Pharmacist-driven mobile health clinics: a qualitative analysis of logistics for program development, implementation, and operation

Abstract

Background

Access to healthcare remains a major issue in the United States, particularly in rural communities. Mobile health clinics (MHCs), including those utilizing a pharmacist-driven model, are one effective solution to address access-related barriers. To our knowledge, limited information is available to aid in the development, implementation, and operation of a pharmacist-driven MHC model. This project aims to fill this gap by exploring the characteristics of existing pharmacist-driven MHCs.

Methods

This project used semi-structured interviews, guided by a 23-item interview guide, conducted with groups and individuals from pharmacist-driven mobile health programs to identify logistics for the development of a pharmacist-driven MHC model. Fifteen pharmacist-driven MHCs that met the inclusion criteria were identified through a web-based search. Of these, eight programs agreed to participate (53%). An additional two programs were identified through snowball sampling, for a total of ten participating programs. Prior to the interview, programs completed a 14-item intake questionnaire to allow for adaptation of the interview guide. Interview data was analyzed using a mixed deductive (hypothesis-driven) strategy, in which four areas of inquiry, logistics, partnerships, outcomes, and lessons learned, were identified through a literature review process and guided the analysis. In this manuscript we focus on program logistics.

Results

Sixteen participants from ten pharmacist-driven MHCs completed an interview. Six subthemes were identified related to program logistics: (1) programs exist to increase access to care; (2) programs have an awareness of scope/role; (3) programs identify and meet community needs; (4) programs meet patients’ needs; (5) programs have a small staff with large volunteer-base; and (6) programs have a three-step clinical workflow.

Conclusions

By utilizing the MHC model, pharmacists may be better able to address health gaps while leveraging existing resources, and providing services tailored to the needs of the patients within a community. These findings may be used as a guide for the development, implementation, and operation of current and future pharmacy-driven MHC programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-12991-4.

Introduction

Access to healthcare remains a significant issue across the United States (US), with millions of individuals having limited or no access to care [1, 2]. Despite the efforts of the Affordable Care Act, health insurance status and cost of care remain the largest barriers individuals face to receiving care [1–3]. In a 2022 nationwide survey, 28% of adults indicated that they delayed receiving care due to cost [4]. Notably, 61% of individuals who are uninsured report forgoing care because of cost [5]. Furthermore, 17% of adults report that they have delayed receiving some form of care due to non-financial barriers including issues with rural access, healthcare workforce shortages, transportation, and language barriers [4, 6–8]. Socioeconomic status, race, and ethnicity also affect healthcare access [4, 6–8].

In response to the COVID-19 pandemic, the use of mobile health clinics (MHCs) expanded across the US, to address access to care issues [9, 10]. To date, there are an estimated 2,000 + MHCs operating and delivering services across the US [11]. A MHC is an innovative healthcare delivery model that brings a variety of services, ranging from primary care to chronic disease management, directly to communities outside of traditional healthcare settings [12–14]. Common MHC models in the US include outreach services provided via motorized vehicles (such as vans, buses, or RVs), non-vehicle methods like pop-up clinics, foot or bicycle outreach, or other temporary setups in community spaces, as well as hybrid approaches (e.g. motorized vehicle + pop-up; motorized vehicle + telehealth) [11, 14–17]. A 2020 study identified 811 MHCs from 2007 to 2017 that were registered with the nationwide Mobile Health Map, reaching rural and underserved populations, including racial/ethnic minorities and uninsured individuals [14, 18]. Since that time, the Mobile Health Map has continued to be updated, as of May 2025 reporting MHCs across the US have shown to improve patient quality of life, with an estimated 16,764 life-years saved over the last five years as measured by the Quality Adjusted Life Year (QALY), with each QALY unit valued at $70,000 [18, 19]. As of May 2025, the Mobile Health Map reports that MHCs operating in the US have a calculated return of $19 for every dollar invested [18]. Mobile healthcare thus has the potential to improve access to care and quality of life, decrease healthcare costs, and decrease health disparities faced by rural and underserved populations [11, 20].

MHCs primarily focus on acute and chronic disease prevention interventions and management strategies which commonly involve pharmacotherapy. As such, incorporating pharmacists into the MHC model may play an important role in medication optimization [21]. As outlined by the evidence-based Pharmacists Patient Care Process, pharmacists can collect, assess, plan, implement, and follow-up to monitor and evaluate interventions impacting the care of patient disease states [22, 23]. Through Comprehensive Medication Management services, such as Medication Therapy Management (MTM), pharmacists improve patient disease state management by educating on optimal medication use and facilitating health behavior-related changes [24, 25]. Pharmacist-led interventions improve patient outcomes related to chronic diseases, including diabetes, cardiovascular disease, chronic obstructive pulmonary disease, high cholesterol, hypertension, and asthma, by increasing medication adherence, reducing polypharmacy, improving patient self-management, and enhancing overall quality of life [26–31]. Moreover, pharmacist-led interventions have shown to reduce health inequalities by expanding access to care and improving outcomes of chronic diseases that are disproportionality prevalent among underserved and low socioeconomic populations [27, 31, 32]. Therefore, pharmacists can be leveraged to expand access to chronic disease care through the MHC model.

