Integrating and Developing the Pharmacist’s Role In a Health Clinic Serving Uninsured Patients in Providence, Rhode Island

Contributed by Joseph D. Honig, Clinical Pharmacist Specialist — Pediatric Pulmonology; Volunteer Clinical Pharmacist

What is Clinica Esperanza?
Since its founding in 2007, Clinica Esperanza has been at the forefront of providing culturally and linguistically appropriate care to those in the greater Providence, Rhode Island area. Serving as a cornerstone for holistic medicine, Clinica Esperanza provides more than just primary healthcare services offering nutrition, social work, and educational workshops to their patients. With a small staff on payroll, volunteer providers are a huge part of their success holding specialty clinics including cardiology, dermatology, diabetes, gynecology, neurology, ophthalmology, and psychology. Clinica Esperanza is a beacon of hope for many. Most patients have incomes far below the federal poverty limit and many do not qualify for insurance benefits. Patients are often forced to sacrifice food, utilities, and transportation to pay for their prescription medications.

The pharmacy services at Clinica Esperanza began during the early stages of the COVID-19 pandemic. Faculty, staff, and pharmacy students/interns from the University of Rhode Island College of Pharmacy volunteered at the clinic and were brought on to the team assisting with the clinic’s mass COVID-19 vaccination events. Following the initial vaccination surge, Clinica Esperanza continued to provide point-of-care COVID testing, screening, and prescribing of Paxlovid (nirmatrelvir/ritonavir) to treat high risk individuals in the community with a pharmacy resident available for assistance in managing drug interactions and dosing adjustments.

Today, the clinic has experienced unprecedented growth. As more patients continue to face barriers with regards to healthcare access and prescription cost, Clinica Esperanza has seen stark increases in their utilization by community members. In 2024, Clinica Esperanza served over 3,000 patients via just under 10,000 unique visits with over 1,400 new patients being seen and evaluated by the clinic. As part of ongoing social determinant of health screen (SDOH) screening during patient intake, currently over 1,200 patients report a barrier to medication access including transportation, financial, and/or gaps in knowledge.

Continued Growth: Expanding Pharmacy Services and Integrating Pharmacy Students and Residents
Since the inception of pharmacy services at Clinic Esperanza during the 2021-2022 pharmacy residency year, the team has grown to over 15 members including current PGY1 community based and PGY2 ambulatory pharmacy residents, graduated pharmacy residents, and other volunteer pharmacists. The bulk of growth and success can be attributed to collaboration efforts with the University of Rhode Island College of Pharmacy and Rhode Island Hospital pharmacy residency programs. With the inclusion of pharmacy students and residents, the pharmacy team at Clinica Esperanza has been able to participate in research projects, improve vaccination rates, and expand the patient care experience.

During the most recent vaccine initiative project, ‘VA-MOS Adelante: Best Practices for increasing Vaccine uptake among Low-income Spanish speaking Adults at a Free Clinic,’ the pharmacy team was responsible for the vaccination of over 500 individuals during the 7-month study period from September 2024 to March 2025. Growth of the ambulatory care pharmacy practice in clinic has been slow. During the first 2-3 years of engagement with the team, the pharmacy team had zero patient specific visits. However, in 2025 alone, the team has been able to see 35 patients and have been seeing steady growth with fully booked clinics for vaccinations and direct patient care encounters. The expansion of the pharmacy’s collaborative practice agreement has directly contributed to increased referrals and patient care activities.

The Future of Pharmacy Services at Clinica Esperanza
Pharmacists and pharmacy services are expanding in clinical sites and in the community setting. Across the United States, legislation is continually being passed giving pharmacists the ability to initiate, modify, and discontinue therapies independently, practicing to the top of their licensure. With prescription drug prices increasing and access being a barrier for those with insurance, ensuring medication access to this high-risk patient population is a key focus for the pharmacy team at Clinica Esperanza.

Recent discussions between the administrative leadership and pharmacy team have centered around obtaining licensure for a retail pharmacy to improve patient medication access and adherence to prescription medications. The goals in obtaining pharmacy licensure are to improve current inventory management measures of donated medications, improve patient access to prescription medications, improve patient adherence, and reduce patient out of pocket costs for prescription medications. All of this is centered around improving patient outcomes. By offering patients severely reduced price or free prescription medications at their site of care, the team is hopeful this would improve patient outcomes and access to life saving prescription medications. This pharmacy design would also offer pharmacy residents and students a unique opportunity to blend the ambulatory care and community pharmacy care models into one role, furthering their educational experience with Clinica Esperanza.

Currently, the clinic faces two major barriers as it pertains to opening its own closed-door pharmacy: funding and infrastructure. With federal medical funding cuts looming, the clinic has already had to make difficult decisions as it pertains to paid staff and the services the clinic can offer its patients. Clinic leadership and the administrative team have been working to obtain external funding as the initial cost of ensuring the proper infrastructure is in place for board of pharmacy licensing is the most difficult piece of this project.

With a growing team, growing patient population, and growing need for medication services, ambulatory pharmacy services at Clinica Esperanza are now a cornerstone of the practice. As those who are uninsured face growing costs associated with medications, introduction of a closed-door retail pharmacy would improve patient access to medications and improve patient outcomes.

Joseph Honig is currently an outpatient clinical pharmacist specialist at Hasbro Children’s pulmonary and allergy clinics. Graduating from the University of Rhode Island College of Pharmacy in 2021, Honig went on to complete a community based PGY-1 pharmacy residency program with Walgreens Pharmacy and the University of Rhode Island. He began his post-residency career with Lifespan Specialty Pharmacy where he helped shape the pulmonary pharmacy service line and transition to his current role. His expertise and passions include pulmonary/respiratory care, pediatrics, health equity, education/mentorship, and leadership.