Midwestern University Chicago College of Pharmacy (MUCCP) is coming up with new and creative ways to ensure that vulnerable, low-income, and uninsured patients continue to receive basic medical care during the coronavirus disease 2019 (COVID-19) pandemic.

According to the World Health Organization, the COVID-19 pandemic has caused over 1 million deaths, and there have been more than 38 million confirmed cases worldwide, as of October 14, 2020.1 The pandemic has had a disproportionate effect on racial and ethnic minorities and those with a lower income. Additionally, social distancing protocol has caused many free clinics to go virtual and appointments to be pushed back or even canceled outright.

In partnership with 2 clinics and 2 food pantries in the Chicago, Illinois area, MUCCP is ensuring that local residents continue receiving the help and medical treatment they need, despite the pandemic. Although the university has been working with the clinics and food pantries for several years, the pandemic has forced them to innovate to serve their communities.

Pharmacy students work with Susan Cornell, PharmD, associate director of clinical education at MUCCP, to help provide care to low-income individuals at the Bolingbrook Christian Health Center and the Will-Grundy Medical Clinic. Cornell has been working in clinics for 16 years, and over the years, student involvement in the project has increased. With students playing a key role in evaluating and treating patients, individuals are seen by a nurse practitioner, a physician’s assistant, or a physician by appointment.

“The first thing [the patients] will do is actually see one of the pharmacy students,” Cornell said in an interview with Pharmacy Careers®. “The pharmacy student does a medication history with them. The pharmacy student will talk to the patient, find what medications [they are] taking, via prescription or over the counter, and then they compare it to the patient’s chart. The student will then focus on adherence issues. So, they’ll not only compare what is the patient taking but how they are taking it.” After the students finish their patient evaluation, they will make their recommendation, under supervision, to the prescriber.

After the patient’s appointment with the prescriber, students follow up to ensure that the patient is adhering to the new regime properly. In one case, a prescriber prepared to increase the dose of atorvastatin (Lipitor), but pharmacy students discovered that the patient had not been taking their prescribed atorvastatin at all.

Additionally, students help patients work with what they have. According to Audra Melton, a PY3 pharmacy student and project coordinator cochair, many of the patients they serve do not have access to healthy fruits and vegetables, so students have to adjust their traditional advice regarding food.

“We found that working in some of the different underserved communities, especially since we partnered with a food pantry, when we’re going into detail about making some of those healthier choices…actually realizing that all of our patients just simply don’t have access to that,” said Melton, in an interview with Pharmacy Careers®. “Us changing our mind-thought and our process on how we can educate them on things that they can still do. Because, yes, they live in a food desert, but there are still some options that they can make.”

The pandemic has forced Cornell and her students to go virtual. Appointments at the 2 clinics are now done using telehealth software. Consults are done either over video chat or voice chat, and a translator is available for those who need it. Over video chat, students and providers can ensure that patients are using inhalers and other medical devices properly.

Switching to telehealth during the pandemic hasn’t been the program’s only innovation. To continue providing care to food bank users, the program launched a drive-through system. After picking up food, patients can get blood pressure, glucose, or pulse oximetry checks without getting out of their cars.

However, the drive-through service comes with its own unique set of challenges such as not knowing if patients are implementing recommendations. “Now that we’ve converted more to drive through clinics, we just don’t have the same amount of time to sit down and develop with each patient,” said Melton.

It isn’t just the drive-through innovations that have serious limitations. Telehealth can also pose a problem. Over video chat, it can be hard to determine if the patient is using their medical device properly. According to Cornell, at least 1 patient has grown so frustrated that he has refused to attend the clinic or take his medications until he is able to visit a clinic in person again. Additionally, many of the patients still show up to the clinic in person for their virtual appointments.

“There is good and bad. The good is that we’re pretty much seeing 90% of our patients now. So, our show rate is much higher. Historically, people wouldn’t show up. It would be a bad day outside they wouldn’t want to drive, something would come up, they couldn’t make it to their medical appointment… It’s more doable [now],” Cornell said. “The problem is that adherence assessment. That’s not easy to do over a Zoom call.”

With the introduction of the drive-through clinics, cars frequently back up, and the food pantry parking lot wasn’t large enough from the start. Patients are now rerouted to another parking lot a few blocks away. Additionally, Chicago winters are also notoriously brutal, and warm weather is quickly disappearing. According to Cornell, the patients may not be let back indoors for another year.

“One of the things we are now going to have to discuss is when the cold weather comes, how are we going to provide drive-through services in the snow or rain, and obviously we can’t,” she said.

According to Cornell, once the COVID-19 pandemic is over, the clinics will likely keep the patient option of telehealth appointment instead of a traditional face to face one. For many patients, a virtual appointment is simply more convenient. They can call the doctor on their way home from work or while watching their children.

In the meantime, Cornell and her students will keep providing patients with the best care possible for as long as possible. According to Cornell, her students are an integral part of ensuring that the clinics function.

“This is truly a student-run project,” she said. “To me, I think it is just so valuable for the students on multiple levels. The students are, of course, our future for pharmacy. I do plan to retire at some point, and I want to know that the profession is in good hands.”


REFERENCE
  1. World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. World Health Organization. Updated October 14, 2020. Accessed October 14, 2020. https://covid19.who.int/