Reaching and supporting patients at The BRIDGE clinic
Finding and enrolling the uninsured and under served individuals who are eligible to use the services of The BRIDGE clinic is a task in itself, according to ambulatory care clinical pharmacist, Dr John Clark, College of Pharmacy, University of South Florida.
All patients at The BRIDGE are seen by appointment rather than as ‘walk-ins’. “The clinic is only open at night after normal business hours so it opens at five o’clock in the evening and it stays up until nine p.m. at night”, explains Dr Clark. In order to qualify for services at free clinics patients have to meet certain requirements. Typically, this would mean that they have no health insurance cover. They also have to be declared residents of the state of Florida. “My whole goal is trying to help them with their with their medical care. I have seen patients that actually die and so I’m very, very sensitive and I try to avoid the politics. If they need help, we just try to get them in there. They also have to have …. an income that’s what we consider in the US below the poverty guidelines and that’s less than about seventeen thousand dollars a year. That’s total household income including two people. …… Now, I don’t check that, we have social workers who can check those things”, says Dr Clark.
From the pharmacy viewpoint, “We use the typical old medication therapy management guidelines and that includes [the stipulation that] they must be taking five or more chronic medications – they could be non-prescription or prescription meds. They have to have at least one chronic disease state that’s being managed on the long term. That’s going to be things like hypertension, diabetes and even certain cardiovascular conditions”, says Dr Clark. Additional criteria include abnormal laboratory values and non-adherence to medication because of absence of medicines’ supplies or because of poor understanding “Health literacy and cultural differences play a big part because the majority of patients coming to our clinic is probably 80 to 90 percent Hispanic; we don’t get too many African American patients coming in, we don’t get too many white patients”, he adds.
“Now, you can imagine in this country right now, with the pandemic going on, a lot of people have lost their jobs – [they’re] out of work [and have] no insurance – and we’re seeing it now in The BRIDGE clinic. We had a lady there just overnight – she has diabetes, lost her job, no insurance, no way to get her insulin. So, lo and behold, this medical staff comes to us and says, “John how do we get this lady insulin because she can’t afford it?” ….. Fortunately, in Florida they have … an insulin distribution program that’s run by the state. …. Most of the time they only cover two insulins, the regular and the NPH insulin and one of the combinations and so we write the prescription”, says Dr Clark. The patient is given a referral form and directed to a State Department of Health office, some of which have on-site pharmacies and can supply insulin immediately. Alternatively, “the prescription is faxed to a state office located ….. in the capital of the state in Tallahassee and then it’s mailed to the patient’s home”, he says.
There are a number of way that people can find out about the services of The BRIDGE clinic. For example, there is an announcement on a local radio service, brochures are distributed and there is information on the clinic website, but the information is commonly spread by word of mouth. In addition, outreach clinics are run periodically. “We go out into the community at least twice a year ……. and we set up what we call health screening clinics”, he says. These could be in churches or in an open park, for example. If, during the screening process they find patients who are eligible for services from the BRIDGE then they are directed to the clinic.
John E Clark studied pharmacy at Southern University in Houston, Texas before completing residency training in Detroit, Michigan. He holds a master’s degree in pharmaceutical administration a PharmD. For 18 years he worked at Jackson Memorial Hospital in Miami before taking up his current appointment at the University of South Florida College of Pharmacy in Tampa, Florida. You can find Dr John Clark’s book here.