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Medication access at a free, urban clinic: a light in the economic storm

Mary Herbert, MS, MPH Clinical Director, Program for Health Care to Underserved Populations Sharon Connor, PharmD Assistant Professor, University of Pittsburgh, School of Pharmacy Director, Grace Lamsam Program Lauren Jonkman, PharmD Instructor, University of Pittsburgh, School of Pharmacy.

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Medication access at a free, urban clinic: a light in the economic storm

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  1. Mary Herbert, MS, MPH Clinical Director, Program for Health Care to Underserved Populations Sharon Connor, PharmD Assistant Professor, University of Pittsburgh, School of Pharmacy Director, Grace Lamsam Program Lauren Jonkman, PharmD Instructor, University of Pittsburgh, School of Pharmacy Medication access at a free, urban clinic: a light in the economic storm

  2. Millions falling through the cracks • Sept 2009: 46 million uninsured in US • July 2009: 8.5% of Pennsylvanians unemployed • 50% increase over 1 year! increase in unemployment rate  increase in the number of uninsured  increased need for safety net services

  3. University of Pittsburgh School of Medicine / Department of General Internal Medicine Community Campus Partnership =Safety-Net Provider Program for Health Care to Underserved Populations University of Pittsburgh School of Pharmacy Grace Lamsam Pharmacy Program Salvation Army Health Care for the Homeless The Birmingham Free Clinic

  4. What do partners bring? • Program for Health Care to Underserved • Admin oversight; network of volunteer physicians; service-learning opportunities for medical students; specialty services and AmeriCorps Members’ service • Salvation Army • Genesis and evolution of Birmingham Clinic; in-kind donation of physical space, maintenance and utilities; provides community access • Grace Lamsam Program • Network of volunteer pharmacy faculty; on-site dispensing and medication management; service-learning for pharmacy students • Health Care for the Homeless • 340B purchasing power • Annual grant support

  5. Birmingham Free Clinic Est. 1994

  6. Who do we see? • Homeless = 52% • Uninsured = 98% • Male = 69% • Minorities = 45% African American & 19% Latino • Low SES = 73% at or below federal poverty limit • Patient Encounters = ~2,100 annually • Unemployed = doubled over past year

  7. How do we meet medication needs? • Limited formulary purchased through: • 340b HCH funding • programmatic budget • Samples • Limited $$ through grant-funded vouchers • $4 prescription programs • Pharmaceutical Manufacturer Assistance Programs (PMAPs)

  8. How much do we receive? • PMAPs = ~ $20,000 estimated monthly value • 139 patients currently receiving meds • ~ 60 individual medications received / month • Purchased meds = ~$100 monthly • antibiotics, miscellaneous • chronic meds not available through PMAPs

  9. How do we do it? • Volunteer pharmacists • identify patients with chronic medication needs • work side-by-side with clinicians to make best therapeutic substitutions, and AmeriCorps members to facilitate PMAP application process • provide patient counseling & medication reconciliation services • Two AmeriCorps National Service Members • dedicated to processing, coordinating and tracking applications • aide pharmacists in identifying patients & “paperwork” • Multi-disciplinary Student Interns • Public Health, Medicine, Nursing, Social Work Streamlined, Efficient, Collaborative Approach

  10. What is the impact? • More medication options for patients & clinicians • Increase opportunity for disease control • Expand access with limited impact on medication budget • Support addition of specialty clinics • mental health services • cardiology • Evolve pharmacist’s role • medication therapy management • refill clinic

  11. What are the “keys to success” • Dedicated, cost-effective staff • AmeriCorps Members are key • Annual stipend = $8,400 vs. $200,000+ annually in free medications for uninsured patients! • Pharmacist involvement • “wrap-around” care • Partnerships • Allows for success in making program work within the processes/structure of clinic itself • community agencies • universities • others

  12. Thank you! Mary Herbert, MS, MPH Clinical Director, Program for Health Care to Underserved Populations herbertmi@upmc.edu Sharon Connor, PharmD Assistant Professor, University of Pittsburgh, School of Pharmacy Director, Grace Lamsam Program Sconnor@pitt.edu Lauren Jonkman, PharmD Instructor, University of Pittsburgh, School of Pharmacy ljf@pitt.edu

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