmacists, along with a few other folks, the Board of Directors of the American Association of Psychiatric Pharmacists for their support for this project, as well as a few other individuals, especially including Greg Payne. So thank you so much for those individuals. Now I'll begin the presentation. These are the learning objectives that I have set out for you. So upon completion of this activity, you'll be able to analyze the impact of social determinants of health on psychiatric disorders, examine the intersection between social determinants of health and medication use, distinguish pharmacist interventions to address social determinants of health, and recommend methods to improve incorporation of social determinants of health within pharmacy. I'd like to start by reviewing what is social determinants of health. There are several organizations with different definitions and different domains. For this presentation, I'm going to be focusing on Healthy People 2030. However, I would like to take a moment to describe the World Health Organization definition. So social determinants of health are conditions in which people are born, grow, work, live, and age, and a wider set of forces and systems that shape the conditions of daily life. The Healthy People 2030 splits up social determinants of health into five domains, education and access and quality, economic stability, social and community context, neighborhood and built environment, health care access and quality. Throughout this presentation, I will be discussing these domains and how they relate to each of the objectives. So social determinants of health have a significant effect on morbidity, mortality, and quality of life. There were studies that show that it could account for 80 to 90 percent of a person's overall health. And in order to address social determinants of health, we have to understand where does it intersect and how does it come about. Also in addressing this, we can overall improve health, health care outcomes, and also reduce inequalities in health care. There are social determinants of mental health, and these are the five domains. There is also an intersection between other chronic diseases as well. So this is not strictly mental health. However, I provide some examples here relating specifically for mental health. So there's many different types of influences that may come about that may influence someone's risk factors for developing a mental health disorder. And as you know, there may be some genetic or biological factors. However, when we're looking at social determinants of mental health, these are some examples that could lead to different mental health disorders. So having unemployment. So this is an economic instability. This could lead to depression, anxiety, low self-esteem, low self-worth. In the neighborhood, if you're in an area where there's overcrowding, if you're in a shelter or unsheltered, this could also affect stress levels, interpersonal relationships within your family, the community at large, and also sleep. When we think about education, poor education is associated with poor health outcomes, physical and mental health outcomes. The higher the education, the more likely there are less health outcomes or more positive health outcomes. When we think about social and community context, low-income families and social discrimination could affect an individual's risk and increase the likelihood of psychiatric disorders. And here in the next couple slides, I'll also discuss a few examples such as ACEs. And then in terms of healthcare access and quality, having a lack of health insurance and not the adequate amount of or availability of transportation could delay care. Individuals could skip appointments, skip medications. And overall, all of these can impact an individual's mental health. There's also discussions of social determinants of health and how they can impact physical or mental health because of the chronic stress and then developing different psychiatric or substance use disorders. This is adapted from Compt et al. And it reviews some more in-depth social determinants of mental health. And I'd like to take a moment to also discuss some of the overarching areas that influence each of these. So for example, public policies, housing, tuition costs, minimum wage, all of these items can affect and influence these social determinants of mental health. Having a family who is not able to support their intake, their amount of their access to healthy foods, their access to medications, access to school, being able to afford gas if they're in an area that they need to drive their car, all of these have some type of influence on these different areas, whether it's poor education, adverse features of the built environment, poor environmental quality, adverse features of the workplace, not being able to take time off to care for oneself or a family member. And I'll also point out that social norms, which are opinions, beliefs on different entities such as race, ethnicity, gender, culture, religion, all those two also have an impact on social determinants of mental health. And there's also an intersect between public policy and social norms. So there are instances where certain areas, certain states are able to allocate certain resources to ensure that there are programs in place that can help foster communities, that can help decrease ACEs, as I mentioned before, adverse childhood life experiences. It's thought that individuals who are in a violent or they're exposed to neglect, abuse, or violence during their childhood, they may be at higher risk of carrying that forward into their adulthood. So