Research and related reporting of pharmacist-driven MHCs are increasingly more represented in the literature, with programs providing a wide range of services including primary care, preventative care, chronic disease management, medication management services, maternal care, and vaccinations [33–39]. Under this model, pharmacist-driven MHCs operate under the larger definition of MHCs, however, pharmacists specifically play a central role in delivering health interventions and managing patient health. Pharmacist-driven MHC models have a unique potential to improve outcomes for patients and make a sustained impact, especially for patients with chronic disease. Mobile outreach programs providing pharmacy services have been successful in reaching rural and other underserved communities that are unable to access such care in traditional health settings [33–40].

Despite the existing literature, to our knowledge, no study has yielded a document or tool that comprehensively describes the key components of pharmacist-driven MHC development and implementation. This project aims to identify key components to develop, implement, and operate a pharmacist-driven MHC by conducting a qualitative project across the US using in-depth interviews with personnel who were involved in the development, implementation, and/or current operation of a pharmacist-driven MHC. Using this data, we will explore and summarize essential components for pharmacist-driven MHC models. This manuscript focuses specifically on components related to program logistics.

Methods

This project used semi-structured interviews conducted with groups and individuals from ten pharmacist-driven mobile outreach programs to identify key components for the development of a pharmacist-driven MHC model. Our methods are reported based on the Consolidated Criteria for Reporting Qualitative Research (COREQ), omitting certain publicly available details related to the moderator(s) [41]. This project was approved by the project university’s Institutional Review Board in January 2024. This paper focuses on the theme of program logistics and supporting subthemes.

Sampling was conducted as follows. A web-based search was conducted in January 2024 to identify and recruit individuals who were involved in the development, implementation, and/or operation of currently active pharmacist-driven MHCs across the US for semi-structured interviews. Contact information was recorded in a master list for individuals affiliated with programs identified via publicly available websites as pharmacist-driven with a mobile outreach component. Additional programs were identified and recruited through snowball sampling. Participants were eligible for inclusion if they (1) held a role in some capacity with a currently operating pharmacist-driven MHC and (2) had a publicly available email to initiate recruitment correspondence. For this process, we opted for the larger definition of pharmacist-driven MHC to be inclusive of programs operating under an outreach healthcare delivery model, in which pharmacists play a central role in providing health services directly to communities outside of traditional healthcare settings, such as through motor, non-motor, and hybrid outreach formats [12–14, 33]. Participants from programs that operated without any pharmacy component and/or did not have a mobile or outreach format, such as those operating exclusively out of a physical brick-and-mortar site, were excluded. Recruited individuals from the programs reached out to self-select who participated in interviews to represent their program. A 14-question intake form was created to contextualize programs prior to the interviews (Table 1). Participants completed the intake form (one intake form per program) and emailed it back to the project team. Program characteristics were reported from the intake data using descriptive statistics (Table 1). The results were used to adapt the interview guide through branching logic, such that questions asked during the interview fit a specific program1.

Table 1.

Program descriptive statistics

Questions	Response	Percent of Programs (n = 10)
1. Does your program provide Medication Therapy Management (also referred to as Complete Medication Review or Total Medication Review)?	Yes	60%
	Partial/some components	10%
	Partner provided	20%
	No	10%
2. What screening services does your program perform? *	Blood pressure check	90%
	Weight/BMI check	80%
	Medication adherence	70%
	Substance Use	70%
	Tobacco use (smoking, vaping, and smokeless)	70%
	Immunization screening and administration	60%
	Social determinants of health	60%
	Cardiovascular risk calculator (i.e. ASCVD 10 year/ASCVD lifetime)	50%
	Health literacy	50%
	Mental Health	40%
	Foot exams	30%
	Patient perception of health	30%
	Fall Prevention	10%
	Fentanyl Test Strip Distribution	10%
	Over the counter medication use	10%
	Primary Care	10%
	Reproductive Health	10%
	Stroke risk indicator (CHA2DS2-VASc)	0%
3. What point of care testing do you offer? *	Blood glucose	80%
	Cholesterol/Serum lipid	70%
	Hemoglobin A1 C	60%
	COVID-19 testing	30%
	Osteoporosis/Bone density screening	30%
	Influenza testing	20%
	HIV/HCV	10%
	Pregnancy	10%
	Skin Scope	10%
	Strep testing	10%
	Urinalysis	10%
	Anticoagulation	0%
	Genetic testing	0%
4. Do you refer patients to additional resources? *	Medical: Primary care	80%
	Medical: Specialty health providers	30%
	Medical: Mental Health	10%
	Medical: Speech and Hearing	10%
	Medical: Physical Therapy	10%
	Medical: Nutrition	10%
	Medical: Substance Use Resources	10%
	Social services: Social work	50%
	Social services: Community programs	50%
	Social services: Care coordination	40%
	Social services: Case management	30%
5. What patient education materials do you offer? *	Diabetes education/management	80%
	Cardiovascular disease (heart disease and/or stroke) education management	70%
	Immunization education	70%
	Smoking cessation and/or counseling	70%
	Other chronic disease education self-management resources	70%
	Health monitoring resources	60%
	Nutrition counseling (including weight loss programs)	60%
	Vaping education and/or counseling	50%
	Poison Prevention	20%
	Asthma	10%
	Substance Use/Naloxone Use	10%
6. Does your program utilize digital health resources (i.e., trackers, portals, etc.)?	Yes	10%
	No	90%
7. In what format are your services provided? *	Pop-up	70%
	Mobile bus	60%
	Permanent Site	20%
	Telehealth	20%
	Hub and spoke	10%
8. Who is your primary target population (i.e. race/ethnicity, underinsured/uninsured, age, gender, rural/urban, etc.)?*	General Population	60%
	Underserved	60%
	Age 18+	40%
	Rural	40%
	Elderly	30%
	Non-English Speaking	30%
	Uninsured/Underinsured	30%
	American Indian/Alaskan Native	10%
9. Are any of your staff roles cross trained to perform multiple roles?	Yes	90%
	No	10%
10. How often do you visit a location (i.e. weekly, bi-weekly, monthly, etc.)?	Weekly	10%
	Biweekly	10%
	Monthly	20%
	Yearly	10%
	Varies	50%

