Implementation of primary care clinical pharmacy services for adults experiencing homelessness

Albertson, Shelby; Murray, Taylor; Triboletti, Jessica; Pence, Lauren; Gonzalvo, Jasmine D.; Meredith, Ashley H.; Walroth, Todd; Rodgers, Judy; Crane, Liza; Sidle, John E.

doi:10.1016/j.japh.2020.10.012

Cited by 8 publications

(24 citation statements)

References 6 publications

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“…Among 152 studies in multiracial or multiethnic populations, 44 studies (28%; comprising 49 interventions) included race or ethnicity variables in their analyses in some way. eTable 11 in Supplement 1 outlines the key characteristics of these 44 studies and 49 interventions.…”

Section: Resultsmentioning

confidence: 99%

Racial Health Equity and Social Needs Interventions

et al. 2023

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ImportanceSocial needs interventions aim to improve health outcomes and mitigate inequities by addressing health-related social needs, such as lack of transportation or food insecurity. However, it is not clear whether these studies are reducing racial or ethnic inequities.ObjectiveTo understand how studies of interventions addressing social needs among multiracial or multiethnic populations conceptualize and analyze differential intervention outcomes by race or ethnicity.Evidence ReviewSources included a scoping review of systematic searches of PubMed and the Cochrane Library from January 1, 1995, through November 29, 2021, expert suggestions, and hand searches of key citations. Eligible studies evaluated interventions addressing social needs; reported behavioral, health, or utilization outcomes or harms; and were conducted in multiracial or multiethnic populations. Two reviewers independently assessed titles, abstracts, and full text for inclusion. The team developed a framework to assess whether the study was “conceptually thoughtful” for understanding root causes of racial health inequities (ie, noted that race or ethnicity are markers of exposure to racism) and whether analyses were “analytically informative” for advancing racial health equity research (ie, examined differential intervention impacts by race or ethnicity).FindingsOf 152 studies conducted in multiracial or multiethnic populations, 44 studies included race or ethnicity in their analyses; of these, only 4 (9%) were conceptually thoughtful. Twenty-one studies (14%) were analytically informative. Seven of 21 analytically informative studies reported differences in outcomes by race or ethnicity, whereas 14 found no differences. Among the 7 that found differential outcomes, 4 found the interventions were associated with improved outcomes for minoritized racial or ethnic populations or reduced inequities between minoritized and White populations. No studies were powered to detect differences.Conclusions and RelevanceIn this review of a scoping review, studies of social needs interventions in multiracial or multiethnic populations were rarely conceptually thoughtful for understanding root causes of racial health inequities and infrequently conducted informative analyses on intervention effectiveness by race or ethnicity. Future work should use a theoretically sound conceptualization of how race (as a proxy for racism) affects social drivers of health and use this understanding to ensure social needs interventions benefit minoritized racial and ethnic groups facing social and structural barriers to health.

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Section: Resultsmentioning

confidence: 99%

Racial Health Equity and Social Needs Interventions

et al. 2023

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“…Figure 2 includes the context or setting for the included sources. Primary health care (n=58) was the setting for almost half of the included sources, 21 , 37 , 39 – 42 , 44 , 45 , 47 – 51 , 54 , 56 , 57 , 62 , 63 , 65 , 67 , 72 , 73 , 75 , 77 , 79 , 81 – 84 , 87 , 88 , 91 , 94 – 96 , 98 – 100 , 104 , 106 , 108 – 110 , 112 , 114 – 116 , 122 , 123 , 125 , 128 , 129 , 140 , 142 , 143 , 146 , 152 , 153 followed by health service/delivery system (n=31), 35 , 36 , 38 , 43 , 71 , 92 , 93 , 97 , 102 , 103 , 105 , 107 , 111 , 117 – 121 , 124 , 126 , 130 , 132 ,…”

Section: Resultsmentioning

confidence: 99%

“…Of the included studies only 55% (n=67) were identified as using a framework or model to guide the research. 21 , 35 , 37 – 41 , 44 , 47 , 48 , 50 , 52 , 54 – 56 , 61 – 63 , 66 , 71 , 73 – 78 , 83 – 85 , 88 , 92 – 94 , 96 , 98 , 101 – 107 , 109 – 112 , 116 – 118 , 123 , 127 , 130 , 131 , 133 , 135 – 138 , 140 , 141 , 143 – 145 , 149 , 151 – 153 The most reported framework was Health Equity Impact Assessment (n=4), 37 , 98 , 133 , 135 followed by the Quality and Outcomes Framework (n=2), 61 , 112 and the Dismantling Racism framework (n=2). 71 , 73 All the remaining sources (n=59) used unique frameworks to operationalize their health equity work within a specific organizational or system context.…”

