PORTLAND, Ore. – Driving along Burnside Street in downtown Portland, it’s difficult to ignore some of the area’s most vulnerable residents. For those living on downtown streets, shelter and food are often uncertain, and basic health care needs go unmet.
In the heart of the neighborhood, though, one organization is committed to providing medical care to this population. The Old Town Clinic has, for nearly three decades, provided health care on a sliding-scale fee schedule to the low-income and homeless citizens. Approximately 40 percent of the clients are uninsured and nearly all fall below 200 percent of the federal poverty level. The clinic is part of the nonprofit organization Central City Concern.
Four years ago, OSU College of Pharmacy alumna and pharmacist Sandra Anderson began volunteering part time at the clinic. Anderson, who is an affiliated faculty member of Oregon State University’s College of Pharmacy, was looking for a way to become more involved in her community and to use her expertise in helping patients with their medications.
Working with physicians, Anderson is able to provide medications to patients at no cost and foster relationships with both clinic staff and patients to improve clinical outcomes, as well as provide pharmacy students at Oregon State with an outstanding opportunity to work closely with clinic patients.
“I really enjoy working with the caring professionals here at the clinic, and it is very rewarding to see the benefits of the collaborative care we are able to provide,” she said. “The providers are very open to working with a pharmacist and communicating with me. I was able to significantly impact the quality of pharmaceutical care that these patients were receiving.”
Originally, Anderson’s job was to label, manage and distribute drug samples donated by pharmaceutical companies for clinic doctors to provide to uninsured patients. Eventually, the clinic became part of a federal program that helps to fund the purchase of medications. At that point, creating a fully functioning pharmacy became imperative.
Last year, with help from the OSU College of Pharmacy, the clinic received a Health Resources and Services Administration (HRSA) grant to create an on-site pharmacy, and Anderson was hired as the pharmacist in charge.
The pharmacy is also the first in the state to be licensed as a Charitable Pharmacy, an entirely new category of pharmacy in Oregon, allowing Anderson to accept medication donations from long-term care facilities and other places that have unused, still-sealed containers of medicine they no longer need. Oregon recently passed a law allowing for the creation of Charitable Pharmacies, thanks in large part to the work of Rep. Sara Gelser (D-Corvallis), who introduced the legislation at the request of her friend Deanna Kingston, an associate professor at OSU who has battled cancer.
Anderson is a preceptor with the OSU College of Pharmacy, which bases part of its program in Portland at Oregon Health Sciences University, and had already been bringing pharmacy students to the clinic on the days she volunteered. The creation of the on-site pharmacy allowed her to significantly expand the opportunities she could provide to those students.
Every six weeks, Anderson gets a new set of three fourth-year OSU College of Pharmacy students who work in the pharmacy every day, as well as three third-year students who work there once a week.
Students are able to answer questions that providers and patients ask, and have time to review charts and evaluate the medications patients are taking. This gives them the opportunity to apply what they’ve learned in class to real-life situations.
“Oregon State University College of Pharmacy at both the Corvallis campus and the OHSU campus, has provided an outstanding pharmacy education,” Anderson said. “The students have a lot to offer. This allows them the opportunity to utilize their clinical pharmacy knowledge and provide excellent pharmaceutical care and medication management to the patients at our clinic.”
At the clinic, students have the time and opportunity to do one-on-one medication consultations with patients, which expands their exposure to direct patient care, helps to streamline and coordinate care at the clinic by preventing duplication of therapy, and keeping providers up to date on the patient’s medications.
“It’s storytelling,” Anderson said. “Often people aren’t fully aware of their health conditions and how their medications impact their health… If they have time to sit and story tell, and say ‘This is how I feel, these are the symptoms,’ we can provide chart notes for providers so that next time they see that patient they have a more complete picture of what’s going on.”
By sitting down with patients, pharmacists can often learn about barriers that prevent them from taking their medications correctly. It can be as simple as a pill that’s too large to swallow, or frustration at having to take several medications at once. The pharmacy student may suggest an alternative form of a medication, changes in the dosing schedule or alternative medications that may help.
“You really choose the medication to fit with the person’s lifestyle and who they are, and find out what works for them, because it’s all about the patient,” Anderson said.
Tyson Elliot is a fourth-year pharmacy student working at the clinic. The Bend native said he liked the collaborative nature of Old Town Clinic, and the impact that the students have on the health and outcomes for the patients.
“What we’re allowed to do here is really progressive,” he said, because students have the chance to use the skills they’ve acquired in class, and encouraging them to consult with patients, something they might not get to do as intently in another pharmacy setting.
Barisa Argo, also an OSU College of Pharmacy student, is from Oromia, in East Africa. He is a former employee of the American Red Cross National Testing Laboratory. Argo said he saw many people dying from lack of care in his home country, and appreciates the opportunity to work in a facility that focused on residents with the greatest needs.
“This is our chance to learn and to give back to the community,” he said.
For fourth-year student Mariah Doty of Portland, building relationships with patients is the most important part of her work.
“We make sure they get the medicine they need,” Doty said. “We’re happy that patients are taking care of themselves.”
“The patients love the pharmacy students,” Anderson said. “The students are so accessible to help answer their questions about their medications. With our clients, when they come into the clinic with a concern or question you must address it immediately because you may not see them again for a month or two.”
Above all, Anderson feels immensely supported by the College of Pharmacy as she continues helping Portland’s most vulnerable community members.
“I owe the OSU College of Pharmacy a big thank you,” she said. “They have been so supportive in helping me develop the pharmacy at Old Town Clinic. The college helped us apply for the HRSA grant, prepares the students for this rigorous clinical experience, and has provided educational programs that have helped me to evolve this practice site as the profession of pharmacy has changed.”
And at the same time, Anderson and her students are helping change lives.
“One of the big things about this clinic is, our message is hope.”
~ Theresa Hogue