Pharmacists moving into tribal health clinics, communities to tackle health disparities

The University of Michigan will embed pharmacists in at least five tribal health clinics in Michigan starting in early 2025.

As part of the College of Pharmacy’s Collaborative for Indigenous Resources in Care, Learning and Equity, the pharmacists will work alongside physicians and clinic staff and engage in education and outreach—all to get to know and care for locals and their health and medication needs.

The tribal health clinic collaborative is built on three years of engagement with Michigan’s American Indian and Alaska Native communities by Nicholas Cushman and Emily Mackler, both adjunct faculty at the College of Pharmacy.

Their work led to the creation of the program.

As a member of the Sault Ste. Marie Tribe of Chippewa Indians, Cushman is uniquely aware of the cultures and customs that shape health and behaviors—and also the equity gaps that worsen health for a community affected by more chronic illnesses and shorter life spans than the general population.

“I’ve seen the strength and resilience of our communities in the face of health care challenges,” said Cushman, who has become a leader on matters of tribal health, including substance use disorder and mental illness.

Cushman is also a commissioned health officer with the U.S. Public Health Service and well positioned to guide pharmacists’ interventions that can treat and prevent illness.

“By partnering with tribal nations, including my own, and my alma mater, we’re building on our cultural values and traditions to implement health care solutions that empower our people and support the prosperity of future generations,” he said.

Michigan is home to more than 240,000 American Indian and Alaska Native residents and 12 federally recognized tribal nations, which are their own sovereign, self-governing entities. As a whole, they experience a disproportionate burden of many chronic conditions, including being three times more likely to be diagnosed with diabetes and twice as likely to die due to complications from the disease compared to the non-Hispanic white population.

“We will be able to leverage the success of integrated pharmacist care for a patient population who has not been part of these programs before and most importantly be able to flex our prior experiences and resources to really meet the priorities of the tribal health clinics and communities,” Mackler said.

Each community has a tribal health clinic that provides basic health care services, including primary and dental care, to both adults and children. For specialized medical needs, patients are generally referred to nontribal facilities across the state.

The program pharmacists in tribal clinics in cities such as Grand Rapids and Fulton are part of an ongoing, broader collaboration between Michigan’s tribal communities and the U-M College of Pharmacy under the leadership of Amy Thompson, clinical professor of pharmacy and director of Community Health and Engagement, and Antoinette (Toni) Coe, assistant professor of pharmacy.

“Our aim is to empower American Indian and Alaska Native communities and advance culturally relevant health care solutions,” Coe said.

In addition to their role as health care providers, Thompson said the plan is for pharmacists to facilitate regular meetings among tribal pharmacists, tailor clinical education programs, participate in community events and enhance student engagement.

“We are committed to advancing a multidisciplinary approach to health care by working with other university schools and programs, with an emphasis on meeting the distinct health care needs of each tribal community,” Thompson said.

The tribal clinic program is similar to the Pharmacy Practice Model developed by College of Pharmacy Associate Dean Hae Mi Choe. It integrates pharmacists in physician practices across the state, enhancing the quality of care and improving patient outcomes. The U.S. Centers for Disease Control has recognized and promoted the program as a model for others.

“We are honored to partner with Indigenous communities in this collaborative, working together to address unique health care needs and priorities,” said Vicki Ellingrod, dean of the College of Pharmacy. “By listening and learning, we aim to support culturally informed care that truly reflects the values and strengths of these communities, as well as our values.”