Use of PQA’s SDOH Resource Guide to Address Barriers in Patients’ Medication Access Journey
Barriers to medication access are a public health issue that affect adherence and patient outcomes. PQA emphasizes the pharmacist’s role in medication access and developed the Medication Access Patient Journey (MAPJ) conceptual framework that defines a patient’s medication access journey and characterizes barriers frequently encountered while seeking medication access. This framework highlights seven steps, or nodes, of the patient's journey to medication access: perceived need, help seeking, encounter, prescribing, prescription adjudication, prescription dispensing, and adherence.
The MAPJ framework can be used to highlight both barriers and opportunities to improve medication access. For example, opportunities exist to leverage PQA’s Social Determinants of Health (SDOH) Resource Guide to address barriers and increase pharmacy services and medication access. The Resource Guide documents 40 real-world SDOH screening and referral services for medication safety and quality.
Below are brief examples overlaying these two resources to improve medication use quality.
Node 01: Perceived Need
Patients may have limited access to healthcare services for unknown or unmanaged chronic diseases like hypertension and diabetes. A patient’s inability to recognize critical symptoms and their need for care to manage a disease can be a barrier to this first step of their journey to access appropriate medications. Page 12 of the SDOH Resource Guide explains how pharmacies can address this barrier by utilizing the community clinic linkage (CCL) model by promoting screenings, point-of-care testing, and referrals to community services. These efforts may increase patients’ awareness of diseases and the benefits of an intervention.
Node 02: Help Seeking
Patients may have trouble accessing pharmacies depending on geographic location, limited public transit, or vehicle ownership. One way to tackle this lack of accessibility is to offer free medication delivery to retail pharmacy patients. The SDOH Resource Guide highlights the Walgreens Free Delivery Services in Chicago on page 18 to increase patient prescription medication access and expand pharmacy services to reach diverse communities.
Node 03: Encounter
Patients require regular assessments and appropriate treatment of chronic diseases. Some patients may also expect providers to be conveniently located for check-ins. A necessary encounter may not occur if a patient has difficulty accessing pharmacy services. The implementation of an in-home medication review and intervention called HomeMeds, described on page 64 of the SDOH Resource Guide, amplifies access to quality healthcare professionals to resolve medication therapy problems and alleviates transportation obstacles. Pharmacy teams can address priority SDOH needs and provide clinical expertise through in-home, telephonic, and online visitations.
Node 04: Prescribing
Patients are often unaware of high copays for their medications. This cost-related barrier to accessing medications exists because providers often do not know details about each patient’s insurance plan coverage and benefits and mainly focus on prescribing the necessary medications. Further, patients may be less likely to accept a prescribed medication if they do not fully understand the prescription. Page 28 of the SDOH Resource Guide highlights the Towncrest Pharmacy tool to screen for unmet social needs in Iowa. The pharmacy team implemented an SDOH screening tool into their workflow that allows them to identify SDOH barriers, including cost of medications and language barriers that may prevent understanding and acceptance of the prescription, and refer patients to community resources based on their needs.
Node 05: Prescription Adjudication
In pharmacies, prescription adjudication, or the processing and payment of a medication claim, can lead to treatment delays, which can affect patient health outcomes. Page 58 of the SDOH Resource Guide describes one initiative that works to avoid delays in medication receipt by having pharmacists collaborate with primary care clinics serving under-insured and uninsured patients, leading to increased access to high-cost medications through patient assistance programs and other forms of financial assistance. This opportunity minimizes potential prescription adjudication barriers and provides more lifesaving, affordable medications to patients.
Node 06: Prescription Dispensing
Prescription dispensing is when a patient receives their medication. A barrier to successful dispensing is poor communication between pharmacies and patients to identify social needs and health disparities. One initiative to alleviate this barrier is described on page 36 of the SDOH Resource Guide. The Community Pharmacy Enhanced Services Network (CPESN) in Missouri developed an initiative to enhance SDOH screening by utilizing community health workers to provide SDOH support. Pharmacy staff leverage the point-of-contact with patients during the dispensing process to complete an initial SDOH screening. The community health workers then provide support to meet patients’ needs. These efforts improve the identification of and ability to address social needs and health disparities at the point of prescription dispensing.
Node 07: Adherence
Medication adherence is essential to meet therapeutic goals. Targeting patient populations to improve medication adherence can heighten patients’ awareness of the purpose, appropriateness, and side effects of their medications, thereby influencing their likelihood of being adherent. As noted on page 48 of the SDOH Resource Guide, SCAN Health Plan led outreach and interventions to reduce medication adherence disparities among their Black and Hispanic members who take medications for diabetes, cholesterol, and blood pressure. Targeting these specific populations reduced adherence disparities and supported patient-centered goals.
Awareness is needed to spotlight pharmacy access in the United States. PQA’s Medication Access Patient Journey framework outlines seven nodes and identifies potential barriers a patient faces in medication access. At the same time, PQA’s SDOH Resource Guide addresses barriers to accessing prescriptions and solutions to impact patient outcomes. By prioritizing potential opportunities, pharmacies can reach greater populations and positively impact healthcare utilization.
Katie Quigley was a PQA MPH Practicum Program student in 2024. Visit PQA’s website to learn more about the program.