Pharmacist care in Federally Qualified Health Centers: A narrative review

Abstract

Federally Qualified Health Centers (FQHCs) are critical to providing care to underserved populations in the United States. Their focus on interprofessional care has also made FQHCs ideal locations to integrate pharmacists into care teams and advance pharmacy practice. However, despite long-standing involvement by pharmacists, there have been limited attempts to synthesize this literature. We conducted a comprehensive search for published literature on the roles of pharmacists in FQHCs and narrowed our search to 54 manuscripts and abstracts for inclusion in this narrative review. We found that pharmacists in FQHCs are providing care that is interprofessional, multifaceted, and evolving rapidly in response to environmental changes.Pharmacists are routinely involved in the traditional management of chronic disease, such as diabetes, hypertension, behavioral health, and respiratory conditions. In addition, pharmacists have forged roles in preventive care, infectious disease, and pain management. Models include appointment-based approaches; however, there was also heterogeneity in approaches consistent with the dynamic nature of the healthcare system in the United States with engagement in population health, transitions of care, and telehealth, as a few examples. Collaborative practice agreements were used to deliver care in some cases, although this was not commonplace, and reimbursement by third party payers was rarely addressed. Relationships with community pharmacies, often driven by the 340B Drug Pricing Program, were also noted.Recommendations for future research in this area include increasing the rigor of future research by standardizing pharmacy interventions and including comparator groups, a greater focus on financial sustainability, and further exploration of how state laws surrounding pharmacist provider status and scope of practice impact pharmacy service development.

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“…Additionally, pharmacy services that may be offered by FQHC pharmacists include Medication Assistance Programs (MAP) and 340B drug pricing programs. 5 , 6 MAP is a program where patients who do not have prescription insurance and meet financial thresholds can apply to receive free medication from the drug manufacturing company. Some drug manufacturers also require that the applicant is a US citizen or can provide an Individual Taxpayer Identification Number.…”

“…Racially and ethnically marginalized patients (Black, Hispanic or Latine, Indigenous, or Pacific Islander) accounted for 61% of FQHC patients. 5 Twenty-four percent of patients were best served in a language other than English. 7 Patients from disadvantaged socioeconomic backgrounds are often especially vulnerable.…”

“…However, pharmacists have also spearheaded initiatives for preventive medicine (i.e., colonoscopy prep, immunizations, tobacco cessation, and falls prevention), infectious diseases like Hepatitis C and HIV, and pain management. 5 Ambulatory care pharmacists in FQHCs may also take a population health approach. 7 , 8 FQHCs have patient populations with individual cultural, language, socioeconomic, and SDOH needs.…”