When public health officials in Washington, D.C., needed medication management help for homeless residents during the early weeks of the COVID-19 pandemic, the city turned to Howard University’s Capitol City Pharmacy Medical Reserve Corps (CCPMRC) unit.
For about a month, eight student volunteers and three pharmacists helped homeless people obtain necessary medications and supplies to treat chronic conditions. The group worked out of a hotel that the city used to isolate homeless people whose age and health status put them at high risk for serious illness or death from COVID-19.
CCPMRC faculty director Tamara McCants said the unit assisted as many as 20–30 patients per day at the height of the deployment.
“It was a good experience, and it was good for the students,” said McCants, who is also executive director of the college of pharmacy’s experiential programs. “It was really meeting the patients where they are and ensuring all of their needs were met.”
The Medical Reserve Corps (MRC) is a national network of about 175,000 healthcare professionals and other volunteers serving in more than 800 community-based units throughout the United States and its territories. Created in response to the Sept. 11, 2001, terrorist attacks, MRCs recruit, train, and activate medical and health professionals to respond to community health needs, including public health emergencies.
According to the Department of Health and Human Services (HHS), MRC units actively responded to the COVID-19 pandemic since it emerged in the United States, logging more than 12,000 hours of service in August alone.
McCants said CCPMRC, founded in 2013 by Howard University student pharmacists, is the first MRC unit attached to a pharmacy school. The unit is one of five MRCs based in the District of Columbia, according to HHS.
When the pandemic struck the district, the D.C. Department of Human Services asked CCPMRC volunteers to perform COVID-19 symptom assessments at the city’s homeless shelters.
“The shelter staff was getting overwhelmed, and they didn’t feel comfortable or competent to do that symptom check. So we got called to see if we would be comfortable doing that as pharmacists and pharmacy students. We said, ‘Of course,’” McCants said.
She said just as the students were preparing to aid the shelters, the city began shifting vulnerable homeless people to hotel rooms. This left some people without access to medications, leading to instances of diabetic ketoacidosis and other serious complications.
“It was truly a situation where the healthcare system was overworked, and they needed some volunteers to help stabilize the situation. So they called us in to run a medication management service,” McCants said.
Medical management of the isolated homeless population was provided by Unity Health Care, a community health center network that has long served the District’s homeless.
Casey Walker, who helped form CCPMRC as a Howard University undergraduate and served a term as the organization’s student director before earning his Pharm.D. degree this year, described the patients as vulnerable people with “nowhere else to go.”
Under the medication management service that Walker and McCants developed, volunteers reviewed medication orders from Unity Health Care’s prescribers, worked with a local independent pharmacy to process prescriptions, and had medications sent to the hotel. The volunteers reviewed patients’ charts, counseled patients by phone, and delivered medications to patients’ rooms.
Walker said some patients were taking buprenorphine or methadone for substance use disorder, and the pharmacy team worked with health department staff to maintain medication access.
“We really had to think on our feet,” said Walker, who is now completing a PGY1 pharmacy residency program in behavioral health at the University of the Sciences in Philadelphia, Pennsylvania.
The counseling sessions revealed that many patients were suffering from nicotine withdrawal because they couldn’t smoke at the hotel.
“We had to get a lot of smoking cessation patches, just because they were very agitated because they couldn’t smoke. That was an issue,” McCants said.
The volunteers also acquired blood glucose monitors and test strips for patients with diabetes who had been going without these necessary tools, sometimes for years, she said. Other patients needed injection devices for their diabetes medications. An HIV-positive transgender woman needed hormone medications and antiretroviral therapy.
“We saw a lot of incomplete regimens as well. We had somebody on diabetes medications without a statin. We had somebody on one HIV antiretroviral when they were supposed to have two things,” McCants said. “So we filled in a lot of gaps [and were] just really feeling like we were helping.”
She said the unit’s work ended after the patients were established on medication regimens that Unity Health Care could manage through its normal processes.
Walker said the District’s Department of Human Services continues to use the CCPMRC’s model for medication management of the underserved.
The pandemic isn’t the first crisis in the District that the pharmacy volunteers have helped manage.
“They call on us because they know we’re going to show up, and we’re trained, equipped to handle it,” McCants said.
She and Walker said that the unit has been active in the District’s past influenza mass vaccination campaigns and even conducted a hepatitis A mass vaccination campaign at a city homeless shelter after an outbreak of that disease.
McCants said CCPMRC owes its origin to an encounter with a senior official from the District’s Health Emergency Preparedness and Response Administration who visited a student-run wellness fair.
“He was so impressed. It was the first time he saw what pharmacy students were able to do, and the gamut of what pharmacy was able to do,” McCants said of the official. “We had blood pressure screenings, diabetes screenings, nutrition education, an exercise class, and all that type of stuff.”
She said the agency at the time was looking for ways to identify and train volunteers to conduct mass immunization campaigns. After discovering that pharmacists and student pharmacists could handle the tasks, the official worked with the college of pharmacy to establish the MRC unit.
McCants, who had experience administering health department grants, became involved in the project when she responded to an email request from the students asking for a faculty advisor.
“I basically just got lucky,” she said.
Walker said that over the years, the unit has held educational symposiums for pharmacists and pharmacy technicians on cardiopulmonary resuscitation training, naloxone training, emergency preparedness, and other topics.
The pandemic has resulted in a shift to virtual training, including a late September symposium.
“We had over 75 pharmacists and pharmacy students who attended,” McCants said. She said the group expects to be actively involved in mass influenza vaccination campaigns in the city this fall.
For additional information about CCPMRC and the homeless project, view the June 16 video poster presentation from Howard University College of Pharmacy students Zulikhat Segunmaru and Rukiya Umoja. The virtual event was hosted by the National Association of Boards of Pharmacy.
[This news story will appear in an upcoming issue of AJHP.]
