National survey of pharmacy services in free medical clinics

Objectives: To characterize the current model of pharmacy services in free clinics, identify the extent to which free clinics serve as training sites for student pharmacists and residents, elucidate pharmacy service gaps in free clinics, and compare results to a 2001 survey. Design: Descriptive, nonexperimental, cross-sectional study. Setting: Free medical clinics in the United States in early 2008. Participants: Clinics registered at www.freeclinicfoundation.org. Intervention: A 26-point questionnaire addressed clinic and pharmacy demographics, pharmacy services, medication storage and distribution processes, and systems management. Survey invitations were sent via postal mail, with responses submitted via hardcopy or online (Survey Monkey). Nonresponders received a second mailing 4 weeks later. Main outcome measures: Characteristics determined by survey responses. Results: 42% of clinics responded (216 of 518). The median annual clinic budget was $145,000, with 1% to 20% spent on medications. Of responding clinics, 30% had a licensed pharmacy that was staffed on average by 3.4 pharmacist volunteers and 0.1 pharmacist employees. Of the 83.5% (177 of 212) that dispensed drugs, clinics filled 67 prescriptions per day with cardiovascular, gastrointestinal, and anti-infective agents as top classes. Pharmacy personnel provided mainly traditional (e.g., distributive) services (61.1%), and 19.3% of clinics trained student pharmacists. Since 2001, the number of clinics (355 vs. 518) and prescriptions dispensed (29 vs. 67 per day) increased but the percentage with a licensed pharmacy (33% vs. 30%) and mean number of pharmacist volunteers/employees (3.8/0.1 vs. 3.4/0.1) remained constant. Conclusion: The model of free clinic pharmacy services is a modified community practice. Pharmacy personnel have the opportunity to expand their role and pharmacy practice in free clinics.