For some Floridians, being diagnosed with a condition that requires medication isn’t just a health issue; it’s a financial one. Patients in underserved communities often have to make tough decisions about whether to focus on their own healing or provide more income for their families.
University of Florida pharmacy student Melissa Thivierge recalls the exact moment she learned about this reality. She also discovered that pharmacists may be key to helping combat the problem statewide.
While completing her Advanced Pharmacy Practice Experiences, or APPEs — a series of clinical training rotations completed by fourth-year students and scheduled by the UF College of Pharmacy — Thivierge gained invaluable insights that she believes will forever shape her approach to caring for patients.
“My experience showed me that socially vulnerable people exist everywhere. Medically underserved populations are not just in rural areas; they live in cities like Gainesville,” said Thivierge, who participated in an APPE rotation at UF Health Family Medicine – Main in Gainesville. “We had crucial conversations with patients who are in the midst of deciding, ‘Do I pay for my medications, or do I put food on the table for my family?’ I learned just how much pharmacists are involved in closing the gap for people in these vulnerable situations.”
During her rotation, Thivierge worked on an ambulatory care team, learning how to manage patients’ chronic diseases by optimizing their treatment regimens. The experience cemented both her passion for providing compassionate care and her belief in the unique role only pharmacists can play in reducing health inequities in Florida.
“Pharmacists can help improve patient care while working collaboratively as a community. We can aid in chronic disease management by providing patient education on the therapies that are available,” said Thivierge, who aims to complete a clinical residency next year before embarking on a career in pharmacy education. “We can do point-of-care testing in both community and clinic settings. We are able to fill in the gaps created by health care provider shortages, especially in medically underserved areas. Pharmacists really do have a measurable impact on Florida’s patient populations.”
Filling the need
Experiences like Thivierge’s spurred a team of UF College of Pharmacy researchers to examine whether all UF pharmacy students on their APPE rotations were receiving enough exposure to patients from medically underserved areas. The findings showed just how significant and comprehensive the students’ work has been.
Showcased in a poster entitled “Prevalence of 2023-24 Advanced Pharmacy Practice Experiences in Medically Underserved and High Social Vulnerability Areas” that was presented at the American Association of Colleges of Pharmacy’s annual meeting, the research revealed that 100% of UF pharmacy students have completed at least one rotation at a clinical site in a medically underserved area (or with patients in regions with moderate to high or high social vulnerability indexes during the previous academic year).
The Florida Department of Health defines medically underserved populations as people in geographic areas who lack access to primary care services. These are individuals from various socioeconomic backgrounds who may face financial, cultural, or language barriers related to health care. The Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry also created the Social Vulnerability Index to identify communities experiencing these issues, with the goal of decreasing health inequities.
“As health care educators, it is our goal to teach pharmacy students about social determinants of health, health disparities, and health literacy. We want to train our students to embrace cultural and structural humility, learn to advocate for all patients, recognize factors that influence the health and wellness of populations, and provide person-centered care to all patients we serve,” said Stacey Curtis, B.Pharm., Pharm.D., C.Ph., a clinical associate professor and the assistant dean for experiential education in the College of Pharmacy, who was part of the research team that developed the APPE poster. “The college is making sure that our students have the opportunity to learn within clinical training sites where they are serving all the residents of the state of Florida.”
Serving the state
Curtis and her research collaborators evaluated 221 APPE sites and 1,092 student rotations, determining that 262,080 hours were spent by students in service to Florida communities. The team concluded that 53% of APPE sites were located in medically underserved areas, while 95% of sites served patients living in areas with a moderate to high or high score on the Social Vulnerability Index. Curtis said this critical exposure encourages students to develop not just an understanding of the factors contributing to health inequity, but also a commitment to rectifying these imbalances.
“Our hope is that our students recognize the important role that a pharmacist can have in the lives of these patient populations. For those who have limited access to primary health care, pharmacists are readily available in those areas to help provide that care,” Curtis said. “When pharmacy students are exposed to underserved populations during their didactic and clinical training, they’re more well-equipped to care for the same populations once they are in clinical practice. It strengthens the health care infrastructure in these underserved communities when students who are trained in these areas return there to help serve when they join health care teams as pharmacists.”
Carolynn Komanski, Ph.D., the assistant director of experiential programs in the UF College of Pharmacy, said the college’s commitment to serving Florida’s most vulnerable populations aligns with UF’s mission to improve the quality of human life through research, education, and service.
“It roots back to supporting the land-grant mission of the institution. We are ensuring that our students are getting a broad experience across the entire state of Florida,” Komanski said. “It also helps us identify areas where we might not be serving specific populations, so we can proactively secure opportunities for our students to supply services in those areas.”