having certain public policies in place to improve or prevent or reduce the chances of late childhood onset of these mental health disorders could overall improve health quality and health outcomes. And I would also like to discuss distribution of opportunities. Sometimes there are not the same between different communities, between different states, between different groups or populations of people. And also inequity. And this is something that is closely related to social determinants of health. So health equity, health justice, and being able to identify where we can intervene to ensure that we can increase health equity amongst all individuals. There are a few items to discuss when it comes to access to health services. And this is more so geared towards the United States. So just to kind of put that in here, because several items such as insurance, geography, transportation, health care resources, all of these items have influence over health care access. And in the US, most individuals are tied, but their insurance is tied with their workplace. Or if that person is unemployed, or if they have state or federal assistance, then they'll get insurance that way. However, in order to gain access to the health care system, one typically needs to have insurance, as well as being able to access health care for a particular location. So individuals need to have access to transportation or have access to telehealth services. And there has to be enough resources in order for people to participate in whatever health care service they're trying to engage in. So being able to obtain a health care provider. And I will say there are a list of opposing forces, and these are some examples that I have added here. So some individuals who don't have insurance may have to pay a very hefty out-of-pocket expense in order to pay for their medication, prescription drugs, or any different tests that they may need. There's also a significant amount of medical debt, and for people who are insured and are uninsured. And a few other things that I didn't mention include mistrust of provider in the health care system. There's individuals that I've met in my practice where they do not trust the health care system for a variety of different reasons. There's also provider shortages in many different disciplines, and especially within psychiatry. There is soon to be a very large shortage of psychiatric providers. And another item too is the long wait times, and the long wait times could also impact the availability of health care resources. So if someone wants to see a specialist, they may have to wait several months in order for them to do so. So these are some examples of opposing forces, but also what are some of the areas that we can understand that can increase and improve access to health care services overall. I'd like to present my first case. So SB is a 56-year-old female with a past medical history of COPD type 2 diabetes, and she resides in a rural area of Maine. Her nearest pharmacy is a 25-minute drive from her home, and she frequently visits her local pharmacy to pick up medications, over-the-counter medications, groceries, a few other items. So the staff are well acquainted with SB, and they have a pretty good relationship. Recently, her pharmacist noticed that SB has been calling a lot less, not picking up her insulin on time, often delayed by a couple weeks. So what do we think may be occurring in SB? Is it that she can't afford her medications? Is she having an episode of occasional non-adherence, or has there been a change in her diabetes status, or is she having transportation issues? Perhaps her car is giving her trouble now. Well, fast forward, the pharmacist has decided to call SB to inquire about some recent changes that she's noticed. And SB describes nearly every day having feelings of hopelessness, not having energy to leave her home, and occasionally having little interest in doing things. So essentially, she scored positive on PHQ-2. And after discussion, SB said that she doesn't have access to intranet, and she doesn't want to do any type of service at home, so no tele-visit services, because she has privacy concerns. And in this case, the pharmacist in the community, where she had been picking up her medications, referred SB to local mental health services, and even offered home delivery of her prescriptions so that she could go home. And even offered home delivery of her prescriptions so that she can continue to take her medications on time. And I would like to just point out this example being that there is a trust to pharmacists and patients who come to pick up their prescriptions. And because of this trust, there was disclosure that there was something going on. And the pharmacist was able to make a referral and have a solution for SB. And I really think this is an example of many that community pharmacists are able to intervene in order to overall help improve the care for their patients. But we don't necessarily see all of this. So the role of pharmacists. As I mentioned, there are community pharmacists, and pharmacists overall are one of the most successful health care professionals of the public. Of course, we vary by practice and specialty. There's a variety of different types of clinical pharmacists in different specialty areas. People do compounding. People are in specialty pharmacy doing biologics. But overall, there is an ability for any pharmacist in any area to impact social determinants of health. Here are some examples of community pharmacists that I'll share. So performing medication therapy management. So this is something that Medicare Part D pays