Free Healthcare Clinic Research Articles

Quality improvement approach to reduce patient cycle time at a student-run free healthcare clinical network

BackgroundThe University of Florida (UF) Equal Access Clinic Network (EACN) is the largest student-run free healthcare clinic network in Florida. The UF EACN serves those who are underinsured or uninsured...

Street Fights and Social Reproduction: The Role of Health Mutualism in Berkeley’s People’s Park Struggle

Abstract: In the social movement literature, the relationship between the political work of collective survival and the politics of the streets remains undertheorized despite robust research on the significance of direct social actions (DSAs). This article revives the work of the Berkeley Free Church during the People’s Park struggles in 1969. Through waves of intense street conflict, the Berkeley Free Church ran grassroots health programs and helped launch a free healthcare clinic. The Free Church’s health programs served both those with daily needs and those needing urgent care in the streets when police responded to demonstrations with violence. This historical case adds complexity to the social movement literature because the Berkeley Free Church’s work reveals a dynamic, interconnected relationship: health mutualism became central to street protest, and street protest in turn made the goals of building projects of health mutualism more feasible.

Enhancing Competency-Based Social Work Skills Through Service Learning and Interprofessional Education in a Student-Run Free Healthcare Clinic

Student-run free clinics (SRFC) offer students the opportunity to learn and work with students from other disciplines; however, there is very little research on the benefits of SRFC to social work students. The purpose of this article is to describe the qualitative student outcomes of a service learning (SL) and interprofessional education (IPE) experience in a SRFC designed to enhance the interprofessional competencies of BSW social work students. Students (n=38) enrolled in a service-learning course and participated in a semester-long SL and IPE experience at a university-affiliated interdisciplinary SRFC. Qualitative findings from student reflections indicated that students perceived that the overall experience facilitated the development of written and verbal communication skills, confidence, and professional identity. The research suggests that SL and IPE were beneficial to student development. We, therefore, recommend that other programs consider exposing BSW students to these experiences early in their program to enhance their educational experience.

Exploring the Relationship between Psychosocial Health and Drug Use among Street Children in Starehe Sub-County, Nairobi, Kenya

Surviving life on the streets is undeniably challenging and takes a toll on the psychosocial well-being of street children, often leading to substance use. This study aimed to investigate the correlation between psychosocial health and drug use among street children in Starehe Sub-County, Nairobi County, Kenya, utilizing the Problem Behavior Theory (PBT). Employing a correlational research design, data were collected from a sample of 100 street children, selected through cluster and simple random sampling from a target population of 30,000 in Starehe Sub-County. Additionally, information was gathered from four officials at the Starehe Children’s Office, eight officials from NGOs/FBOs operating in the sub-county, one sub-county administrator, and four ward administrators. The qualitative data obtained through questionnaires were analyzed using descriptive statistics such as mean, percentage, and frequencies, along with inferential statistics like Pearson correlation and regression analysis. The presentation of findings utilized charts and tables, while qualitative interview data underwent thematic analysis and were presented in a narrative format. The study's outcomes revealed a noteworthy impact of psychosocial health on drug use among street children, with a significant correlation between the two (r=0.503). The findings suggested that interventions aimed at improving the mental health of street children had a meaningful effect on reducing drug use. Recommendations stemming from the study include the necessity for providing homes to street children to mitigate exposure to stressful conditions leading to mental health issues. Furthermore, the study proposed the implementation of regular free mental healthcare clinics for all street children and emphasized the importance of awareness campaigns to educate them on the detrimental consequences of drug use. Strengthening behavioral counseling, support groups, and creating sober social networks for street children were also highlighted. The study advocated for government and non-governmental organizations to develop programs supporting access to counseling services and training certain street children to provide peer counseling to their fellow youths.

Assessing Adherence to Statin Prescription Guidelines at a Student-Run Free Clinic: A Retrospective Review.

