Implementation of primary care clinical pharmacy services for adults experiencing homelessness

Abstract

Background: It is estimated that on any given night in the United States, more than half a million individuals experience homelessness. Within the homeless population, chronic conditions such as diabetes, heart disease, and human immunodeficiency virus are found at rates 3-6 times higher than in the general population. Despite this, access to appropriate treatment and preventive care remains difficult for those experiencing homelessness, and many barriers exist to achieving positive health outcomes.

Objective: The primary objective of this study was to determine the clinical impact and sustainability of implementing clinical pharmacy services in a clinic for adults experiencing homelessness.

Practice description: As a pilot service, a postgraduate year 2 ambulatory care pharmacy resident attended the Pedigo clinic for adults experiencing homelessness 1 half-day per week to provide independent cardiovascular risk reduction (CVRR) disease state management under a collaborative practice agreement.

Practice innovation: The existing CVRR model was applied at a clinic location that did not previously have clinical pharmacy services. The provision of these services was adapted to meet the unique health needs of the homeless population.

Evaluation methods: The outcomes from having a clinical pharmacist in this clinic setting were retrospectively reviewed from September 2019 to March 2020.

Results: During the pilot period, the pharmacist conducted 28 encounters for 14 unique patients and made a mean of 4 clinical interventions per patient encounter. A total of 124 interventions occurred, including comprehensive medication review (n = 23; 82.1%), patient education (n = 21; 75%), medication regimen optimization (n = 18; 64.3%), and tobacco cessation (n = 18; 64.3%), among several others. Clinical outcomes (glycosylated hemoglobin level, blood pressure, and weight) remained stable with pharmacist management throughout the pilot period.

Conclusion: The addition of a clinical pharmacist to the interdisciplinary care team for patients experiencing homelessness addresses a health care disparity and enhances the care provided to this vulnerable population.