for. Reviewing the medications for any drug interactions, any issues, duplications of therapy, offering essentially medication review of services, screening for depression. In some states, pharmacists can administer long-acting medications, including long-acting antipsychotics. They could also administer immunizations to, of course, this varies to pediatrics, all the way up to adults. And then also offering some type of insurance navigation, whether it's enrolling in Medicare or finding different formulary alternatives if their insurance isn't paid for certain medications. And then we have clinical pharmacists, and I'll give a quick overview. So pharmacists are, there is a PharmD degree, and you earn your doctorate of pharmacy, and then you can apply for a couple of years of residency to specialize in a certain area. I'm not gonna go into detail about the differences between pharmacists and their education and residency programs and board certifications, but I do want to just provide that quick overview. So clinical pharmacist is another type of pharmacist specialty, and they can perform a variety of different tasks that can impact social determinants of health. And I'll be going over comprehensive medication management, as well as collaborative practice agreements. And there are many other items that they can participate in in order to address social determinants of health. And increasing the specialty, so I'll talk now about psychiatric pharmacists. So these are a subspecialty of clinical pharmacists. There are over 1,500 board certified psychiatric pharmacists, and these pharmacists may even aid in the psychiatric provider shortage that has been experienced and will continue to experience. There are certain practices, practice specialty areas, like I had mentioned, so people can focus on mental health disorders or substance use disorders, but we could also understand that there are collaborative practice agreements for either of those. And in order to underscore some of the application of social determinants of health, we also have to understand that there's a variety of different things that psychiatric pharmacists can impact. So pharmacogenetic testing, also being able to aid in the transitions of care, that is also one of the points where patients are very vulnerable because there are medication changes, psychiatric and medical, whether it's from the hospital to the community or vice versa, there's definitely an opportunity to understand and appreciate some of the interventions that can be made during that time. A pharmacist can also provide education to family members, friends, and caregivers regarding disease states, medications, medication administration, improving medication adherence to psychotropic medications, monitoring for different side effects, personalized adherence strategies, and addressing any cost concerns. And I'll give another, I wanna elaborate a little bit about personalized adherence strategies and as it relates to social determinants of health. Medication adherence is a very large pillar of the patient care outcomes. And we know that many individuals are not very adherent to some of their medications, whether they're not being optimized or they're having medication side effects or issues, but adhering to medication and having someone review and understand what are some of the challenges that these patients face, we can then be able to come up with a strategy to improve. So whether it's cost is a factor, whether it's their living situation is a factor, I'll be going over some specific details in future slides, but overall, these are methods and ways that psychiatric pharmacists can impact social determinants of health. And in order to follow through and loop as a full circle, it's also important for individuals, clinicians included, to follow through and follow up with any type of intervention that was made or referral that was made for a social determinant of health. And actually, one last point on here, although pharmacists and psychiatric pharmacists are not experts in solving food insecurities, they are still positioned to identify and screen and be able to refer to the proper or most appropriate individual who can help that patient resolve or address that issue. So I just want to add that point as well. So this is a table on the next slide as well of the social determinants of health and medication use. So there are a variety of potential impact of medication use has on each domain of social determinants of health. So first I'll start with economics stability. Typically, this is about the finances related to prescription drug use, insurance, but it could also play into any food and drug interactions. Sometimes when we think about food and drug interactions and their current disease states, we think about what access does this person have to healthy foods? Are they in a food swamp, which is categorized by being in an area that has more fried foods, unhealthy foods, but foods that are also cheaper, they're inexpensive, they're easier to attain, especially when someone's on a limited income. There's also religious and cultural influences that have an impact on this domain as well and how it affects taking medication, prescription drugs. And overall, thinking about the financial impact of prescription medications and drug interactions and food and insurance, all these different things can impact medication use. So this is something that pharmacists can potentially intervene and address. When it comes to food insecurities, it may be a little bit more challenging and depends on where you live and where you practice. In the state of New York, we have