Provision of Comprehensive Clinical Pharmacy Services to Underserved Populations through Community Safety Net Clinics
Steven Chen, Pharm.D., FASHP, Kathleen A. Johnson Pharm.D., M.P.H., Ph.D., Mel Baron, Pharm.D., M.P.A., Sally Lu, Pharm.D., Cecilia Wu, Pharm.D., B. Elizabeth Cervantes, Pharm.D., R. Pete Vanderveen, R.Ph., Ph.D.
USC School of Pharmacy Safety Net Clinic Group, Los Angeles, California
The majority of safety net clinics in Los Angeles County does not employ pharmacists and is unfamiliar with the broad range of clinical services that pharmacists can provide. Our faculty team partnered with several safety net clinics to:
- Assist clinics in purchasing drugs through lower cost 340B programs;
- Organize dispensary formularies to take advantage of free medications from patient assistance programs;
- Provide disease state management (DSM) services targeting high-risk safety net clinic patients; and
- Increase the number of student pharmacists and residents exposed to and trained to provide care to diverse safety net clinic patients.
Three safety net clinics interested in developing clinical pharmacy services were chosen as initial partners. Pharmacists were hired through start-up grants. Initial meetings between the pharmacy team and medical administrators from each of the three safety net clinics revealed that all clinics were purchasing expensive medications for which low- or no-cost alternatives were available and were struggling to manage diabetes, hypertension, asthma, and dyslipidemia. Disease management protocols and collaborative practice agreements were drafted. A computerized documentation system developed by one of the faculty members was hosted on the university server to document care and facilitate collection of chronic disease measures and outcomes. Funding was obtained to begin a student pharmacist volunteer program that helped to provide prescription drug counseling and patient education classes. Additional foundation grants were obtained to expand the pharmacy services to other safety net clinics.
The program has been successful in meeting the established objectives. By maximizing the use of low- and no-cost medications under the pharmacists’ direction, the three initial clinics together saved nearly $700,000 in annual drug costs. Although the initial grant that paid for the first pharmacist has expired, the program has become self-sustaining. The clinics now pay for the pharmacists based on the cost savings and demonstrated value of the program. The pharmacist-run disease management services have been highly effective at helping patients meet treatment goals. For example, pharmacist care was associated with a reduction in systolic blood pressure of 26 mm Hg and diastolic blood pressure of 12 mmHg among hypertension patients and a reduction in A1C of 3.7 points from baseline among diabetic patients. Similarly, a retrospective cohort study of the impact of our clinical pharmacists on the care of diabetic safety net patients when compared to “usual care” demonstrated that clinical pharmacist care is associated with significantly greater glycemic, lipid, and blood pressure control.
The clinical pharmacy services established in our partnering safety net clinics are an integral component of the health care provided in these settings. They provide a comprehensive package of self-management education, drug information, disease management, and formulary and dispensing assistance to both patients and clinics.
View a pdf of the poster from the Midyear Meeting (512 KB).