(239) Making the case for inclusion of structural competency training in pharmacy experiential education

Objective : Structural competency is the capacity for health professionals to recognize and respond to health and illness as the downstream effects of broad social, political, and economic structures. These structures produce the conditions in the environments where people are born, live, learn, work, play, worship, and age - termed social determinants of health (SDOH). The primary objective of this study was to determine whether pharmacists’ social determinants of health (SDOH) assessed as historical exposure, is associated with their self-assessed structural awareness.

Methods: A web-based cross-sectional survey was administered to pharmacists currently licensed in Minnesota. SDOH risk scores (using a modified Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences [PRAPARE] questionnaire); and structural awareness scores using a modified component of the Cultural Competence Self-Assessment Questionnaire [CCSAQ], were calculated, respectively. Multiple linear regression was employed to examine the association between structural awareness and SDOH risk score, controlling for year of first licensure, pharmacy practice type, race, and gender.

Results: One-third (33.2%) of the respondents (N=611) practiced in community/retail settings, 27.2% in hospital, and 17.7% in ambulatory care. Most respondents had never had unmet needs for an extended period (75.5%)); never been without insurance for ≥ 3 months (83%); never experienced food insecurity (92.8%) , housing instability (85.6%) or transportation needs (92.3%) over an extended period (≥1 month). SDOH risk was significantly associated with structural awareness (95% CI; p-value = 0.0013)

Conclusions: Pharmacists without the lived experience of adverse SDOH, or relevant exposure, are less likely to connect structural factors to clinical presentation of disease. Pharmacy experiential education should therefore include structural competency training to enable pharmacists to recognize and contribute to addressing the root causes of health inequity.