Student Perspective: Aaren

April 30, 2019

The socio-economic barriers that everyone must face will inevitably define access to many things, including healthcare.  Yet, these barriers can be the last thing we consider as providers when managing the disease states of our patients.  Our pharmacy extern for the month April, Aaren, was tasked to face those barriers head, and his skills will be forever changed due to it.  He shares his experiences in this month’s Student Perspective:

My time at HPFC has been very eye opening, informative and an incredible learning experience. Prior to my exposure with the underserved and uninsured population it was hard for me to understand and comprehend how a person could allow themselves to fall into the rut of unhealthy life choices and not prioritizing their individual health. I have been in settings in which patients have been able to afford proper healthcare or had insurance that covered a majority of their care. However, upon serving the population that HPFC sees on a daily basis, my thought process had to change to correlate with the affordability mindset and the formulary that is available through HPFC.

For example, for a patient who is diagnosed with A. Fib., Eliquis or Xarelto have become very commonly prescribed in this disease state and for good reason. The Factor Xa inhibitors are much less burdensome on the patient compared to warfarin and often time result in less side effects and better compliance. However, a patient with A. Fib. at HPFC likely could not afford these medications due to high cost and the limited formulary available. Throughout my schooling, we have been taught to focus on using the best possible drug available for our patients and affordability constraints were rarely implemented. This thought process that was used/taught in school does not work with patients who do not have insurance or a way to afford these more expensive and newer medications.

The most memorable patient that comes to my mind from the month was TW. TW has been suffering from constant GI upset and pain even when being treated with a PPI and H2 blocker. After discussions with Joann and reviewing her chart, Joann was concerned about the possibility of eosinophilic esophagitis (EoE) in this patient. Generally, the treatment for EoE is aerosolized fluticasone, usually in the form of Flovent HFA, swallowed twice daily. Unfortunately, the patient could not afford a Flovent inhaler and we could not provide one due to lack of availability. After the patient had left and been referred to a GI specialist, I was able to figure out a viable cost-effective alternative treatment for this patient. Instead of using the Flovent inhaler, nasal fluticasone could serve as a replacement by being swallowed. This option would provide adequate doses of fluticasone and cost well under $20. After discussing this option with Joann, she agreed that it could be a good treatment option if the patient comes in for a return visit and is willing to try it.

Without experiencing first-hand the struggles and priorities of the underserved and uninsured, I would not have had the practice and creative thinking oriented to working around extreme financial barriers that I’m sure I will encounter later on in my career whether in the community or hospital setting. My experience at HPFC has been an extremely valuable and eye opening one and I look forward to using the knowledge and experience I have gained here to better serve my future patients.