Questions	Response	Range Across Programs
11. How many locations do you serve?	Fill in the blank	1–100 + Sites
12. How many hours do you typically spend at a location?	Fill in the blank	1–10 h
13. How much time do you spend per patient?	Fill in the blank	10–120 min
14. How many people do you serve?	Per occurrence: Fill in the blank	10 − 1,000 people
	Per year: Fill in the blank	50–50,000 people

*Percentages add up to over 100% indicating multiple responses

To develop the interview guide, a literature review process was utilized due to the lack of publicly available standardized tools for pharmacist-driven MHC development and implementation. This review was conducted in the PubMed research database from November 2023-January 2024 using the search terms “Pharmacist-driven”, “mobile health clinic”, and “outreach program”. Titles were filtered from 2000 to current and extracted. Abstracts were scanned for relevance, removing any studies that were not pharmacy-driven and/or an MHC. Twenty-two articles representing the pharmacist-driven MHC model were identified and reviewed (see Additional file 1 for complete findings from literature review). Characteristics of pharmacist-driven MHCs discussed across the articles included program logistics, such as services offered, format of services, program staffing, training procedures, program supplies, policies and procedures, licensing, target population, and reach of services. Additional details commonly reported were program outcomes which explained how the program collected impact data and measured success, including descriptive statistics, qualitative evaluation, quantitative evaluation, implementation science, and quality improvement.

An inductive analysis of the 22 articles identified in the literature review was conducted to identify a guiding model for pharmacist-driven MHCs. The results of our review identified four key areas of inquiry—logistics, partnerships, outcomes, and lessons learned—and was used to create a 23-item, semi-structured interview guide (Additional file 2). Initial topics for the guide were augmented through project team discussion. The final interview guide was organized into four deductive thematic areas of inquiry: Logistics (11 questions), Program Partnerships (2 questions), Outcomes (3 questions), and Lessons Learned (7 questions). Internal validity testing of the question guide was performed by the project team. External validity testing, including piloting, was not performed.

Interviews were conducted from February-April 2024 via Zoom and were audio and video recorded. No prior relationship was established between the interviewers and the participants before the commencement of the project. Participants had no previous interactions with the research team other than recruitment email correspondence to schedule an interview session. At the start of each interview, the moderator(s) introduced themselves, explained the purpose of the project, described their role in the project, and outlined the interview process, allowing participants to ask any clarifying questions before providing informed consent. Verbal informed consent was obtained from all participants and documented at the start of each session through audio and video recording. Each of the interviews were facilitated by two members of the project team; one member acted as the moderator (SS) for all interviews to ensure consistent delivery of the interview guide. The moderator held an MPH degree and received university-based continuing education in conducting qualitative interviews and focus groups, including training in rapport-building, question design, and unbiased facilitation. While the interviews were conducted, notes were additionally taken on a copy of the interview guide by the acting co-moderator (SP and EM) to capture potential insights and nuances. The co-moderator(s) received project-based training, including guided practice in qualitative interviewing, note-taking, and supporting interview facilitation. Interview sessions lasted 60–90 min. Participants were offered monetary compensation for their participation. Repeat interviews were not conducted.

Some of the recruited individuals requested to have more than one participant present to represent their program during an interview, so some interviews were performed in groups. The data was then collected and evaluated at the program level, meaning data from interviews with more than one participant were organized and analyzed by specific programs. The methods of utilizing the interview guide and collecting data were consistent across interviews, whether performed singularly or in a group. Audio recordings were transcribed verbatim using Rev.com and were manually de-identified by a project team member. De-identification was then verified by a second team member prior to data analysis.

Interview data was analyzed using a mixed deductive (hypothesis-driven) strategy [42]. Four categories of inquiry were explored through deductive coding by hand, which were previously identified in the literature review and augmented by project team expertise, as outlined in the interview guide — logistics, partnerships, outcomes, and lessons learned. To ensure consistency and rigor in the development of the codebook, two coders (SS and TF) independently reviewed and openly coded an initial subset of transcripts, resulting in 1,190 initial codes. Discrepancies in coding were discussed collaboratively through a series of consensus meetings, during which definitions were clarified, codes were refined, and new codes were added as needed between the coding team (SS, TF, EM, and SH). This iterative process continued until full agreement was reached on the application and meaning of all codes. Identified codes were then consolidated into a finalized codebook, resulting in 683 codes, with similar codes organized under the four broader themes, per a deductive thematic analysis approach [42]. The final codebook was then used to guide coding of the remaining data. All transcripts were then recoded by hand without a formalized software after random assignment to a three-member project team (SS, EM, and SH), and analytic induction was utilized to add newly identified codes as needed, resulting in 1,245 final codes. 20% of transcripts were selected at random to be coded by two members of the analysis team and compared for consistency to ensure intercoder reliability [43]. Due to the methods of hand coding, a reliability metric was not calculated. After coding of all transcripts was completed, the three coders met for a final set of consensus meetings to resolve discrepancies and identify key subthemes within the four deductive themes. Data saturation was not formally assessed; however, interviews were conducted until the research team determined that key themes were consistently identified across programs.

