Integrating social determinants into pharmacotherapy courses: A case-based learning approach

Approaches for Embedding Structural Competency and Social Determinants of Health in Pharmacy Curricula

There is emerging scholarship related to teaching social determinants of health (SDOH) in pharmacy education; however, challenges remain for pharmacy educators due to a lack of formal consensus on which aspects of SDOH should be taught or evaluated. SDOH is often confused with similar, overlapping concepts such as cultural competence, cultural humility, Diversity, Equity, and Inclusion; however, there are key differences. While all domains of SDOH are relevant to patient health outcomes, educators may find it challenging to determine which competencies are most essential for student pharmacists and most applicable to direct patient care in pharmacy practice. This article reviews literature from pharmacy and multiple health professions disciplines relating to teaching SDOH. The objective of this paper is to use this literature as support and leverage the expertise within the American Association of Colleges of Pharmacy (AACP) Health Disparities and Cultural Competence Special Interest Group, to provide guidance to pharmacy programs aiming to meet accreditation requirements. The recommendations herein are evidence-based, with practical insights and recommendations from forward-thinking pharmacy educators.

Curricular Assessment Blueprint and Needs Analysis for the Social, Administrative, and Behavioral Foundational Sciences

OBJECTIVES

The objective of this integrative review is to analyze conceptual topics, applied content, teaching and learning strategies, and assessment methods within social, administrative, and behavioral sciences (SAS) syllabi and literature. The goal is to evaluate opportunities for enhancing the adoption and implementation of Curricular Outcomes and Entrustable Professional Activities 2022. Recommendations to better inform curriculum and assessment planning efforts are presented for programs and faculty seeking to optimize the integration of SAS content.

FINDINGS

Our search yielded 69 SAS-related syllabi from the American Association of Colleges of Pharmacy Connect repository and 296 publications from pharmacy journals focused on education. Most SAS literature was published in the didactic setting, which represents an opportunity to interweave and apply SAS knowledge concepts through the experiential, cocurricular, and interprofessional settings. In the future, it would be prudent to thoughtfully design assessment measures that encompass both summative and formative evaluations. The literature findings offer valuable insights and examples regarding content, teaching strategies, and assessment methods. These findings can serve as a practical framework, providing ideas and guidance for programs and faculty aiming to enhance the integration of SAS content into their curricula.

SUMMARY

In response to the recent guidelines from Curricular Outcomes and Entrustable Professional Activities 2022 and the release of the Accreditation Council for Pharmacy Education Standards 2025, programs and faculty have the responsibility to thoughtfully revise and improve the delivery and assessment of SAS content. The intentional integration of SAS knowledge, skills, and attitudes should be guided by a collaborative effort to develop pharmacists who deliver effective person-centered care and are well-equipped to navigate the complexities of health care.

The Spanish pathway program: Introducing, recruiting, and retaining Spanish-speaking students to the pharmacy profession

BACKGROUND AND PURPOSE

Although 19% of the US population is Hispanic or Latino, less than 5 % of pharmacists identify as Hispanic. To increase patients' access to Spanish-speaking pharmacists, we created a Spanish Pathway Program. This program is adaptable to other colleges or schools of pharmacy with high Hispanic or Latino populations or for addressing disparities in other underrepresented groups.

EDUCATIONAL ACTIVITY AND SETTING

The program was designed with three objectives: 1) attracting Hispanic, Latino, and/or Spanish-speaking students to pharmacy careers, 2) recruiting and retaining Spanish-speaking pharmacy students to the program with leadership development, mentoring, education, and networking opportunities, and 3) preparing students to serve Hispanic and Latino communities through experiential rotations and health outreaches. Outcomes included student application and retention rates, graduate job placement, and clinical interventions made by program students on experiential rotations in Hispanic/Latino communities.

FINDINGS

Over six years, the program has grown from two students on one campus to 20 students from two campuses. Program retention is 97% with three-fourths of graduates securing community pharmacy careers. Students report positive patient interactions because of their ability to communicate in Spanish.

DISCUSSION

This program successfully increased the number of Spanish-speaking pharmacists by increasing the number of Spanish-speaking students in our pharmacy program and subsequent employment in practice. We refined the program by adding a medical Spanish certification course and student projects which aid the Hispanic and Latino community.

SUMMARY

The Spanish Pathway Program established at Roseman University has had six years of success increasing the Spanish-speaking pharmacist workforce.

