Social Determinants of Health in People Living with Psychiatric Disorders: The Role of Pharmacists

Abstract

Introduction: Social determinants of health (SDOH) affect outcomes of people living with psychiatric disorders, including substance use disorders. As experts in medication optimization, pharmacists play a vital role in identifying and addressing medication-related problems associated with SDOH. However, there is a paucity of literature on how pharmacists can be part of the solution.

Objective: The purpose of this article is to provide a narrative review and commentary on the intersection between SDOH, medication-related outcomes in people living with psychiatric disorders, and the role of pharmacists in addressing them.

Method: The American Association of Psychiatric Pharmacists appointed an expert panel to research the issue, identify barriers, and develop a framework for including pharmacists in addressing medication therapy problems associated with SDOH in people with psychiatric disorders. The panel used Healthy People 2030 as the framework and sought input from public health officials to propose solutions for their commentary.

Results: We identified potential connections between SDOH and their impact on medication use in people with psychiatric disorders. We provide examples of how comprehensive medication management can afford opportunities for pharmacists to mitigate medication-related problems associated with SDOH.

Conclusion: Public health officials should be aware of the vital role that pharmacists play in addressing medication therapy problems associated with SDOH to improve health outcomes and to incorporate them in health promotion programs.

Keywords: clinical pharmacists; community pharmacists; healthy people programs; psychiatric disorders; public health; social determinants of health.

FIG. 1.

Overview of pharmacist training and specialization in the United States. The diagram provides a simplified overview of the credentials, training, and practice settings for pharmacists, with a focus on distinguishing clinical pharmacists and psychiatric pharmacists from other pharmacists. This diagram does not represent all forms of pharmacy practice, as pharmacists practice in several other settings, including hospital pharmacy administration, industry, and academia. The Doctor of Pharmacy (PharmD) has been the entry-level educational credential for pharmacists since 2000, requiring a total of 6–8 years of undergraduate and professional education. Community pharmacists, practicing in the outpatient, retail setting in either chain or independent pharmacies, are essential providers of medication advice and are responsible for the safe and effective dispensing of medications pursuant to legally valid prescriptions. Clinical pharmacists, whose roles are frequently divorced from traditional dispensing responsibilities, are generally board certified in their specialty areas, have completed 1–2 years of postgraduate residency training, and may practice in either the inpatient (hospital) or outpatient (ambulatory care) settings. Some pharmacists are board certified in pharmacotherapy or ambulatory care pharmacy while others have expertise in psychiatry or 1 of the other 11 BPS-recognized specialties. Community pharmacists, while not required, may also be board certified and residency trained. BPS, Board of Pharmacy Specialties.