Techniques to meet the four criteria of qualitative research—credibility, transferability, dependability, and confirmability—were utilized to enhance trustworthiness [42]. To ensure credibility, interviews were audio and video recorded, producing a verbatim transcript for coding. Interview participants comprised of individuals with diverse roles within a pharmacist-driven MHC program, including pharmacists, other healthcare providers, administrative leaders, and other support staff allowing for data triangulation. Investigator triangulation was achieved through the diverse coding team, which comprised of individuals from multiple disciplines, including pharmacy, public health, and social work, who worked together to make analysis and interpretation decisions. Additionally, the process of developing an initial codebook was completed by consensus discussions to resolve any coder disagreements and 20% of transcripts were coded by two coding team members, enhancing inter-coder reliability. Further, member checking was completed to confirm the accurate interpretation of interview participants’ experiences. Transferability was completed through the program-intake process, in which we collected thick descriptions of each program to describe the context for which the experiences were being described. Dependability standards were met through the recording of an audit trail throughout the project process, including the analysis process of coding and interpretation of the data, in addition to the data collection techniques previously described. Finally, methods of the audit trail and inter-coder reliability were used to enhance the confirmability of project findings.

Results

Twenty programs were reviewed for inclusion in this study. Fifteen pharmacist-driven mobile outreach programs that met the inclusion criteria were identified and were contacted February 6–8, 2024, to invite program representatives to participate in a semi-structured interview. Of these, nine programs (60%) responded to the initial recruitment inquiry, after which eight programs agreed to participate in an interview (53%) with one program opting out (7%). An additional two programs were identified through snowball sampling with 100% response rate for agreeing to participate in an interview. Following the recruitment process, participants from ten programs agreed to schedule a semi-structured interview. Seven interviews were completed with a single participant, two interviews were completed with two participants, and one interview was completed as a group of five participants, totaling 16 interview participants across ten programs. Interviews with two or more participants represented the same program, such that the participants from the interviews conducted in pairs and groups were from the same program.

A participant from each program completed and returned the pre-interview intake form via email. One program returned two forms, representing two-sites of their program. For simplification, information from this program was combined into one form. Table 1 summarizes the data collected from the intake form. Of the programs represented, eight were affiliated with a university (80%), one was affiliated with a state government agency (10%), and one was a part of a state-wide non-profit (10%). Geographically, programs were representative of all four regions of the US, including the South (50%), the Midwest (30%), the Northeast (10%) and the West (10%). All programs were pharmacist-led, with 30% of programs operating solely under a pharmacy model, while a majority (70%) of programs operated under an interdisciplinary model, including medical professionals—physicians, nurse practitioners, nurses—and allied health professionals–physical therapists, occupational therapists, nutritionists, community health workers, and social workers. Reported funding of the programs heavily relied on grants, philanthropic donations, government support, and university support.

Four deductive themes were identified-logistics, partnerships, outcomes, and lessons learned. Here we focus on the theme of logistics, in which six main logistical subthemes were identified: (1) programs exist to increase access to care; (2) programs have an awareness of scope/role; (3) programs identify and meet community needs; (4) programs meet patients’ needs; (5) programs have a small staff with large volunteer-base; and (6) programs have a three-step clinical workflow. Table 2 summarizes the subthemes and provides illustrative quotes (see Additional file 3 for expanded supporting quotes).

Table 2.