Section: Resultsmentioning

confidence: 99%

“… 71 , 73 All the remaining sources (n=59) used unique frameworks to operationalize their health equity work within a specific organizational or system context. 21 , 35 , 38 – 41 , 44 , 47 , 48 , 50 , 52 , 54 – 56 , 62 , 63 , 66 , 74 – 78 , 83 – 85 , 88 , 92 – 94 , 96 , 101 – 107 , 109 – 111 , 116 – 118 , 123 , 127 , 130 , 131 , 136 – 138 , 140 , 141 , 143 – 145 , 149 , 151 – 153 The health equity work described in our included sources took place in multiple settings that ranged from a whole health system to clinical and community health service providers, meaning there was substantial variation in the frameworks that were used. This made it challenging to assess their utility.…”

Section: Resultsmentioning

confidence: 99%

“… 21 , 36 , 57 , 61 , 78 , 95 , 107 , 110 , 121 , 122 , 124 , 143 , 150 A combination of delivery arrangements (ie, changes in how and who delivers care) with implementation strategies was the most common combination (n=45). 35 , 39 – 41 , 52 , 53 , 55 , 62 – 67 , 69 , 70 , 74 , 77 , 80 – 84 , 89 , 91 , 94 , 96 , 99 , 101 , 106 , 109 , 111 , 113 – 116 , 119 , 123 , 125 , 128 , 131 , 137 , 139 , 140 , 148 , 149 Strategies categorized solely as delivery arrangements (n=13) 38 , 45 , 47 , 51 , 54 , 58 , 68 , 86 , 87 , 104 , 105 , 129 , 154 or solely as implementation strategies interventions (n=11) 42 – 44 …”

Section: Resultsmentioning

confidence: 99%

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Strategies and indicators to integrate health equity in health service and delivery systems in high-income countries: a scoping review

Caldwell,

Yusuf,

Carrea

et al. 2024

JBI Evidence Synthesis

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Objective: The objective of this review was to describe how health service and delivery systems in high-income countries define and operationalize health equity. A secondary objective is to identify implementation strategies and indicators being used to integrate and measure health equity. Introduction: To improve the health of populations, a population health and health equity approach is needed. To date, most work on health equity integration has focused on reducing health inequities within public health, health care delivery, or providers within a health system, but less is known about integration across the health service and delivery system. Inclusion criteria: This review included academic and gray literature sources that described the definitions, frameworks, level of integration, strategies, and indicators that health service and delivery systems in high-income countries have used to describe, integrate, and/or measure health equity. Sources were excluded if they were not available in English (or a translation was not available), were published before 1986, focused on strategies that were not implemented, did not provide health equity indicators, or featured strategies that were implemented outside the health service or delivery systems (eg, community-based strategies). Methods: This review was conducted in accordance with the JBI methodology for scoping reviews. Titles and abstracts were assessed followed by a full-text review. The information extracted consisted of study design and key findings, such as health equity definitions, strategies, frameworks, level of integration, and indicators. Most data have been quantitatively tabulated and presented according to 5 review questions. Some findings (eg, definitions and indicators) were summarized using qualitative methods. Most findings are visually presented in charts and diagrams or presented in tabular format. Results: Following review of 16,297 titles and abstracts and 824 full-text sources, we included 122 sources (113 peer-reviewed, 9 gray literature) in this scoping review. We found that health equity was inconsistently defined and operationalized. Only 17 sources included definitions of health equity and we found that both indicators and strategies were lacking adequate descriptions. The use of health equity frameworks was limited and, where present, there was little consistency or agreement in their use. We found that strategies were often specific to programs, services, or clinics, rather than broadly applied across health service and delivery systems. Conclusions: Our findings suggest that strategies to advance health equity work are siloed within health service and delivery systems and are not currently being implemented system-wide (ie, across all health settings). Healthy equity definitions and frameworks are varied in the included sources, and indicators for health equity are variable and inconsistently measured. Health equity integration needs to be prioritized within and across health service and delivery systems. There is also a need for system-wide strategies to promote health equity, alongside robust accountability mechanisms for measuring health equity. This is necessary to ensure that an integrated, whole-system approach can be consistently applied in health service and delivery systems internationally. Review registration: Dal Space dalspace.library.dal.ca/handle/10222/80835 Supplemental digital content is available for this review: http://links.lww.com/SRX/A45

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