Abstract
Background: Although the ranks of the uninsured in the United States have decreased in recent years, some states still lack Medicaid expansion programs, leaving many Americans, especially the indigent and homeless, without adequate healthcare coverage. Free-for-care clinics are oftentimes the last safety net for these vulnerable populations. Because these clinics have limited funding, a thorough understanding of the patients they serve is necessary to effectively direct their resources. The objective of the present study is to investigate the characteristics and clinical profiles of patients utilizing a free clinic in Miami, Florida.Methods: Aggregate EMR data reflecting consecutive adult patient visits to the Miami Rescue Mission Clinic in Miami, Florida between January 1st, 2018 to March 15th, 2019 (n = 846) were reviewed for sociodemographic characteristics and chronic disease prevalence. Prevalence rates were compared by sex and to county estimates from the Florida Behavioral Risk Factor Surveillance System.Results: The most common conditions were mental health (19.3%), circulatory system (14.7%), and musculoskeletal system disorders (13.9%). Males had a greater prevalence of depression (difference = 6.6%; 95% CI [1.5 to 10.7%]; χ2 = 6.2; p = 0.013) and overall mental illness (22.0 vs. 10.4%, difference = 11.6%; 95% CI [5.7 to 16.4%]; χ2 = 13.2; p = 0.0003) compared to females, and male sex was identified as an independent risk factor for mental illness on multivariate logistic regression analysis (OR = 2.8; 95% CI [1.7 to 4.7]; p < 0.001). There was also a higher prevalence of depression (difference = 6.41%; 95% CI [2.1 to 10.2%]; χ2 = 8.0; p = 0.0047) and HIV (difference = 1.4%; 95% CI [0.3 to 3.0%]; χ2 = 7.3; p = 0.007) in male patients compared to county estimates. Rates of hypertension, diabetes, elevated cholesterol, asthma, and COPD were lower in the clinic population compared to the surrounding county.Conclusion: There is an acute need for mental health services in this population. The lowered prevalence of other chronic conditions is due to underdiagnosis and loss to follow-up. Such analyses are important in guiding policy decisions for meeting the health needs of vulnerable, at risk populations.
Highlights
The lack of health insurance is associated with numerous adverse clinical outcomes [1]
Every state saw a reduction in uninsured rates, the greatest gains were seen in states which have adopted Medicaid expansion [13], and these differences in coverage rates have already translated into measurable differences in clinical outcomes [14]
A large majority (76%) of patients were male, reflecting the responsibility of Miami Rescue Mission Clinic (MRMC) as the entry point as well as the primary clinic for the adjoining Miami Rescue Mission’s Center for Men, a “comprehensive, year-long residential regeneration Program for men who suffer from various life-controlling problems such as homelessness, chemical abuse or addiction, medical and mental issues, illiteracy, and lack of adequate job skills” [30]
Summary
The lack of health insurance is associated with numerous adverse clinical outcomes [1]. Long recognized as a significant public health problem which affected a peak of 49.9 million Americans in 2010 [2], uninsurance has been linked with decreased health status [3], treatment delays [4], lower quality of care [5], underuse of preventive services [6], and increased overall mortality [7] Because of these consequences, there has been an increasing push for the adoption of universal health coverage (UHC) by a number of agencies, including the World Health Organization (WHO) [8] and the United Nations General Assembly [9]. By expanding access to Medicaid coverage and subsidizing private insurance premiums to adults with incomes below 138 and 400% of the federal poverty level (FPL), respectively [10], the ACA has reduced the ranks of the uninsured by some 43% five years after its implementation [11] The objective of the present study is to investigate the characteristics and clinical profiles of patients utilizing a free clinic in Miami, Florida
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