different programs that we can refer patients to, whether it's food that is delivered to patients' homes, providing an area of accessible food pantries and kitchens, especially when patients have comorbid diseases such as diabetes, hypertension, and they have limited options. Moving on to the next domain, neighborhood and built environment. I spoke a little bit about pharmacy deserts or access to pharmacy. In my example, that patient, S.B., was 25 minutes from her pharmacy, and that's not always the case. Some individuals may have an hour drive to their pharmacy to pick up their medications. So understanding the transportation barriers is an important aspect of how social determinants of health can impact medication use. As well as a few other examples, healthy housing. What are the conditions of their housing? Are they in a house that is from public assistance? Has it been frequently checked on? Some of these air quality issues can also influence an individual's respiratory health. Their development of asthma in the future, whether it's children or adults. We also think about housing instability, adherence, public safety, telehealth infrastructure. Do they have the means in order to have internet? Wi-Fi is something that people have to pay for. And are there different areas around their living quarters where they can exercise? And are they able to enroll in a gym membership? Or do they have the means within their home to exercise? We know all of these items are important and certain medications have influence over these. Next domain is education access and quality. And this is an important domain because health literacy and education is something that pharmacists in adherence and counseling and medication instructions, reviewing them in details. This is a really important part to make sure that patients understand their instructions and how to take a medication. What are the potential side effects? So this is a very large domain. And I would like to also suggest there are certain features within Word documents where you can actually assess the health literacy of a document. Of course, it depends on like different applications, but it can tell you if something is a ninth grader level, 10th grader level. And of course we try to strive for fifth or sixth grader level, but we also wanna make sure that it's in that individual's language, preferred language. So those are important items under this domain. And if an individual knows how to use their phone or the internet or their computer in order to access some of this technology, such as continuous glucose monitors. The next domain is social and community context. So here we have support groups, medication groups, in order to provide that education, discussing the culture around taking medication. My community, there is a predominance of Caribbean and some individuals, for example, practice Rastafari. And there are certain aspects of that culture such as being geared more towards herbalistic, holistic approach that could impact potential use of medications. So truly understanding the social and community context is an important part of social determinants of health and how it intersects with medication use. Healthcare access and quality, and I alluded to a few examples earlier about collaborative practice agreements, being able to provide long acting injectable medications, but all of that does improve and lower the threshold for people to gain access to the healthcare system and obtain their medications and their healthcare needs in an easier way. I'll also add being able to obtain Naloxone for opioid overdose and providing that education in certain states it's over the counter now, a pharmacist having prescriptive authority, as well as a few other items like monitoring individuals, providing education and understanding about beliefs about the healthcare, vaccinations and other medications. So this will bring me to case two. So R.A. is a 29 year old Haitian male with a past medical history of schizophrenia, hyperlipidemia and a six lifetime psychiatric hospitalizations, who was recently discharged from a three week admission for acute psychosis. He was successfully initiated on Clozapine and titrated to an effective dose of 450 milligrams per day. One week post discharge, he presented to his outpatient psychiatrist and was subsequently referred to a clinical psychiatric pharmacist for bi-weekly medication management and monitoring under a collaborative practice agreement. So today he presents to the clinical pharmacist for medication and laboratory monitoring accompanied by a caregiver. And this medication list is to the right as follows, Clozapine, Benzotropine, Polyethylene Glycol and Atorvastatin. During the assessment and valuation by the clinical pharmacist, the following were identified. So after speaking with them, it was noted that the caregiver had a below basic healthcare literacy and their caregiver is someone who addresses most of their healthcare needs, brings this patient to their healthcare providers, ensures that they're being cared for by their healthcare providers, ensures that they are taking their medication at home. So it's very important to be able to identify this and provide healthcare literacy that is appropriate for the caregiver so that they completely understand what are some of the items that they need to do on their end and fully appreciate the conversation that's had during the visit as well. It was noted that the preferred language for this patient is Haitian Creole. So ensuring that question is asked immediately, that should be one of the first questions. What is your preferred language and using