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.
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.”
One of the points we made in our article last month (👇🏾) is that #Pharmacoequity extends beyond prescription drug access to the entire therapeutic cascade. A couple of interesting papers led by @ashwin_nathan & @ACFanaroff on TAVRs and #HealthEquity.
3/3 A month later, the team showed in @JAMACardio that zip codes with ⬆️ rates of Black & Hispanic patients and those with more socioeconomic disadvantages had ⬇️ rates of TAVR, adjusting for age and clinical conditions.
2/ Ensuring that all individuals, regardless of race & ethnicity, socioeconomic status, or availability of resources, have access to the highest quality medications required to manage their health needs is paramount. This is what we call #Pharmacoequity.
3/ The #COVID19 pandemic has brought health equity to the forefront, especially in how we ensure access to novel therapies, from antivirals like #remdesivir and #molnupiravir to the Covid vaccine...
But inequities in access to novel drugs are much more than a Covid problem. 👇🏾
2/ The pandemic has taught us so much about our health system, but it has especially shone a bright light on the social determinants as key drivers of #HealthEquity. Our review focused on:
🔸 race/ethnicity
🔸 finances
🔸 rurality/neighborhood
🔸 health literacy
🔸 social network
3/ The social construct of race has been one of the most well-studied determinants of #AFib incidence, treatment (including our work in anticoagulation disparities), and outcomes. Here we discuss why such inequities exist across the AFib care continuum.