City Rounds

Homeless men and women on Skid Row gain control of their diseases when pharmacists modify drug therapies to reach treatment goals.

By Kukla Vera

Many times, devising patient care plans requires a healthcare provider to think outside the box. And on Skid Row in Los Angeles, the box may be where the patient lives.

“One of my patients kept telling me that he was taking his medicine and watching his diet, but still his diabetes was out of control. Finally, I went to visit him at the address he provided. He lived on a vacant lot and kept his vials of insulin in an abandoned refrigerator,” says Steve Chen, Pharm.D., assistant professor at the USC School of Pharmacy.

Chen provides clinical pharmacy services to patients at the JWCH Medical Clinic at the Weingart Center in the Skid Row area, one of eight safety-net clinics supervised by Chen and served by the School of Pharmacy. He works with Dennis Bleakley, M.D., associate medical director of the clinic, caring primarily for homeless men and women. Bleakley relies on Chen’s expertise when drug therapy issues play a key role in patients failing to gain control of their diseases. In most cases, the primary disease is diabetes.

“Think about how tough it is to control diabetes under the best circumstances: testing your blood multiple times a day, eating a structured diet and needing refrigerated insulin. Add homelessness and you really have a complicated issue,” Chen says.

To further complicate the equation, many of the clinic’s diabetic patients also struggle with high cholesterol and high blood pressure, two conditions that carry their own risks when left unattended.

Chen gets to know the patients through regular appointments, monitoring their progress and teaching them about their diseases. He helps them understand the importance of lifestyle changes and of taking their medications regularly, while also addressing the difficulties posed by their unpredictable lives. Through physician-approved protocols, he is able to modify drug therapy as needed to help patients reach treatment goals.

“We have taken patients whose diabetes was so out of control that they could barely get through the day and brought them into compliance. Now they are here every week for their appointments and, in many cases, with stellar results,” Chen says. “But there are others who are still in need of our help. I don’t give up.”

It is this attitude that Chen passes on to his pharmacy students and residents. He teaches them how to ask questions, make physical assessments, recognize and analyze drug problems and find solutions. He tells residents to meet the needs of patients by working with them and the entire health care team to reach positive clinical outcomes.

“Clinical pharmacists help patients gain control of their diseases and when the diseases are controlled, the patients don’t end up in hospital beds or emergency rooms requiring expensive, drastic care that could have been prevented,” Chen says. “This improves the patient’s quality of life and decreases overall medical costs.”