HOPE Dispensary of Greater Bridgeport
Christine Toni, BS Pharm, Founding Coordinator
Angela Faulhaber, PharmD, Current Coordinator
HOPE Dispensary of Greater Bridgeport was started as a collaboration between health care agencies within the city (Primary Care Action Group (PCAG)) to address recurrent ED visits and hospital admissions by low income, uninsured patients at two hospitals. Medication access for this population was determined as a primary factor. A charitable pharmacy, offering medication access, education, and referring patients to primary care providers would offer the city’s uninsured a cost-effective health care option.
Initial funders provided a startup grant (2-year Ascension Health), location and utilities (City of Bridgeport Department of Health building), and fixtures and salary mechanism (St. Vincent’s Medical Center). Community groups (rotary, water company, and others) provided funding for software and vendor memberships. Bridgeport Hospital and five area clinics acted as referral sources for patients to and from HOPE. The initial site was chosen to meet state pharmacy regulations and offer familiarity and convenience for patients (on a local bus route with other social services provided in the building). Funding provided for 21 hours of operation, open 3 days weekly. Initial staffing was one pharmacist and one pharmacy assistant. More funding became available as metrics demonstrated the positive impact of the pharmacy on the health of the community. As work volume both for prescriptions and manufacturer patient assistance programs increased, a pharmacy technician was added to the staff.
It was determined for pharmacy safety there would be no fees for patients (therefore no money) and no control medications. A limited formulary provided the maximum use of resources for most of the disease states seen in this population. The initial formulary list was distributed to area providers, utilizing therapeutic interchange as needed with provider consent. With the institution of Collaborative Practice in Connecticut, a collaborative practice agreement for therapeutic interchange was obtained with many physicians, allowing dispensing of prescriptions upon initial visit.
Initial marketing included presentations at physician groups, clinics, local churches, health fairs, and other organizations serving the uninsured population. Though physicians were important, APRNs, PAs, social workers, case managers, and clinic liaisons provided the most patient referrals and constructive feedback. Fliers in multiple languages with a map and hours of operation were made available at all clinics, food pantries and grocery stores. Another referral source became local pharmacies that had patients who could not afford their medication.
As the primary goal of the PCAG was to decrease inappropriate ED visits and decrease hospitalizations, patient education became as important a service as medication access. Greater than 50% of the patients speak a language other than English so having staff and technology to interpret was essential. Providers soon depended on the pharmacy to compliment what they were not always staffed to offer for patient education, including targeted Medication Therapy Management, device utilization, and motivational techniques. The pharmacy became more of an ambulatory care site, with the city donating another space for patient counselling.
A collaboration with local universities developed as the pharmacy workload increased. Pharmacy students volunteered for service hours as well as IPPE, APPE, and Pharmacy Resident rotations. A program for Experiential Service Learning for nursing, foreign language and social worker students was developed, providing students professional encounters with this population and donating volumes of chart maintenance for the pharmacy.