appropriate translating services for that patient and that caregiver? It was also identified that this patient didn't have a primary care doctor. They were, I guess, diagnosed with the hyperlipidemia while they were inpatient. So this was a perfect opportunity for the pharmacist to provide that education and reinforce the importance of engaging in primary care, especially as preventative medicine. And the pharmacist identified that there was an unnecessary medication, benztropine, that may have been contributing to added side effects, you know, anti-cholinergic side effects to the medication regimen that the patient was on. And they were able to address another item or side effect that the patient was complaining of, sialaria. So they were able to add atropine sublingual to help with that. And to review some of the benefits of collaborative practice agreements, I'd like to just take a moment to kind of go through this list. Not only does it increase access to care, but it also provides providers, psychiatrists or nurse practitioners, whichever state you're in, you may have some limitations, but it allows the providers to reallocate their time to either other patients or other activities. And the pharmacist can see those patients during that time. We can optimize drug therapy, improve medication adherence, improve patient outcomes, enhance satisfaction, both for the patient and the provider, reduce hospital and emergency department visits, and enhance ability to pay or achieve, pay for performance goals. Comprehensive medication management is another way that pharmacists can address social determinants of health. In persons living with psychiatric disorders, many of them have very complex medication regimens and they could have medication therapy problems. And CMM for short is Individualized Approach to Identify and Resolve Medication Therapy Problems. And this also is an opportunity to recognize and mitigate any social determinants related issues as they often come up during interview using open-ended questions and truly understanding from the patient perspective what is their illness, what do they have, any issues with the medications, et cetera. So CMM assesses for indication, effectiveness, safety, adherence, overall with the goal to identify and resolve any medication therapy problems, as well as moving towards ultimately treating their treatment goal and achieving their treatment goals. So these are some of the definitions for each of those categories. I'm not gonna get into them, but they're there for you. So here is a crosswalk between comprehensive medication management and medication therapy problems as they relate to social determinants of health domains. So on the left, you will see some of the social determinants of health domains, and then each column represents indication, effectiveness, safety, and adherence. And this slide and the next goes over the same crosswalk, and I want to take you through some of these examples, because these are true examples of how pharmacists can impact social determinants of health through CMM. So I'm going to pop out some examples, but for sake of time, I'm not going to go through each one of them. So for economic stability, being able to reduce prescription costs by deprescribing unnecessary medications, or addressing adherence by providing an alternative drug regimen that is within the drug formulary. In the neighborhood and built, providing a means for safe needle disposal and pamphlets for patients to connect them with substance use disorder treatment services. Training individuals how to use and administer naloxone to reduce fatal overdoses in the community. For education, providing education on the utility of medications to treat commonly used psychiatric disorders like alcohol use disorder, ADHD, opioid use disorder, depression, etc. Teaching adolescents about the harms of cannabis use. Also consulting with parents regarding medication holidays for people who are on stimulants. So discussing that risk benefit with them. So those are some examples from these domains. Now I'll take you to the following page. This is related to social and community context. So, being able to manage opioid use disorder with buprenorphine to reduce the impact of substance use in the community. That could be through a collaborative practice agreement. Taking CMM and improving health literacy, participating in group educations, whether you're going to certain community outreach centers, community centers, religious groups, being able to go into the community and provide that education directly can address this. And also tailoring the handouts and any educational materials to the reading level and the culture of the audience. In terms of healthcare access and care, screening individuals, psychiatric pharmacists, pharmacists in general can screen for a variety of different conditions and refer those patients to providers who can diagnose. But screening for depression, ADHD, anxiety, referring them to primary care, being able to monitor patients who are at risk of metabolic syndrome, secondary to antipsychotics, connecting patients with outpatient pharmacies to provide bubble packs. This has been something that I've used in my practice for a while, especially for patients who are just, it's just very challenging for them to remember to take their medications and often taking multiple on accident. Bubble packing makes it a lot easier for people to understand when, how to take their medications, how many medications they're taking either in the morning, afternoon, at bedtime, especially for those who are on more than 10 medications per day. I'd also