As part of a special issue on 💊 costs & access, we wrote a broad review on “Pursuing #Pharmacoequity - Determinants, Drivers, and Pathways to Progress.
We talk social & health policy, research, patient & prescriber factors. 👇🏾👇🏾
2/ Understanding the multilevel determinants that influence equitable access to medications (and trying to do so in <5000 words (!) was the goal of our review.
With so many factors out there, we know we only began to scratch the surface.
🔴 Public transportation & geographic access to pharmacies
🔴 Income and wealth inequities
🔴 Research representation
🔴 Health insurance coverage (e.g., ACA & Medicare Part D)
🔴 Clinician bias & trustworthiness
🔴 Patient primary language
4/ Along with the drivers, we discuss some possible solutions:
🟢 Decreasing cost of drugs
🟢 Provide low-cost drug coverage for uninsured & under-insured
🟢 Reduce geographic barriers to pharmacies
🟢 Engage community in developing interventions to increase pharmacoequity
5/5 This #Pharmacoequity review was a definite labor of love.
Amazing to work with rockstar med students @rohanchalasani & @sudkrish who led the paper, and get pharmacy (@Sudamonas & Dr. Terri Newman) and legal (@S_Delaney) expertise while writing this.
This was a study of >81,000 MCAT examinees (0.3% American Indian or Alaska Native, 21.3% Asian, 10.1% Black, 8.0% Hispanic, and 60.4% White) from 2015-2018.
I don’t know about y’all, but this was *the* hardest test I took. 😳
If y’all read *one* thing today, might I suggest this new article in @NEJM?
“The belief that Black people have denser bones, more muscle, or thicker skin led radiologists and technicians to use higher radiation exposure during x-ray procedures.”
In the latest issue of @JAMA_current, my mentor Michael Fine, Donna Washington and I were invited to discuss a new 📝 on disparities in SGLT2i and GLP1-RA use for diabetes and what it means for the field of #Pharmacoequity research.
2/ As has been discussed frequently over the last month with the insulin co-pay provisions in the #InflationReductionAct, >37 million people in the US have #diabetes.
Regrettably, underrepresented racial and ethnic groups folks have ⬆️ rates of diabetes.
3/ Even with the ⬆️ rates of diabetes, Black, Hispanic, and Asian patients in the US have been shown to have lower rates of #diabetes treatment, especially with the newer drugs available such as SGLT2i & GLP1-RAs.
In @JAMANetworkOpen, we found that VA patients with #AFib who experience homelessness had a 21% ⬇️ odds of receiving stroke-preventing anticoagulation (blood thinners).
Previously, if you looked up "homeless & atrial fibrillation" in PubMed, only 5 results came up.
This included a 2003 @JAMAInternalMed study that saw that Ohio Medicaid enrollees had ⬇️ use of warfarin if they had homelessness or inadequate housing.
Led by future Dr. @rohankhaz, we dive into the challenges & opportunities in ensuring that patients and communities most affected by the pandemic can get the care they need.
2/ At risk of redundancy, we previously discussed the challenges in achieving #Pharmacoequity, including in the pandemic, noting, “…For example, treatment of patients with #COVID19 has revealed substantial inequities in access to life-saving treatments.”
3/ That observation was supported by national CDC data from earlier this year, as well as a recent national analysis of Medicare enrollees that found that Black patients had a 23% ⬇️ odds of receiving monoclonal antibodies when diagnosed with #COVID19.
A time for us to re-learn and re-discover our history.
A history beyond the chapter on Civil Rightsin our high school textbooks.
A history beyond the Emancipation Proclamation and Brown v. Board of Education.
So what are you reading this month?
2/ The ship grew larger & more terrifying w. each stroke of the paddle. The smells grew stronger, the sounds louder, crying & wailing from one quarter, low singing from another; the anarchic noise of children given an underbeat by hands drumming on wood.”
“Locked out of the greatest opportunity for wealth accumulation in history, African Americans who were able to afford homes found themselves consigned to communities where their investments were affected by the FHA.”