Logistics subthemes and example quotes

Theme	Subthemes	Example Quotes
Logistics*	Programs exist to increase access to care	“I think just overall, when you look at social determinants of health and underserved populations, the big thing is a lot of them aren’t in the system and have no entryway into the system. And I think [our program] gives them a non-pressure easy way to get in the system… And then once we have you, how do we keep you well and keep you on a path to wellness while increasing your health literacy at the same time?” “When we started, as pharmacists-led, it was a lot of trying to identify conditions within the community that were being untreated and then, scheduling them or plugging the medical, the help system along the way.”
	Programs have an awareness of scope/role	“So we’re filling that gap, but maybe it’s one of those things that you’re there a few times a year and you’re able to make referrals to other resources in the community… So you’re relying on the rest of the healthcare system to fill in those other gaps.” “All we can do is educate and recommend… So a lot of education, and we have ancillary programs that we take out into those communities in which we do. We’re fortunate to have partnerships with physicians, nurse practitioners, et cetera, specialists that will go out and… deliver education and more importantly, do screenings. And because they are licensed, this is what it looks is happening with you, and you really need to go see someone to take care of this. We cannot do that. We can just recommend…and we cannot diagnose.”
	Programs identify and meet community needs	“And then as we identify public health needs within the state, we’re from a college level trying to advance those prescriptive authorities to fill or help just initiate therapy for patients… And so right now we have just an increase in STIs, sexually transmitted infections like chlamydia and gonorrhea. So because our law encompasses that, we have already begun to work towards adding that to our test to treat prescriptive authority, and then our students are also going to get that in their certifications upon graduation.” “Just as far as our scope of implementation, we do have a pretty concrete process for how we engage communities, and I think that has been a strength of our program just in the way that we start with looking at the statistics in the community, then we engage with the leadership, and then we engage with the community, do a community health needs and assets assessment. And there are several other steps to that.” “For us, what we find out here is that the hospitals and the physicians are so overwhelmed. There is no time for education. The other thing we find is that if some of our population are able to see a physician…and [the providers] do not speak Spanish, so they can’t even communicate with their provider. So there’s zero education. So this is really helpful, and we have to be very visual even in our classes, because here even we don’t have people with maybe third or fourth grade level of education and that’s it.”
	Programs meet patient’s needs	“…trying to make sure we’re being intentional, making sure every single event has somebody doing something like that. That’s where the biggest impact has been because we know it’s needed. Thinking about it that way has changed for the better, what we can say and the stories that we tell about people who have received not only medicine from us, but like I mentioned, someone was sent to the emergency room because they’re like, “This is not normal.” What opportunity would they have had a free chance to get an EKG on a mobile unit and then be sent to the hospital? You would’ve never known that. So those are the things that I think about, making sure we’re being very needs-focused with the people versus funding-focused for us.” “So everything is tailored to be culturally sensitive, all the education we deliver and to be sensitive to those issues. We don’t make it a point of embarrassing anybody. So, all our educational materials have a lot of pictures, very few words. Everything’s explained by our team, by the educators with a lot of examples, and we have the other staff rotating the audience, those receiving education, and they’ll communicate back to the people delivering, saying, Hey, they’re not capturing this. Explain it in another way. Or, hey, let’s pull out some of our models and explain this because every group of people is different. It just depends on which community or which county, because our counties are very different here. Very different.”
	Programs have a small staff with a large volunteer-base	“With our participants that come in… if they have very specific questions like let’s say they’re on, “Hey, I’m on high blood pressure medication. Can I actually get this?” or they’re needing help with something… we always make sure we recruit volunteers that are also licensed pharmacists, doctors and nurses to answer those questions.” “We specifically find entities, organizations or people that we already work with to provide those types of services, whether it’s clinical services or something else outside of that or social determinants of health. We partner with those organizations because once we’re gone, that patient still needs that help, so they know who’s available or who they can go to.”
	Programs have a three-step clinical workflow	“The flow is they get assigned a patient. The three of them are looking in the chart and triaging what they’re going to talk about before even going in. Then just the two med students go in to talk…Then they come out and talk with the pharmacy student about what went on before they go staff with the physician. Then the three of them together go and staff with the physician for the day. Then the physician and the med students go back in while the pharmacy student starts to input meds and things like that. They come out and say, “Yep, that is the plan.” Or if something else changes, the pharmacy student finishes putting in the meds into the chart, sends them over to our dispensing pharmacy, and then the patient goes there.” “We have health fairs there. We try to do educational types of things. We’ll do lots of interventions there. For example, we would do in the health fairs, we do hep C testing, we do HIV testing, diabetic testing, and then actually follow up with them.”

*This table presents findings related to the theme of logistics. Additional themes, including partnerships, outcomes, and lessons learned, will be explored in future manuscripts

Subtheme 1: Programs exist to increase access to care

All respondents expressed that increasing access to care is one of the main purposes of their program. However, the specific ways these programs increased access to care varied significantly from directly providing services to patients, leveraging partners to provide services, navigating and bridging patients into healthcare and social services in the community, as well as addressing patient social barriers to develop their abilities to enter the healthcare system.

Despite the program’s approach, they often referred to working to fill unmet needs and gaps in the existing care landscape faced by target communities. Gaps in care discussed by programs were presented at the individual (patient) level, such as lack of insurance and/or transportation, or at the systems level (healthcare or environmental) including limited hours of service and/or rural hospital closures. This participant discussed common barriers their patients face when accessing care through the existing care landscape:

“There’s some patients that don’t want to go because they’ve had very negative experiences within healthcare… some patients that are afraid to go because of their immigration status… some patients that can’t go because of timing.”

Two approaches for increasing access to care were apparent: (1) provision of interim services with a goal of integrating patients into local services, and/or (2) direct provision of care for patients. This participant discussed how their program meets both aims by increasing access to care, at an individual level:

“One of the partners is social work, so trying to get patients hooked up with our social workers and seeing if we could get them insurance….”

By leveraging partnerships, this program worked to set patients up for success in gaining access into the healthcare system. However, when specific barriers occur at the system’s level, programs may be the sole care system for some patients. This same participant discussed how they work to combat system level barriers:

“Our clinics are intentionally in the evening and on Saturdays, because working the nine-to-five type of job might not allow them to seek healthcare in any other way.”

Subtheme 2: Programs have an awareness of scope/role

Programs had a strong understanding of their scope, which was based on unmet needs within their community and the resources available to them. They showed their commitment to fulfilling their role in the community while leveraging the infrastructure available in the community to reduce individual and systemic barriers. Programs understand the limitations of their services and that they are not able to fully provide comprehensive care without leveraging partnerships with the existing healthcare and social service landscape. This participant discussed their program’s limitations in care provision, highlighting that they work to integrate patients into the healthcare system by addressing barriers and filling patient care gaps in the interim:

“There’s things that they’re missing and robust care that we would like them to have. If we can get them access to that care, that’s what we want.”

Often, programs worked to build a relationship with the existing healthcare system and community partners which enabled collaboration benefiting both parties. This participant reflected on how their program performed strategic outreach to promote their program and increase its visibility:

“It could be free clinics, federally qualified health centers, hospital systems, shelters, rehab centers. Anybody that is providing any type of direct care to the uninsured individuals in [our state], they need to know that we have this free pharmacy program that’s available….”

This participant discussed how a bidirectional referral system facilitates a closed loop process to improve access to care and the overall health of the community:

“Working backwards from the health systems, like the emergency departments know about us. Then we try to get them back into those health systems if they’re insured or if they can, if there’s an accessed way that we can do that.”

