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Volunteering at the Bread of Healing Clinic offers pharmacy students a different perspective

MCW School of Pharmacy students volunteering at Bread of Healing Clinic

Arslan Aslam, a third-year student at the Medical College of Wisconsin (MCW) School of Pharmacy, is originally from Michigan. In the fall of his first academic year, the school informed him of a new volunteering opportunity at the Bread of Healing Clinic (BOHC). “I jumped on it,” says Aslam. “I thought it was interesting and since I was from out of state, it could help me learn more about the community. I wanted to get more involved and get a different type of exposure.”

Aslam was one of the first students to volunteer at the clinic and begin the partnership between the MCW School of Pharmacy and the BOHC. “I learned about the different needs of the Milwaukee community and how a place like Bread of Healing is essential. It’s not just for people who have a different socioeconomic background – it’s people who don’t have insurance,” says Aslam.

The BOHC is a free clinic that provides healthcare and medications for people with chronic conditions who don’t have health insurance. In 2017, the BOHC provided medications valued at over $3.5 million to its patients. “Almost all of the patients have at least two chronic conditions. They are on a higher amount of medications than you would usually see in the community because they don’t have to ration medications or find money to pay for it. It’s not uncommon to see our patients on nine or ten medications,” says Paul Hoffmann, BPharm, RPh, Director of Medication Access at the BOHC and Affiliate Clinical Instructor at MCW School of Pharmacy. The most common conditions of these patients include diabetes, hypertension, lipid disorders, and asthma.

MCW School of Pharmacy students primarily volunteer at the BOHC’s Cross Lutheran Church location on Thursdays. The location has four medical exam rooms and provides medical, dental, and behavioral healthcare for patients as well as dispenses medications. The patients need to visit at least once every four weeks for medication pickup. When the patients visit for medication pickup, the volunteer students who are dispensing check their blood pressure, weight, and pulse. They also do a finger-stick test for every diabetic patient. If intervention is necessary, the students can have the doctor onsite conduct a mini-visit with the patients. If not, the students will counsel the patients and make sure they aren’t having adherence issues or side effects.

The BOHC has a physician-run dispensary rather than a pharmacy. This means that they are able to organize the medications in categories of medications they are similar to. This is important because the medications are donated – sometimes they won’t have a patient’s exact prescription available and will refill a similar medication at an equivalent dosage instead. This also means that medication counseling is even more important due to the frequency of medication and dosage changes. Professor Hoffmann encourages his student volunteers to individualize patient education and make the appointments as long as necessary. “I want them to assess the patient’s understanding,” says Professor Hoffmann. Volunteer pharmacy students walk patients through inhaler techniques or steps of the insulin injection process. They also ask patients if they are missing doses of their medications, and if so, how often. “We’re getting more patients fitted with 7-day pill boxes than ever before,” says Professor Hoffmann.

MCW School of Pharmacy students volunteering at Bread of Healing ClinicThe BOHC is a highly interprofessional clinic, which fits with the MCW School of Pharmacy’s core value to embrace interprofessional collaboration in education, scholarship, and practice. Volunteer pharmacy students have the opportunity to shadow physicians, including specialty physicians, and complete physical exams. “The allergist always has students looking up noses and at fluids in ears. Last week, the nephrologist had the students palpitating a liver,” says Professor Hoffmann. The students also work with nurses, behavioral health and social services professionals.

The students can gain confidence and comfort in working with an interprofessional team to provide care for patients. “Physicians really take our recommendations seriously,” says Aslam. “Physicians might not see things from our perspective when it comes to medications or how to get patients to adhere. It is nice to get a pharmacist’s perspective to go along with their own knowledge.”

Pharmacy students who volunteer at The BOHC gain skills unique to the free clinic setting. “I learned how to get medications for free or very low cost,” says Aslam. They also get to practice skills that they learn in their didactic classes and in Patient Care Lab. “Volunteering at the BOHC reinforced how to talk to patients and how to use motivational interviewing, which is a very effective technique that we learned at the MCW School of Pharmacy that works in real-world practice. Volunteering prepares us for our rotations,” says Aslam. Motivational interviewing is a counseling approach that can help pharmacists elicit behavior changes in their patients such as medication adherence or tobacco cessation. Sometimes students even learn skills while volunteering before they learn them in class or on rotation.

The clinic benefits from having an increased pharmacy presence while the students are on-site. Pharmacy students are equipped to be more in-depth while counseling and dispensing medications to patients, which saves time for the physicians. The MCW School of Pharmacy’s curriculum prepares students for advanced patient care services allowing them to be an asset to the others members of the care team while completing necessary services, such as medication reconciliation.

The volunteer program between the MCW School of Pharmacy and the BOHC has come a long way since its beginning. “The first five or six students were really test cases. After each afternoon, we would ask what they liked and what they didn’t like. Even when the students only knew the top 200 drugs, they were still able to be involved with patients professionally.” says Professor Hoffmann. As the students learned more and progressed, they became more involved with the rest of the medical team. Now, both first and second-year students volunteer at the BOHC. There are two student co-coordinators, Tarah Hraba and Cassandra Rucks, who manage the volunteer schedule and serve as student liaisons between Professor Hoffmann and the other MCW School of Pharmacy students. Both Hraba and Rucks have been volunteering at the BOHC since the program started in the fall of 2017. “I have been able to see how much I’ve grown since the beginning. I feel very confident now in making suggestions to the team,” says Rucks.

In addition to the volunteer partnership with the MCW School of Pharmacy, the BOHC also has precepted five students on Introductory Pharmacy Practice Experience rotations and has accepted five students for Advanced Pharmacy Practice Experience rotations in the upcoming year.

Professor Hoffmann hopes that by volunteering, students will get a better understanding of the level of need that the patients have. “There are a lot of misconceptions about free clinics and I think that volunteering here will dispel a lot of those,” he says.

Through volunteering at the BOHC, Aslam has had valuable experiences that he wouldn’t have with a more traditional clinical pharmacy experience. “I think that doing volunteer work as a pharmacy student is really important,” Aslam says. “You can see the other side of people who are less fortunate. We can learn about it and professors can describe it all they want, but it’s different when you see the challenges and barriers that patients have in improving their health. It humbles students.”