We’ve all heard it a thousand times: pharmacists are any team’s medication experts. They’re often called upon to review medications, provide recommendations on drug therapy, and educate patients on their treatments. What’s talked about less, however, is the work that hospital pharmacists undertake to minimize health inequities for underserved populations.

The ever-growing body of evidence demonstrates that pharmacotherapeutic outcomes are worse for marginalized populations, and the impacts of social determinants of health can decrease access to care, create health inequities, and ultimately worsen outcomes for marginalized patients.

The American Society of Health-System Pharmacists’ (ASHP) 2023 Forecast panelists predicted that there will be integration of community-level social determinants of health data into a patient’s record within 5 years, and that this data will be supported to implement care plans. Are pharmacists ready to utilize this data to improve patient outcomes? Do they have the necessary expertise? Do they have the support from their colleagues and organizations? 

As a pharmacy resident, I’ve had the opportunity to observe many pharmacists in action, and the above are all questions I’ve asked myself and my colleagues throughout my residency.

Despite often working quietly behind the scenes, pharmacists play a vital role in enhancing pharmacotherapeutic outcomes for underserved populations. They achieve this in a multitude of ways. Be it through liaising with community organizations or patient assistance programs to obtain drug coverage for patients who couldn’t otherwise access medications or educating their teams on the monitoring of lab values for individuals on gender-affirming hormone therapy, the pharmacist is an ally and advocate for equitable healthcare access and outcomes. However, I don’t know if many of these pharmacists would self-declare themselves as equity, diversity, and inclusion (EDI) “champions”, despite being perfectly positioned to be advocates for practice and policy changes to improve health outcomes for underserved populations. 

While many pharmacists may not have received formal education on health inequities and culturally safe care, there is still a strong sense of pride among pharmacists in serving as patient advocates.

While many pharmacists may not have received formal education on health inequities and culturally safe care, there is still a strong sense of pride among pharmacists in serving as patient advocates. What’s more, there a strong commitment to supporting patients, particularly those who are most vulnerable. The dedication and tenacity displayed by the pharmacists I’ve had the chance to learn from, for example, are an invaluable resource that teams should utilize to help minimize care gaps for vulnerable patients. 

For instance, while on an obstetrics rotation, I saw some of the most vulnerable patients come through the hospital doors. Pregnant individuals who had been traumatized by the medical system, had very little social and financial support, and difficulty with trusting health care professional. My preceptor, with great confidence, shattered what I thought I knew about our role as pharmacists. She identified gaps in care that were inevitably going to lead to patients falling through the cracks, and filled them without hesitation, even though these tasks often fell far outside of her job description. In my eyes, she was the last line of defense against these patients being left behind, working tirelessly by doing everything from organizing outpatient care visits for patients, to going above and beyond to ensure that her patients on opioid agonist maintenance therapy got the appropriate therapy and never missed a dose. This served as evidence that pharmacists are ideally positioned to act as patient advocates, despite not always having the structural support.

During a mental health and addictions rotation, I got to work with a team who proudly exemplifies what it means to incorporate trauma-informed care and social determinants of health into practice. Though, the hospital pharmacist with whom I had the privilege of working, like other pharmacists, would likely never call herself an EDI champion, she recognized and opposed the systemic barriers and inequalities that created an unfair playing field for her patients. Drawing on her wealth of knowledge regarding the health inequities faced by her patients, she was able to confidently make drug therapy recommendations that others may not have considered. She took the time to gather information about a patient’s past experiences, family histories, beliefs, and attitudes with regards to psychotropic medications to predict with which therapies the patient would likely succeed. She prompted the team to think about potential financial and socioeconomic barriers faced by the patient, and always incorporated the intersection of medications and patients’ personal and cultural beliefs. Ultimately, this illustrated the utility of providing pharmacists with time and support to address the needs of underserved populations.

Based on these experiences, it appears evident to me that pharmacists can be great advocates for their patients, in the area of EDI, particularly when nobody else takes up that role. However, despite having the best intentions, there are still great distances to travel to turn intentions into concrete impact. As I finish my pharmacy residency and reflect on my experiences in EDI, here are a few of my take home messages, I would like to share: 

To the pharmacists: Become painfully aware of the health inequities faced by the marginalized populations you serve. Your voice is incredibly valuable, therefore change what you can, and advocate for what you
cannot. 

To the pharmacy leaders: Incorporate EDI initiatives into your organizational culture and promote diversity in your workforce. Create an environment where health inequities, resources, and experiences can safely be shared and discussed. 

To the organizations and other healthcare professionals: Invest in your pharmacists and allocate the appropriate resources to allow them to thrive. Utilize their tenacity and expertise to improve patient care and get closer to health equity.

By Zach Kennedy

Zach Kennedy is a pharmacist and is currently completing his pharmacy residency at iwk health in Halifax, NS. He aims to utilize his platform to promote edi in hospital pharmacy and advocate for underserved populations