The goals of this quality improvement project are to assess the BRIDGE Student-Run Free Clinic's adherence to the 2019 American College of Cardiology (ACC)/American Heart Association (AHA)Guideline on the Primary Prevention of Cardiovascular Disease and to compare our rate of statin prescription to the national average and to uninsured groups. A quality improvement project of 205 patients qualified by initial inclusion criteria at a student-run free healthcare clinic. Socio-demographic information, clinical measures associated with cardiovascular risk, and documentation regarding statin prescription at the follow-up visit after a patient's first lipid panel were abstracted from medical records. Descriptive statistics were calculated on the sample (proportions, means), and the proportion of patients eligible for statin treatment was determined. Of 58 patients eligible by guidelines to receive statins, 29 received a statin (50%) at their follow-up visit. Patients with clinical atherosclerotic cardiovascular disease (ASCVD) were more likely to receive statin therapy (83.3%) compared to other groups. Patients who were prescribed a statin were older, had higher total cholesterol, higher low-density lipoprotein (LDL), higher systolic blood pressure, and had higher ASCVD risk. Patients receiving statins were also more likely to be male or have a history of either hypertension, diabetes, or clinical ASCVD. Patients with established ASCVD had high rates of statin prescription.Following the first lipid panel, clinicians prescribed statins to approximately 50% of eligible patients.Although this proportion is below the national average for insured patients, it is higher than the national average for uninsured patients and represents a relatively high proportion of eligible patients within the examined time frame.

Latinx immigrant experiences with chronic illness management in Central Texas: reframing agency and liminality through nepantla

Immigrant rights have become increasingly contentious and partisan issues in the United States, and especially within the U.S. healthcare system. It is particularly essential to pay attention to Latinx immigrants—the largest immigrant and uninsured population in the United States. Latinx immigrants face many structural and legal challenges that may impact their biomedical healthcare access and treatment, creating a state of liminality or in-betweenness, especially when managing a chronic illness such as diabetes, hypertension, or arthritis. Using qualitative methods at a free healthcare clinic in Central Texas, the study reveals how the chronic illness narrative becomes inextricable from the immigrant narrative for this particular group, and how a unique ‘dual-liminality’ emerges from living with both an immigrant status and chronic condition. This study also introduces how Gloria Anzaldúa’s theory of nepantla can be used to push existing understandings of migrant liminality in medical anthropology by reframing the experiences of U.S. Latinx immigrants with chronic illness as ones of opportunity. Nepantla functions as a novel theoretical lens to better understand how Latinx immigrants may regain agency in their chronic illness management and promote social change by helping others in similar situations.

RELATIONSHIP BETWEEN PSYCHOSOCIAL HEALTH AND DRUG USE AMONG STREET CHILDREN IN STAREHE SUB-COUNTY, NAIROBI COUNTY KENYA

Life in the streets is not easy. It has immense negative effects on the psychosocial health of street children which could result in substance use. This study set out to examine the relationship between psycho-social health and drug use among street children in Starehe Sub-County, Nairobi County Kenya. This study was based on the Problem Behaviour Theory (PBT). This study adopts the correlational research design. Data were collected from 100 street children. These were sampled using cluster and simple random sampling techniques from a target population of 30,000 in the Starehe Sub-County of Nairobi County. In addition, data was collected from purposively sampled four officials from the Starehe Children’s Office, eight officials of NGO/FBO operating in the sub-county, 1 sub-county administrator, and 4 ward administrators from the Sub-County. The qualitative data collected using questionnaires were analyzed using descriptive statistics like mean, percentage, and frequencies, as well as inferential statistics such as Pearson correlation and regression analysis. The findings obtained were presented using charts and tables. The qualitative data collected using interviews were analyzed thematically. The findings were then presented in prose. The findings show that psychosocial health affected drug use among street children. Pearson correlation showed that there was a significant relationship between drug use and psychosocial health, r=0.503. The findings show that the measures put in place to enhance the mental health of street children made had significant influences on their drug use. There is also a need to provide street children with homes to reduce exposure to stressful conditions that could lead to mental health problems. Regular free mental healthcare clinics should also be availed for all street children. Raising awareness and sensitizing the street children on the negative implications of drugs is also important. There is a need to strengthen behaviour counseling, support groups, and sober social networks for street children. The government and non-governmental organizations should come up with programs for supporting access to counseling services. Some of the street children should also be trained to prop up their abilities to offer peer counseling services to their colleagues.

