How Far Should Community Outreach Go for Pharmacies?

A pharmacist’s role in a community cannot be overstated. Providing proper health care services is one of the fundamental pillars of success for a community; when the people are healthy, they are more likely to be happy, safe, and contributing members of a group.

In recent years, the scope of pharmacists’ roles and prescribing powers have expanded—a trend that does not appear to be slowing down any time soon. “Studies show that integrating pharmacists into patient care can have a tremendous impact on health outcomes when they are involved in patient care, including improving medication adherence and outcomes in chronic conditions as well as preventing hospitalizations,” according to Digital Health Insights.¹

But just how far does that expanded role go? How can pharmacists reach every corner of a community, including individuals and groups that are often passed over and neglected?

Individuals experiencing homelessness are generally some of the most vulnerable people in our society, and their access to healthcare is limited at best and nonexistent at worst. Rates of HIV/AIDS, diabetes, asthma, and other diseases are exorbitantly higher for homeless people, life expectancy is more than a decade shorter than the average American, and general exposure to elements like weather and malnutrition are far higher in homeless populations.

Access to hospitals, emergency departments, and care professionals is more difficult to find for anyone without insurance, a struggle that is compounded by homelessness. But data from multiple studies has implied that pharmacists and health care workers in general can make a real difference in the overall health of homeless populations in their communities.

“Respondents indicated optimism that health care services, the healthcare professionals and pharmacists can do more to reduce homelessness and its health impact,” according to a study published by the National Institute of Health (NIH).² Now, what exactly “more” means in this situation is bound to be wholly different for each pharmacist. But the ideas of education, trust, and patient safety are consistent tenets throughoutmost data.

While the specifics of what medications and assistance people experiencing homelessness may need—and likely changes by location and the type of environment they are surrounded by—vaccination rates are generally much lower among homeless populations than housed people. But like most systematic institutions, the resolution isn’t necessarily simple. A different study published by the NIH, in which researchers and health care professionals attempted to raise vaccination levels among homeless populations, and one conclusion the researchers came to involved location of potential vaccination sites. “Though there are multiple options for vaccine delivery locations, ‘non-traditional’ sites – where staff travel to people who are homeless, in areas convenient to them – are a key consideration. The need for sites which are convenient for people who are homeless is also emphasised in the broader literature.”⁶

Overall, the act of community outreach to marginalized populations stems from the idea that patient safety is paramount for all community pharmacists. Patient Safety Network, an organization dedicated to the wellbeing of patients across health care, says “Patient safety is best achieved in organizations that have a strong culture of safety. Organizations with a strong culture of safety are not only better positioned to ensure patient safety from the outset, but also more likely to recognize the importance of dedicating the time and resources to tracking, understanding, and appropriately addressing patient safety events or near-misses.”³

Structures of homelessness and poor health care accessibility have been in place for centuries—thus, physically reaching a person trapped in a cycle of extreme poverty, and being able to connect with them, are 2 different tasks. The NIH details the possible barriersa pharmacist and other health care provider may need to overcomein order to service people in need. “In addition to their distrust of authority, many homeless people are disenchanted with health and mental health care providers. Some have had bad experiences with medications, hospitals, doctors, and other human service professionals and are leery of further involvement.”⁴

Once that trust is established, then the question of how to best serve that community comes into play. A study in BMC Health Services wanted to examine what type of approach could assist people experiencing homelessness, and the conclusion was simple: going out and supplying health services to people who need it most. The researchers, who conducted the study in Glasgow, United Kingdom, stated “A proactive, informal, flexible, holistic and person-centred outreach service delivered within homelessness service settings and on the street can act as a valuable bridge to both primary and secondary healthcare for people experiencing homelessness who would otherwise ‘fall through the gaps’ of provision.”⁵ Researchers from a study cited earlier, when describing health care professionals, said “Respondents indicated lack of knowledge, skills, intentions as well as contextual factors such as lack of guidelines impacted on their counselling and management of homeless patients.”

It must also be noted that a fair amount of these studies were done in the United Kingdom, a region with a more accessible health care system. In the United States, a country where well over half of all health insurance is private, and for-profit entities essentially run the market, professionals may run into more obstacles along the way. Nevertheless, the problems facing the homeless populations in both areas essentially mirror one another.

The scope of services and prescribing power of pharmacists has grown in recent years and continues to grow. With that growing role, pharmacists are tasked with a greater responsibility of taking care of all ofthe individuals in their community. The word “community” comes before the word “marketing,” because putting the health of the community above everything else is how pharmacists truly gain the trust of the community they oversee. In order for real growth to happen in the health of an entire community, many of these studies should be taken into account by pharmacists. Establishing rapport with marginalized populations, making them sure that their safety and wellbeing is the only objective of the pharmacist, and taking the proper steps in making sure the care provided is safe and effective are all necessary to being someone who protects the entire community. 

References

1. Expanding pharmacists’ scope of practice improves health outcomes. March 14, 2023. DHI. Accessed May 18, 2023. https://www.dhinsights.org/news/pharmacists-scope-of-practice

2. Paudyal V, Gibson Smith K, MacLure K, Forbes-McKay K, Radley A, Stewart D. Perceived roles and barriers in caring for the people who are homeless: a survey of UK community pharmacists. Int J Clin Pharm. Published January 18, 2019. Accessed May 18, 2019. doi: 10.1007/s11096-019-00789-4.

3. Luchen G, Pharm. D. Hall K, MD, MS. Hough. The role of community pharmacists in patient safety.Patient Safety Network. Published October 24, 2021. Accessed May 16, 2023.

4. Johnsen, S., Cuthill, F. & Blenkinsopp, J. Outreach-based clinical pharmacist prescribing input into the healthcare of people experiencing homelessness: a qualitative investigation. BMC Health Serv. Published January 4, 2021.Accessed May 16, 2023. https://doi.org/10.1186/s12913-020- 06013-8

5. Homelessness, Health, and Human Needs.Institute of Medicine (US) Committee on Health Care for Homeless People.Health Care Services for Homeless People. Accessed May 17, 2023. https://www.ncbi.nlm.nih.gov/books/NBK218235/

6. McCosker LK, El-Heneidy A, Seale H, Ware RS, Downes MJ. Strategies to improve vaccination rates in people who are homeless: A systematic review. Vaccine. 2022 May 20;40(23):3109-3126. doi: 10.1016/j.vaccine.2022.04.022. Epub 2022 Apr 26. PMID: 35484042; PMCID: PMC9040475.