Subtheme 3: Programs identify and meet community needs

Most programs worked with communities to identify needs, such as through a community health assessment (CHA), key stakeholder engagement, and/or community conversations. Thereafter, programs aligned their services to the needs prioritized by the community. Notably, the needs that were most important differed by location. Often there was misalignment between identified needs that are formally determined in a broad manner, such as through national and state organizations, and the actual perceived, prioritized needs of the community. Thus, to maximize engagement, it was important to learn and address the prioritized needs identified by the community, in addition to the formally determined needs. This participant discussed how they tailor their partnered service vendors to different communities, based on identified need:

“Our mobile free pharmacy director makes sure she looks up the community health assessment for each county that we go into to make sure she’s bringing in the people that are needed just for that specific county because the priorities change with every community….”

With an established purpose to increase access to care, programs found their role in filling gaps in care to meet the needs of underserved populations and communities. This participant discussed how they identified a whole population of non-English speaking individuals not receiving care in their primary language and thus were not able to fully utilize the care that was available to them:

“…There’s a whole population there that they have healthcare, but they don’t really necessarily always have someone that can help them understand.”

The importance of engaging with communities to meet their needs is underscored by past program failures to do so. One participant reflected on a past program shortcoming resulting from failing to engage the community:

“…We didn’t work with the community enough to say, “What actually do you need?… Not what I perceive as your needs are, but your perceived needs.”

In addition to initial community engagement, programs must also remain flexible and responsive over time. Although programs engaged with community members while initiating their services, programs reflected on having to adapt the logistics of their program over time to meet the needs of the community and make changes to improve quality.

“…Continuing to show up and continuing to pivot and adjust, and really hear the community and adjust to what they need. And not being dead set on it has to be done this way at this time, but being able to treat the community as equal partners and adjust as we need.”

Programs described how they enact quality improvement efforts with two main sources of feedback identified: internal and external. This participant discussed how they leveraged their relationships with community members to drive the growth and quality improvement processes of their program:

“And so I do think that because we’ve built these long-lasting relationships, we’re planning on continuing them to the best of my knowledge and really transforming the profession to what best fits our patients.”

Subtheme 4: Programs meet the patients’ needs

Programs worked to tailor the logistics of their program, from services performed, to format of delivery, and even program planning of event schedule and location, to prioritize meeting their patients’ needs. This participant discussed how they tailor each patient encounter, often assuming multiple roles to meet the needs of the patient:

“Different patients are going to have vastly different needs, so… I would say, meeting the patient where they need and filling and fulfilling as many roles as possible, as practical that we’re able to do.”

In effort to provide equitable, needs-based care, the pharmacist-driven MHC programs tailored the services and patient’s next steps to the needs of the patient. This participant illustrates how their free mobile screening event demonstrated their tangible, life-saving impact:

“We just had an event. [One of our partners} was a mobile medical unit screening for irregular heartbeats or arrhythmias. One person had to be sent to the hospital…What opportunity would they have had a free chance to get an EKG on a mobile unit and then be sent to the hospital? You would’ve never known that. So those are the things that I think about, making sure we’re being very needs-focused with the people….”

While tailoring services to meet the diverse needs of patients is crucial, programs explained that establishing trust and building rapport with patients beforehand is a foundational step that must occur to ensure patients are receptive to receive program services. This participant illustrated how jumping into clinical interventions prior to establishing a rapport was met with disengagement by the community members:

“I remember telling the students to pack away the blood pressure cuffs, take off your white coats and go into the kitchen, and see if there’s anything you can do to help. So, the rest of that clinic, they were wiping down trays and they were sitting down talking to patients, people… And that’s something now that we try to do when we go to these sites is we try to have a presence first, before we start, I guess pushing more of a medical side of things, if that makes sense. And that’s really helpful.”

Once trust is established, another essential step prior to delivery of services for some patients is education on the value of and need for the services. Programs identified that in areas where healthcare access is limited or non-existent, individuals adapt, such as by accessing health information through internet sources. As a result, these patients do not perceive the benefit of program services. This participant discussed the harmful consequences of this misalignment in perceived need:

“…Their perceived need is they don’t need us because they can look it up, but they don’t necessarily understand what they’re reading or seeing. And so that’s the challenge right… we can help you use that information to be healthier.”

Subtheme 5: Programs have a small staff with large volunteer base

All programs utilized a small core group of staff. Within the core of the program, staff often held multiple roles with vast duties, including program planning and coordination, program promotion and outreach, training and oversight of staff, program operations, attending events, delivery of direct patient care, and program maintenance and sustainability. Some participants explained their role within the program entailed multiple titles with various duties:

“I’m a nurse with the College of Nursing, and I’m a professor. I’m also the outreach coordinator….”

Most programs (n = 9) leverage a large volunteer base to help facilitate the delivery of their services.

“...We heavily rely on volunteers. We use probably about 6,000 volunteers a year….”

Programs affiliated with a university found value in leveraging their student-base to recruit volunteer staff.

“[Students] want to be involved in something that they find meaningful… there’s some enrollment value in the mobile clinic being out there in advertising within the community.”

However, programs similarly leveraged community volunteers, including volunteer health professionals. With one participant stating,

“…We always make sure we recruit volunteers that are also licensed pharmacists, doctors and nurses.”