Accessing vulnerable undocumented migrants through a healthcare clinic including a community outreach programme: a 12-year retrospective cohort study in Denmark.

Little is known about the healthcare needs of the increasing number of undocumented migrants in Europe. We aimed to gain knowledge about undocumented migrants use of a free healthcare clinic including an outreach programme in Denmark. We conducted a retrospective cohort study of all patients registered in the database at the AmiAmi healthcare clinic in Fredericia, Denmark, 1 January 2006-30 July 2019. In all, 579 patients from 47 different countries were included, of which 525 (90.7%) were cis-women (= assigned female sex at birth and identifies as female). They had a total of 3135 consultations (median 3, interquartile range 2-6), and 19% used the clinic over a period of >2 years. In all, 820 consultations (26%) were done as part of the outreach programme, and the number of outreach contacts increased significantly over the study period (P < 0.001). Of 738 tests for sexually transmitted infections (STIs), 76 (13.1%) patients were found positive for one or several STIs. Transgender women and cross-dressing men had significantly higher risk of STIs (25.8% vs 10.3%, P = 0.007) compared with cis-women. Of 94 patients referred to the public healthcare system, the majority (n = 64) was referred to the department of gynaecology during pregnancy or for induced abortion. A total of 52 patients (9.0%) reported being submitted to abuse or violence while in Denmark, and another 24 (4.1%) were registered as victims of human trafficking. Our results highlight the multifaceted healthcare needs of undocumented migrants, with an increasing use of healthcare services over the study period. It underlines the importance of outreach programmes to reach this patient group at their place of work or stay. Finally, it emphasizes that transgender female and cross-dressing male sex workers are an especially vulnerable group with higher risk of human immunodeficiency virus and other STIs compared with cis-women.

Survey on Impact of Operational Policies and Procedures on Patient Satisfaction at a Rural Free Healthcare Clinic in Florida.

Aims Free healthcare clinics provide highly necessary services for the populations they serve, particularly in rural, low socioeconomic areas. When assessing for quality of clinic performance, it is important to consider the background of the population it serves in addition to observations given by clinic volunteers. Contextualizing the healthcare challenges patients face will help the clinic assist them to a greater capacity. Here, we assess how different areas of clinic operations (service, safety, accessibility, interactions with volunteers, and wait time) impact patient satisfaction in the setting of a small, rural, free clinic.MethodsEligible participants were asked to fill out an anonymous, 21-question survey that assessed their experiences and perspectives on various aspects of the clinic. The study was single-blinded with clinic staff unaware of the nature of the study.ResultsThirty-five patients responded to the survey. Overall, patients were extremely satisfied with the clinic with an average Likert score of 4.8/5; 14 of 15 categories scored a four or higher. Wait time scored lowest (3.6/5), with waits up to eight hours. Additionally, we found that transportation was not a major barrier to patients, with 80% arriving by personal transport.ConclusionsThe clinic provided valued and satisfactory services without coming across as discriminatory to the community. Areas of improvement include wait times, role clarification, and better integration of medical students. Additional studies to further understand the community will facilitate tailoring healthcare to a rural underserved population in the Southeastern United States.

Identifying Gaps in OT Services in a Developing Country: Healthcare-Clinic Needs-Assessment in Rural Belize

Abstract Date Presented 03/28/20 Limited healthcare in Punta Gorda, Belize, and surrounding villages called for an assessment of needed OT services. Interviews were conducted remotely and with a free healthcare clinic. Four main themes emerged: (1) lack of early intervention, (2) barriers to accessing school for children with developmental disabilities, (3) high caregiver burden, and (4) lack of social-emotional care. Findings support the addition of OT to the available care in rural Belize. Primary Author and Speaker: Kyra Barillier Additional Authors and Speakers: Lisa Jaegers

Impact of Student-Run Free Clinics in Urgent Care.