like to share a few additional case scenarios that I've encountered related to social determinants of health. There's plenty of individuals that I see who are undomiciled. So I live in a shelter. I can't choose what or when I eat. And this is important for people who have to take certain medications before a meal or they have certain dietary restrictions and unfortunately they can't choose when the shelter is providing a meal for them. People steal medications. I have no place to store my medications. This could be a very big issue, whether the patient's prescribed a controlled substance or they have just medications that they're taking and they feel that there's a lack of security in these, in this position. Interpreter services, including American Sign Language. I've encountered a patient who I had, there was no notation that they needed American Sign Language, but it was actually for their caregiver who was in the room and that patient wanted the caregiver to understand what was happening during the visit. So do, like, do individuals have access to American Sign Language services? I want to exercise, but I don't feel safe leaving my apartment sometimes. I want to exercise, but I don't have the time because I work seven days a week. I can't afford to miss a day of work to come to my appointments. Many of these relate to their work, their living environment, neighborhood and built. And all of these can affect their health care outcomes. I can't quit smoking until I get my legal case resolved. I've had to refer an individual to someone to help with legal assistance because that was a major stressor in their life. I moved here from California. Does the insurance work here? And I'll also take a moment to describe during a natural disaster or an emergency, individuals may immediately lose access to basic needs like food, shelter, water, their own medications, being able to care for their conditions or their caregivers or their, you know, for their children. So different organizations are available to provide assistance during these times of need, during this vulnerable situation, and they can help bridge the patient during that difficult time. And all these are some examples of social determinants of health and how I've encountered them in my practice and how they relate to medication use, overall health care, their health quality outcomes, and patients just, you know, not being able to do what they would like to do, which is take their medications. It's often because of another issue that has come up. So working with them to kind of unpack that and seeing how you can come up with a plan together. And during this next slide, this is geared towards an improved incorporation of social determinants of health within pharmacy. So whether it's education or advocacy, there are definitely ways that we can further increase the awareness and education of social determinants of health. In terms of education, individuals can screen for social determinants of health and make referrals. There are some quick tools and resources that are embedded in some EMRs, however, not others. And it's also not highly utilized as it should. And I think as time goes on, there may be more individuals asking these questions and making these areas a hard stop, so needing to fill these out. There also can be more training on the evaluation of ACEs and trauma-informed care, incorporating social determinants of health application into psychiatric pharmacy residencies, as well as in curriculum. And also, I believe there has been a recent addition of social determinants of health in national board certification exams for pharmacists. And lastly, within advocacy, there are several ways to participate in either local, state, or federal platforms in order to push for health policy development and legislation in order to address social determinants of health. And at the more local level, one can sit on a community board, be on an advocacy group, grassroot movements, or within the healthcare system community in order to advocate for individuals to expand the incorporation of social determinants of health and increase awareness. And there are also opportunities for pharmacists to lead in community outreach programs, whether it's medication safety, diabetes education, psychotropic education, there are definitely opportunities to embed oneself into the community or one's own healthcare system in order to advocate for these items. And this is my bibliography, and I would be happy to take any questions. Thank you so much for this opportunity. Thank you so much. If you could switch just to the next slide, we're going to give people a few moments. If you'll go to one more slide. While you're thinking about questions and getting those into the question and answer, SMI Advisor does have a mobile app. This is great to utilize a lot of different resources, education catalogs, rating scales, all sorts of things. And so here's the link. To download that app if you're looking for it. New tools are always being added. So be on the lookout. All right, if we go to the next slide. The first question that I have for you is, tell us a little bit about some of your interest in this area. This isn't typically an area. I think we see a lot of pharmacists. Maybe typically engaged in or what maybe the public doesn't think about that pharmacists might be doing behind the scenes. So where did your interest come from? Thank you for that question. So my interest was initiated when I had moved into my community of Brooklyn. I was in a different area out on Long Island and moving into this community of Brooklyn, and also in my practice, I encountered