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Clinicians, Students Fill Health Services Gap for Houston's Homeless

Donna Young

Health-related problems are the leading cause of homelessness for nearly half of the 10,000 people living on the streets or in shelters in Houston, Texas, said pharmacist David Wallace, a clinical assistant professor for the University of Houston College of Pharmacy.

Because most of Houston’s shelters lack the funding or capacity to provide health services, he said, many of the homeless often have medical conditions that go untreated—only worsening the problems that keep a person homeless.

Some of the homeless seek treatment at local hospital emergency rooms—a costly and ineffective way to treat many illnesses and chronic conditions, Wallace noted.

But, he said, a group of pharmacists, physicians, and other local volunteers have joined with pharmacy, medical, and public health students in Houston to “bridge the gap for the disenfranchised people seeking health care.”

As pharmacist-in-chief for Healthcare for the Homeless—Houston (HHH), a nonprofit consortium of health care clinicians, educational institutions, and community-based agencies, Wallace helps to provide needed medications free to the homeless at Houston’s Lord of the Streets Episcopal Church shelter and a community volunteer-run shelter known as the Search Homeless Project.

HHH is opening a third health clinic pharmacy at the Star of Hope Men’s Development Center in Houston, said HHH Executive Director Frances E. Isbell.

The three pharmacies are licensed under a special Texas State Board of Pharmacy “D” classification that allows pharmacists volunteering at community health clinics to provide certain types of medications to homeless patients, Wallace said.

However, he noted, the classification does not license the health clinic to fully dispense drug products.

“Dispensing, as in the case of a retail pharmacy, would require us to keep more paperwork on our patients and the drugs we provide,” he said. “We do keep records that are as complete as possible. But there are more requirements involved in licensing a retail dispensing pharmacy than there are for a health clinic for the homeless. Therefore, we cannot officially say that we dispense. But rather, the state tells us that we can disperse or provide the medications.”

HHH purchases most of its pharmaceuticals with donations from private corporations and foundations or grants awarded by city, county, state, or federal agencies, Wallace said. Some of the organization’s medication supplies are unit dose manufacturer samples that have been donated by local physician offices.

General Electric Company recently donated an electronic medical record system to HHH that enables the organization to readily share patient information among its various clinics, Isbell said.

Last August, the Department of Health and Human Services Bureau of Primary Heath Care awarded HHH the status of federally qualified health center (FQHC), which allows the organization to purchase pharmaceuticals at a large savings under the federal 340B drug-pricing program.

“The FQHC status is helping us a great deal in being able to provide needed medications to our patients,” said Wallace, who spends many volunteer hours repackaging medications purchased in bulk by HHH into sandwich-size self-sealing plastic bags.

“The bags make it easier for our patients to carry their medications in their pockets since they have no where else to store the drugs except physically on them,” he said. Patients with children may request amber prescription bottles with child-resistant caps if needed, he added.

HHH provides patients with no more than a 10-day supply of medications per clinic visit, Wallace said.

“A 10-day supply is easier for our patients to keep track of and easier for us to replace if they lose the drugs or the drugs are stolen from patients,” he said. “On the average, a homeless person is assaulted and robbed once every six weeks. Carrying a 30-day supply of drugs could make a homeless person a target for assault and robbery.”

HHH’s clinics offer primary care services, psychiatry and mental health counseling, dentistry services, health education, and pharmaceutical counseling. The Lord of the Streets clinic also offers a special primary care and immunization clinic for women and children on Tuesdays.

On Sunday mornings at the Lord of the Streets shelter, pharmacy students from the University of Houston, medical students from Baylor College of Medicine and the University of Texas—Houston (UT-H) Health Science Center, and UT-H public health students run the HHH-sponsored Houston Outreach Medicine, Education, and Social Services (HOMES) clinic.

The HOMES clinic provides students an opportunity to work with a special population, said Wallace who oversees the clinic’s pharmacy students as their faculty adviser and preceptor.

“Students at the HOMES clinic are learning a very human aspect of health care,” he said. “Students must think about different types of treatment needed by the homeless. A homeless person who has to take an antibiotic can’t always take it four times a day or with a meal when they might not have a meal available to them. The homeless patient is probably going to need an antibiotic that is simple to take, will not cause diarrhea, and is easier on the stomach.”

The knowledge and experience gained by pharmacy students volunteering at the clinic is irreplaceable, Wallace said.

“It’s a kick to watch these students grow professionally as they interact with other disciplines and see what they can do as pharmacists,” he said. “The experience is helping these students to think on their own. They are also learning that it is not such a bad thing to give back to their community.”

Even though services provided by clinics for the homeless are limited, Wallace said, HHH’s volunteer health professionals strive to provide the best care possible.

“We really try to provide the same standard of care to our patients as the care expected by a person who is insured,” he said. “Just because a person is homeless does not mean their care should be substandard.”

Most of the medications provided to homeless patients at HHH clinics are for the relief of cold symptoms or to treat respiratory-tract infections or minor fungal infections like athlete’s foot, Wallace said.

For those who need medical management of severe chronic conditions, such as tuberculosis or hypertension, he said, HHH assists homeless patients in seeking health services provided by the Department of Veterans Affairs, if patients are eligible, or state and county agencies and facilities.

“We try to help our patients navigate their way through the health care system and gain access to the services they need,” he said. “And that is not easy for a person who has no ID [card] or records of military service.”

Up to 40% of the nation’s homeless population, Wallace said, may be infected with the hepatitis A virus.

“It’s very necessary for those patients to receive care,” he said. “But too often, the homeless are turned away because of a lack of health services available at a shelter. And most of the time, they have no place else to go.”