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Pharmacy and Medical Students Work Together to Provide Care at Saturday Clinic for the Uninsured

Pharmacy and medical students work together to provide care at Saturday Clinic for the Uninsured

The Saturday Clinic for the Uninsured (SCU) is a free clinic that has existed as an organization at the Medical College of Wisconsin (MCW) for more than 25 years. Until recently, the clinic was run by medical students and physician volunteers. Today, the SCU is an interprofessional organization that now includes students from the MCW School of Pharmacy, who volunteer at the clinic every Saturday.

The SCU sees between 15 and 25 uninsured patients every Saturday at Ascension Columbia St. Mary’s Milwaukee Family Health Center in Milwaukee. In 2018, the clinic experienced 760 patient visits and filled 1,050 prescriptions. For the 2018 - 2019 academic year, a total of 24 first- and second-year pharmacy students volunteered over 27 weekends, volunteering a collective 270 hours of time.

The SCU and the MCW School of Pharmacy discussed a possible collaboration soon after the MCW School of Pharmacy’s founding in 2017. Nathan Lamberton, PharmD, BCPS, Assistant Professor of Clinical Sciences, took on the role of a faculty board member and Truong Vu, now a third-year pharmacy student, stepped up as the Founding Pharmacy Student Liaison.

“The reason I took this position is because I grew up in a town that had poor access to healthcare and was mainly uninsured. The closest hospital was an hour away. My family never went to see doctors. Time, distance and language barriers were all issues,” says Vu. “I relate with the population that visits the SCU whose resources are limited. I know what it feels like to be in their shoes. I knew that was the population that I wanted to serve.”

Dr. Lamberton and Vu spent months volunteering in the dispensary at the SCU evaluating opportunities where they could optimize the workflow and integrate pharmacy students into the clinic. They revamped the dispensary, moving its location to a different, more suitable location. Then Dr. Lamberton and Vu began recruiting pharmacy student volunteers. At the time, the MCW School of Pharmacy only had first-year students, who began to work in the dispensary alongside medical students. Dr. Lamberton and Vu also created a position for a pharmacist preceptor to volunteer in the dispensary with the students.

“Over two years, we were able to improve the dispensary workflow. We created a process that made it easier for everyone to understand,” says Vu. “The main things we improved include the time it takes to fill the prescription and inventory management.”

Pharmacy School students in dispensary at the Saturday Clinic for the Uninsured

Once the pharmacy students advanced further into their curriculum, Dr. Lamberton and Vu were able to add a clinical role for them as well. “Students get to do medication education, talk to patients about new medications, and teach them how to use devices such as insulin pens or inhalers.” says Vu.

Pharmacy students volunteering at the SCU can gain practical experience. “The first-year students in the dispensary gain organizational, collaborative, and problem-solving skills,” says Dr. Lamberton. “The second-year students get a lot of patient interaction. They build empathy and compassion and work on communication and information gathering skills.”

Both pharmacy and medical students benefit from working at the interprofessional clinic. “I think they learn similar things, but in a different order. The emphasis on certain skills and knowledge is different. When they are able to work together they can enhance those skills and bring in knowledge and strategies that they haven’t learned officially yet in the curriculum,” says Rebecca Lundh, MD, Medical Director for the SCU. “In the real world, we all work together in teams. Learning that from the beginning is really beneficial.”

Working in a free clinic provides a unique learning experience for pharmacy students. “I think they are learning the gray areas of pharmacy. At this free clinic, we only have certain supply of medications and the students learn in an environment that considers a more expansive list. The students know the appropriate medications from the guideline recommendations, but have to choose what medication to provide based on available resources,” says Dr. Lamberton.

Integrating pharmacy students and pharmacists into the clinic has been a benefit to patients. Dr. Lamberton recalls a patient who came to the clinic who had medications prescribed to him from both India and the United States. This was his third visit to the clinic, but the first visit in which he saw a pharmacy student. “The pharmacy student went through all of his medications and found that at least half were duplicates. The patient was doubling up on medications and had resulting kidney injury and difficult to control blood pressure. Had a pharmacy student not seen this, it would have perpetuated,” says Dr. Lamberton.

“Because of the low health literacy of the uninsured population, there is a knowledge gap you can fill for them. There is a much higher learning potential. For example, a patient might not know what hypertension is,” says Vu. "Pharmacists can get involved in teaching about the medication and providing device counseling. If patients can’t take their medication, then everything the doctor did might be irrelevant.”

There are plans to further the interprofessional nature of the clinic in the future. So far, the SCU Student Board has created a thirteenth board position for a dispensary co-manager, pharmacy student Molly Schmidt. “Within our clinic, we need to have the insight and experience of the pharmacy students so that we can see where they’re coming from and see how they can incorporate into the current clinic flow, so we thought the management of a pharmacy student was helpful and important,” says Dr. Lundh, “She’s done a lot of things to improve dispensary workflow but Molly’s insight on general clinic flow is also beneficial.”

Dr. Lamberton, Schmidt and the SCU Board are currently spearheading movements for the clinic to incorporate more official interprofessional education between the medical and pharmacy students, including the recent development of pre-clinic morning huddles and educational talks with all student team members at the beginning of the day.

“I think there’s a lot that we can learn from the two professions of pharmacy and medicine. We’re trying to find the balance of how we can both work together to provide the best care for the patient,” says Vu.