a lot of issues related to social determinants of health and how impactful and how big of a barrier it was in order for me to be able to do that. And how big of a barrier it was for them to be able to treat themselves with their prescribed medications and engage with their healthcare providers. So I would say the spark started there. And as I was engaging with more patients and getting a better understanding of what are some of the barriers that they've encountered, it became a really big item for me. And I think by taking that on and moving forward with what I see on a day to day, I'm able to better address them. I know what resources I have here. And I know how to leverage that in order for patients to come to an agreement and understanding on how we can both treat their chronic diseases or acute diseases as well. So, thank you. I was very interested in how you have the resources available in your area. I think that's a struggle that many of us have in pharmacy, maybe even as providers as well, to think about, how am I aware of what the resources are in my community? How did you go about cataloging those? Yeah. For me, in my health system, there's a strong presence of social work. And then the psychiatrists are also aware of various resources. Being in New York State, there are several websites with a variety of different programs that they put on and they've sponsored, as well as other programs that may not be on the forefront of people's ideas, I guess. Many of the social workers here, they're just so familiar with the community and what they have access to. It may not always be on these bigger government or state websites. So, I think I rely on both. I rely on my local resources here, as well as what the state and city has to offer, as well as reaching out to some of the folks within my health system. So, patient advocacy. I don't know if individuals have that at their institution, but I've encountered many issues where I'm trying to come up with a document that aligns well with health literacy for my patients. And I've often had to send it to them in order for them to outsource some assistance in order to get the proper and most appropriate format for my patients. So, I think understanding what resources you have at your local facility, as well as pulling from resources from your state, from your community, from your city or town. Thank you so much. There's a question asking, are there any best practices for pharmacists operationalizing the social determinants of health screening within comprehensive medication management? For example, are people doing direct screening during visits? Are they doing waiting room screening, then addressing anything that's positive in the visits? Is it at every visit or established intervals? Maybe a little bit about the process. Yeah. So, me and the other group of co-authors, as we were digging into the literature, we realized that there wasn't a lot of information out there. There wasn't a lot of research looking at the pharmacist's role in addressing social determinants of health. So, we were able to pull from other papers and other resources. And in terms of CMM, there's no standardized way to incorporate social determinants of health. So, I think it would be most appropriate to determine what would work for your practice. Having a patient perform screeners before their appointment or doing it during. It also depends on what you have access in your EMR. Sometimes these are screened by other providers. So, you can actually get that information because someone else has been able to screen them. So, it really depends on your practice and what would work. But I do think that at every visit, certain things should be addressed, especially when it comes to medication side effects and adherence. So, I hope that answers that question. Well, thank you so much for your time today. If you'll flip to the next slide. Yes. Perfect. So, if you have more questions, you can access this course through your SMI advisor account. There's a discussion tab. We can continue to post questions and share ideas as colleagues in the field. If you need a consult specifically on a particular patient case or thoughts about medications, recoveries, therapy, family support, or any other topic around SMI, please reach out to our consult service. Our experts are able to answer those usually within one business day for those consults. Next slide, please. Future resource. Here is the Addressing Social Needs and Social Determinants of Health for People Experiencing SMI. It's a webinar, so here's the link if you're interested in this product. It's also been dropped in the chat as well, so you can just click and open that. All right. To claim credit for participating in the webinar, you need to meet the prerequisite attendance threshold for your profession. A verification of attendance may take up to one hour, so after the webinar ends, please select Continue on the pop-up, then select Evaluation to the left of the event detail to complete the evaluation and claim your credit. Our upcoming webinar, March 15th, please join us as Kim Davison presents Mental Health and Harm Reduction, Meeting Clients Where They Are. This will be a very exciting topic about uncovering harm reduction as an approach to treatment. I want to thank everyone for your time today, especially you, Dr. Loma, for joining us and providing some insight. Thank you so much. Thank you. I appreciate it.

Social Determinants of Health

People Living with Psychiatric Disorders

Pharmacists

Medication Therapy Management

Healthcare Providers

Advocacy for Patients

Pharmacy Practice

Patient Care

Case Scenarios