As Emergency Departments (EDs) become increasingly crowded, the non-urgent use of EDs exacerbates this problem. Uninsured patients have the highest percentage of non-urgent ED visits and free healthcare clinics provide access to care for the uninsured. This study analyzed the patient population of the 12th Street Health and Wellness Center (HWC), a student-run free clinic (SRFC), to understand the impact of SRFCs in urgent care. 2024 return and new patient intake forms from the HWC were analyzed. Multivariable logistic regression was performed to see which factors from the patient intake forms increase the probability that a patient came will into the clinic for urgent care. About 10% of the HWC patient population uses the clinic for emergencies, of which, 94% of them were not referred to the ED. If the HWC was not available, most of these uninsured individuals would have gone to an ED and incurred an estimated total cost of $39,515.80 in 2019. Multivariable logistic regression indicated that patients that came via walk-in are significantly more likely to seek urgent care at the clinic. Further, patients without insurance and patients who need a Spanish interpreter have a higher tendency to seek urgent care at this clinic. SRFCs save their surrounding EDs thousands of dollars in non-urgent ED visits. SRFCs should be attentive to patients who come in without an appointment, without insurance, and who need a Spanish interpreter because they are more likely to come in for an emergency.

Four Years of CHEER: Cost and QALY Savings of a Free Nurse-run Walk-in Clinic Serving an Uninsured, Predominantly Spanish-speaking Immigrant Population in Providence.

Non-emergent visits to emergency departments by uninsured patients impose unnecessary costs on both patients and safety-net institutions. We evaluated the health and economic impacts of providing free, walk-in care to low-income, uninsured adults-most of them Hispanic-at a free clinic between January 2013 and December 2016. Providing access to health care services for uninsured patients at Clínica Esperanza/Hope Clinic reduced emergency department expenditures in Rhode Island by approximately $448,876 (range: $410,377-$487,375) annually and may have also reduced future healthcare costs for this population by more than $48 million ($12,034,469 annually) over the four-year evaluation period. For every $1 in funding for walk-in clinic operation, delivering free care provided a return on investment of $71.18 (range: $70.95-71.40) in healthcare value. Providing access to non-emergent walk-in care at the more than 12,000 free healthcare clinics nationwide may save billions in ED costs while improving the health of uninsured individuals.

Perspectives of Health Care Services among Free Clinic Patients in the USA: A Qualitative Study

The United States (US) is the only developed country which does not have universal health insurance. Free healthcare clinics are operated largely by volunteers for the purpose of providing healthcare services to populations who are under- or un- uninsured in the US. Few qualitative studies have been conducted on patient experience and satisfaction at free clinics and, of those that do exist; most have been administered through focus groups. Thus, the purpose of this study is to explore perceptions and satisfaction among patients at a free clinic using a qualitative approach. Free clinic patients (N=649) participated in a survey with one open-ended question asking about their perceptions of the free clinic in 2017. This study analyzed the qualitative data from the openended question only. On average, the participants responded as being grateful and satisfied with the services provided by the free clinic. However, participants felt that they would benefit from further continuity of care and a higher number of medical providers, as well as more specialists. Future services to be modified or added, as indicated by the participants, include a greater variety of class times for health education and exercise classes, as well as the addition of urgent care services. To improve patient satisfaction, it is recommended to increase promotions for volunteer opportunities in addition to more training. Furthermore, it is necessary to give patients better access to referrals to community resources that offer the additional services that they are interested in.

The role of social work in free healthcare clinics and student-run clinics

ABSTRACTBackground: The role of social work in free healthcare clinics and student-run clinics remains an understudied topic. Method: We conducted a literature review of the published studies through four online databases: Google Scholar, Social Work s, Academic Search Complete, and PsycInfo. Results: The literature review revealed 449 possibly relevant studies, but only nine met the criteria for the final review. Based on these findings, social work is not fully utilized in free healthcare clinics and student-run clinics. Conclusion: Our literature review provides evidence for the need for social work in free healthcare clinics and student-run clinics.