Subtheme 6: Programs have a three-step clinical workflow

Across interviews, a three-step workflow was identified, including (1) intervention, (2) education, and (3) patient next steps (Fig. 1). Although programs provided different services, the workflow remained consistent across organizations. Figure 1 identifies the common categories and gives examples of services provided in each step of the workflow.

Fig. 1.

Core operations across program workflows with examples

First, the pharmacist-driven programs led with a patient intervention. Across programs, five components of this step were identified: health screenings, social determinants of health screenings and intervention, medication services, primary care, and specialty care. Frequency of types of screenings delivered across programs are outlined in Table 1. When available, programs leveraged internal resources to provide services; however, programs that could not meet the patient’s needs directly leveraged external partnerships for services. For example, this participant outlined the internal workflow of conducting a patient MTM:

“…Sitting down with them, collecting a thorough medication list with what you’re prescribed, how are you taking it, what’s it for, who’s your doctor, what problems are you having with it, can you afford it? So really asking all those in-depth questions. Then the student will review that list to see, also asking the patient, “What concerns do you have? What’s your goal for this session?“… So, they’ll review the patient’s goals, but then also look for any other interactions or adherence issues or anything that we could improve and then make a recommendation based off that.”

In contrast, when this participant was asked why their program does not provide MTM, they described how it is an indirect service through them and that they,

“…Work collaboratively with a lot of organizations to make sure that’s happening.”

Second, the pharmacist-driven programs provided patient education. Education topics match each of the intervention steps, i.e., each intervention was complemented with education. Education was provided at both the individual and community levels. For example, this participant described individual education provided during screening events:

“So with diabetes though, what we do is even when we do general screenings where they’re not part of our class and we’re asked to do those a lot, part of that screening process is we educate them on the difference between glucose levels and A1C, what they mean.”

In contrast, this same participant described their eight-month classroom format community education sessions:

“[Education] needs to be something that’s planned and coordinated and open to all of our community… So again, it’s education on a larger scale….”

Third, the pharmacist-driven programs provided patients with next steps for continued disease state monitoring and management. When accessible, programs commonly referred patients to the local healthcare system and community resources, thus providing patients with a direct connection.

“Navigation, I think is our biggest thing… we have a whole list of people that we’re already working with directly and we can say, “Hey, call this number. They should be able to help you. You can get an appointment here.”

However, when the broader healthcare landscape did not exist and programs had internal capacity, they often set patients up with follow-up appointments. This participant described their robust medication refill protocol:

“We’ve implemented a refill protocol where when patients come back to the pharmacy… there’s certain things that we’ll look at. If it’s a blood pressure medicine, we’ll check their blood pressure. We’ll talk to them about symptoms… any changes that have happened. We’ll do little mini assessments with them, as well as a chart review….”

Discussion

Qualitative findings of interviews with individuals directly involved in a pharmacist-driven MHC revealed several implications of note. First, apparent similarities between program logistics, resulting in the six subthemes identified in this project, illustrate a cohesive framework in which pharmacist-driven mobile health programs are grounded in a shared mission to increase access to care, while adapting their operations to meet patient and community needs through intentional, flexible logistics. Programs operate with a clear awareness of their scope and limitations, often positioning themselves as connectors that bridge individuals to broader healthcare and social systems, particularly in contexts where formal infrastructure is lacking. Their logistics—from scheduling and service delivery to volunteer engagement—are shaped by ongoing community input, a foundational understanding of local needs, and the practical realities of limited staff capacity. Community-informed responsiveness enables these programs to adjust both service content and delivery formats, ensuring care remains patient-centered and accessible. Programs further structure their clinical services using a three-step workflow (intervention, education, and next steps), often leveraging a large volunteer-base for delivery, reinforcing their role as both direct care providers and facilitators of long-term health engagement. Taken together, these subthemes reflect an integrated, logistics-driven approach to care that is both strategic and adaptive, rooted in collaboration, trust-building, and continuous quality improvement.

While similarities were seen across these six themes of program logistics, how each program increased access to care varied. Though all sites followed a three-step workflow to provide care, some programs acted as a pre-step of care before helping patients enter into the healthcare system, while other programs directly provided the care. The difference in approach was generally related to what services were available in the community and the gaps in care that needed to be filled, including lack of access to health care and social services, navigation of language barriers, and building trusted healthcare provider relationships. As reported by Yu et al. in their recent review on the scope of mobile health clinics, MHCs in general are widely recognized as being able to address both individual and social determinants of health [44]. Similar to our pharmacist-driven MHC findings, MHCs gain the advantage of understanding the medical and social needs of communities they serve, by going directly into the communities they serve, resulting in tailored services based on individual barriers and needs [44, 45].

Across our interviews, notable components of MHCs were identified, which may aid programs in tailoring their pharmacist-driven clinic models. For example, while our interviews revealed that the programs we interviewed consistently applied a three-step clinical workflow (intervention, education, and next steps), other program logistics varied, however. Such logistical differences included program planning, policies and procedures, licensing, documentation, services delivered, depth and format of education, approach to outreach, as well as how programs addressed patient and staff/volunteer feedback and quality improvement. This variation even existed within programs when discussing different sites or types of outreach event. Therefore, this variation in logistics between and within programs may be explained by individual tailoring of program logistics to meet the needs of different locations, as programs were located across the US and even noted differences between service sites within their states, such as rural and urban contexts. Despite the lack of standardization, this logistic variation allows pharmacist-led MHCs to tailor strategies to different individual and community needs, thereby maximizing their impact.