Enhancing hypertension pharmacotherapeutics education by integrating social determinants of health

OBJECTIVE

Social determinants of health (SDOHs) play a significant role in hypertension management. Pharmacy program accreditation standards include that students should understand SDOHs. However, there are limited data regarding approaches to incorporating SDOHs within pharmacotherapeutics courses. This study evaluated the changes in student knowledge, understanding, perceptions, beliefs, and confidence by integrating SDOH topics in hypertension pharmacotherapeutics lectures.

METHODS

The study invited students enrolled in cardiovascular pharmacotherapeutics courses at 2 institutions to participate. Participation involved a preintervention questionnaire, a lecture on clinical management of hypertension incorporating SDOH concepts, an assignment involving reading a journal article and answering related questions, and a postintervention questionnaire. Data analysis was conducted using SPSS, with a predetermined α level of 0.05 for statistical significance. Mean composite questionnaire scores were calculated and compared with Wilcoxon signed rank test.

RESULTS

Of 109 students, the response rate was 85.3 % (93 participants). The combined questionnaire results demonstrated a statistically significant improvement in all questionnaire item composites. The open-ended knowledge assessment yielded a mean score of 5.75 (range 3-6).

CONCLUSION

The study intervention enhanced student knowledge, understanding, perceptions, beliefs, and confidence regarding the impact of SDOHs on hypertension. This practical and reproducible approach offers a valuable method for incorporating SDOH concepts into pharmacotherapeutics courses.

A roadmap beyond dispensing for educating and training community pharmacists on key mental health competencies: A mixed-methods national study

BACKGROUND

Including pharmacists in collaborative mental healthcare models has yielded positive results. Establishing processes to enhance pharmacists' mental health care capabilities is crucial for addressing the increasing burden and improving access to mental health services.

OBJECTIVES

This study evaluated community pharmacists' mental health competencies and analyzed associated factors using a rigorous international framework. Additionally, it sought to identify pharmacists' training needs and support requirements as the first stop in creating a roadmap for enhancing mental healthcare through community pharmacies.

METHODS

A large-scale national study employing a mixed-methods approach was conducted with community pharmacists in United Arab Emirates. Semi-structured individual interviews and a cross-sectional survey were conducted. Pharmacists' core competencies were assessed using the Core Mental Health Competencies Framework for all Pharmacy Professionals. Generalized linear models were utilized to identify predictors of pharmacists' competency levels. Thematic analysis was used to analyze qualitative data.

RESULTS

In total 650 community pharmacists completed the survey (93.7% response rate). Eight pharmacists participated in semi-structured interviews. Nearly two-thirds (63.7%) received general communication skills training, while training in motivational interviewing (44.7%), shared decision-making (37.2%), and mental illness stereotyping/stigma (23.9%) were less common. Pharmacists reported lower perceived competence in their relationship with multidisciplinary teams (M = 3.02, SD = 0.89), stigma recognition (M = 3.02, SD = 1.04), and identifying mental health crises and aiding in the person's safety (M = 3.01, SD = 1.05). Poor communication skills (p < 0.001) and working in pharmacies that do not stock psychotropic medications (p = 0.023) were associated with lower perceived competence. Qualitative analysis identified training needs in various domains, including attitudes, values, and beliefs about mental health; relationships with multidisciplinary teams; communication skills; pharmaceutical knowledge; and personal and service development.

CONCLUSIONS

Mental health-related training is needed for community pharmacists. Addressing these needs through an intentional roadmap approach will enable pharmacists to better engage with patients with mental illness and increase access to care.

Impact of Teaching Social Determinants of Health on PIF in the Health Professions

OBJECTIVE

To address the lack of methods for assessing learning on social determinants of health, particularly from a health systems perspective. Using a conceptual framework of professional identity formation applied across 3 professions (athletic training, occupational therapy, and pharmacy), the study aimed to describe students' level of professional identity when applying knowledge of structural factors' impact on health.

METHODS

This study was a deductive content analysis of students' written reflections. Identified themes explored how students explained sociopolitical influences on health as well as their assessed level of professional identity.

RESULTS

Students were inclined to author narratives focused on the ways in which structural factors influence individual outcomes and aspects within the health care system. Most students were assessed to be at the initial levels of professional identity formation, but those with a comparatively higher level of professional identity expressed a commitment to professional behaviors that address social determinants of health.

CONCLUSION

This analysis created a foundation for future pedagogical work in health care system-related structural learning outcomes within and between different health professions. Findings suggest that across professions, most first-year students demonstrated the ability to reconcile different perspectives and were in the early stages of aligning personal values with professional values. The use of reflection has the potential to assess professional identity formation among a range of health professional students.