The Effect of Volunteering at a Student-Run Free Healthcare Clinic on Medical Students' Self-Efficacy, Comfortableness, Attitude, and Interest in Working with the Underserved Population and Interest in Primary Care.

IntroductionThe number of primary care physicians in the United States continues to lag behind the number of uninsured people. There has been a growing demand for medical students to improve their self-efficacy, comfortableness, attitude, and interest in working with the underserved and in primary care. This study aims to discern whether volunteering at a student-run, free healthcare clinic has a positive impact on these five variables of interest or not.MethodsA 95-item survey was distributed through Qualtrics Survey Software (Qualtrics, Provo, UT, USA) to medical students from the Class of 2018 and Class of 2019 at the University of Central Florida College of Medicine. They were recruited via emails, Facebook, and in-classroom announcements. Mean responses on a Likert-like scale to different survey items were collected and compared between two study cohorts: Keeping Neighbors In Good Health Through Service (KNIGHTS) Clinic volunteers and non-volunteers.ResultsResults from 128 students showed no significant differences in the means between the two cohorts (p-values were not significant). When volunteers were asked the survey item, “KNIGHTS Clinic positively influenced my attitude towards working with underserved patients,” 62% strongly agreed, 26% agreed, 10% were neutral, and 2% disagreed.DiscussionBased on the results, volunteering at KNIGHTS Clinic may not have a positive impact on the five variables of interest. However, the lack of significance may also be due to certain limitations of this study addressed elsewhere in this paper. With the majority of KNIGHTS Clinic volunteers agreeing that “KNIGHTS Clinic positively influenced […their] attitude towards working with underserved patients,” there may be a positive impact of volunteering on volunteers’ attitude towards working with the underserved.

Beyond Access

We explore how social safety nets shape the utilization of services in a free health care clinic. Sociological research demonstrates that social interactions greatly influence decision making and help-seeking behaviors. However, little is known about the role of community-based organizations (CBOs) in this process and whether the effect of social safety nets varies across different types of services. Using original survey data from 1,044 patients at a free health care clinic, we find clear evidence that one’s social safety net, comprising CBOs and health-related discussion network ties, significantly affects the utilization of specialty care. Patients who are embedded in a social safety net are more likely than others to use these types of services. Importantly, this pattern does not hold for a patient’s use of primary care services. Our findings emphasize the importance of further examining the role of social safety nets, once access to health care is guaranteed.

Strategies in Development of an mHealth Technology for Low Socioeconomic Groups in Free Healthcare Clinics.

Welsh, Pamela D. DNP, CRNP, NP-CEditor(s): Cummins, Mollie R. PhD, RN, FAAN Author Information

A Parish-Based Free Health-Care Clinic: An Expression of Faith

Pastoral ministry entails a responsibility to read the signs of one’s context in order to respond in an appropriate and life-giving manner. Access to health care is a growing concern that affects the daily living of our communities, and disproportionately affects our poorest and most vulnerable neighbors. This is one parish’s story to meet this need in a collaborative venture on the local level.

Access Carroll: Community asthma education initiative

Grant funding from the American Academy of Nurse Practitioners Foundation was used to develop a community asthma education initiative for patients at Access Carroll. This initiative provided asthma education and supplies to current patients seen at the free healthcare clinic. While the focus was on patient education, the majority of funds were used to purchase supplies, including bronchodilators, spacer devices, nebulizers, and peak flow meters. Using an asthma self-management and symptom control questionnaire, data were collected before and after the asthma education program. While on a small scale, this project was deemed successful by increasing patient asthma treatment awareness, improving patient quality of life, and reducing emergency department visits for the patients at Access Carroll. Using specific tools to assess asthma treatment knowledge and current self-perception of asthma control can help healthcare professionals quantify patients' symptoms and specify areas of augmentation in asthma understanding.

Will reform mean the end of free healthcare clinics?

Will reform mean the end of free healthcare clinics?