Driven by a patient-centered culture, the MHC programs that we interviewed indicated that they are always striving to help the communities they serve by supporting existing services and care providers. As such, participants were aware of the limitations of their services, all while highlighting the importance of staying within their scope of work. By acknowledging these limitations, these programs are better able to address access to care through collaboration with healthcare systems in the community and by providing targeted support to navigate patients to more robust care. This helps facilitate the integration of pharmacist-driven programs into the broader healthcare landscape.

Facilitating pharmacist-driven programs integration into a broader health care context may be further accomplished through MHC programs seeking to build a more symbiotic relationship with the existing healthcare system. Established relationships would allow for bidirectional referrals between the existing care landscape and MHC programs. Overall, these programs are neither competing with, nor duplicating services of existing providers. Rather, when possible, they increase the number of patients receiving care from the broader healthcare system. For example, in a recent study of an innovative pharmacists-driven MHC serving persons experiencing homelessness, 85% of the clinic’s clients reported attending a follow-up visit with the pharmacist or referral visit with a provider within the broader healthcare system [45]. Thus, pharmacists-driven MHC programs may serve as a complement to traditional mobile health outreach models that are driven through a primary medical care approach.

Broadly, mobile health clinics are effective in increasing access to care for underserved populations [14, 44, 46–48]. Similarly, we identified that pharmacist-driven MHCs predominantly serve the underserved and untreated, striving to increase access to quality and necessary care. To facilitate this work, participants across the programs we interviewed emphasized the importance of working to develop partnerships and build relationships with communities, thus allowing the communities and the programs to work together. These symbiotic relationships allowed the programs to grow and evolve to meet the needs of the individuals they served as well as the broader community. This finding is supported by research findings from a Georgia-based MHC, in which the project staff highlighted the importance of integrating community voices into their program implementation and evaluation processes to ensure program success [49]. By employing five community conversation sessions, the project staff were further able to identify and tailor strategies to meet the specific needs of their community, including understanding the existing healthcare landscape, barriers to care, community strengths, and health service needs [49].

To our knowledge, no prior research has examined and detailed the logistical components for the development and implementation of a pharmacist-driven MHC model. Thus, our project contributes to the literature by providing a more comprehensive model of the logistical details of a pharmacist-driven MHC, which may aid other groups’ efforts to develop similar models. Our succeeding publications focusing on partnerships, lessons learned, and outcomes/sustainability will be published to expand upon the findings from the interviews. Based on our findings, we recommend that MHCs leverage pharmacists in their care delivery model.

Limitations

Our project population was limited to individuals directly involved in a pharmacist-driven MHC, which may have introduced selection bias. However, organizations recruited for interviews were intentionally similar in providing services via a pharmacist-led mobile clinic. Although other models exist, the authors were specifically looking for information on a pharmacist-led model. Additionally, no external validity testing was conducted for the developed interview guide, which may affect the generalizability of the questions across different settings or populations. Further, inter-coder reliability was not quantified using a formal metric; instead, coder agreement was established through a verbal consensus process, which may have introduced subjectivity and limit the replicability of the coding decisions. Unlike quantitative research, qualitative research does not seek to be generalizable as much as it seeks to produce information that readers might find transferable to other contexts [50].

Conclusion

Pharmacist-driven MHCs provide an innovative solution to address the access to care crisis. Pharmacist-driven MHCs use flexible, community-informed logistics to respond to healthcare gaps by providing adaptable, patient-centered services that integrate clinical care, education, and navigation within underserved communities. This integrated approach allows programs to remain responsive, patient-centered, and impactful within diverse care landscapes. Utilizing the MHC model, pharmacists may be better able to address health gaps while leveraging existing resources, and providing services tailored to the needs of the patients within a community.

Authors’ contributions

EM: Conceptualization of research idea and design; Formulation of overarching project goals; Design of qualitative methods; Investigation process for data collection; Acquisition, coding, analysis and interpretation of data; Drafting original manuscript; Reviewing and revising written work; Acquisition of the financial support for the project; Management, coordination, and supervision of project execution. SS: Conceptualization of research idea and design; Design of qualitative methods; Investigation process for data collection; Acquisition, coding, analysis and interpretation of data; Management activities to organize, transcribe, and de-identify data; Drafting original manuscript; Reviewing, and revising written work; Verification of findings. AM: Conceptualization of research idea and design; Interpretation of data; Reviewing and revising written work. DVG: Conceptualization of research idea and design; Interpretation of data; Reviewing and revising written work. JA: Conceptualization of research idea and design; Formulation of overarching project goals; Reviewing and revising written work. PA: Interpretation of data; Reviewing and revising written work. SH: Conceptualization of research idea and design; Design of qualitative methods; Coding, analysis and interpretation of data; Reviewing and revising written work; Verification of findings; Supervision of qualitative methods and study execution. All authors read and approved the final manuscript.

Funding

This project was completed in collaboration with the South Dakota Department of Health, supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services under grant # 5 NU58DP007438-02-00, Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke in South Dakota. The contents are those of the author(s) and do not necessarily represent the official views of the U.S. Government.

Data availability

The datasets used and/or analyzed during the current study are included in part in this manuscript & in supplementary information files. Full datasets are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval for this project was obtained from the South Dakota State University Institutional Review Board (approval number: IRB-2401006-EXM), which upholds the principles articulated in the Belmont Report and applies the regulations articulated in the Common Rule, which is in compliance with the Declaration of Helsinki. Informed consent was obtained from all participants prior to data collection.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.