Student-run Free Clinic Research Articles

Call to Action: A Faculty Survey to Inform Future Efforts at Student-Run Clinics.

Existing literature about student-run clinics (SRCs) often focuses on student rather than patient experiences. To begin to gather data on norms and practices at SRCs nationally, this pilot study surveyed faculty leaders from SRCs around the country about metrics such as clinic organization, patient demographics, and care services. A 38-question survey was distributed via email to members of the Student Run Free Clinic Faculty Association (SRFCFA) in October 2021. All responses were collected electronically via Qualtrics survey software. Most SRCs are held at least once weekly in variable physical locations. All SRCs surveyed use an electronic medical record. Student leadership typically rotates annually. Preceptors skew towards generalists rather than specialists. Clinics have variable patient volumes but see majority uninsured and non-English-speaking patient populations. Responses about consistency of result communication, follow-up visits, referrals to specialty care, and management of high-risk patients were mixed. The majority of respondents did not feel that learner experience was prioritized over patient care. The design and operations of SRCs nationwide is variable and not standardized. There remains a limited understanding of patient experiences and patient-centered outcomes at SRCs, and thus it is difficult to guide best practices. Future efforts to collect patient perspectives and outcomes should be emphasized given the vulnerable populations these clinics serve.

The Chicagoland Free Clinics Consortium: A Model for Student-Run Free Clinic Collaboration.

While student-run free clinics (SRFCs) play an important role in care for underserved populations, few mechanisms exist to promote collaboration among regional SRFCs. To address this gap, the Chicagoland Free Clinics Consortium (CFCC) was formed to (1) facilitate collaboration between Chicagoland SRFCs, (2) provide innovation grant funding, and (3) host an annual conference. In 2018, students from the Pritzker School of Medicine founded the CFCC and partnered with peers from area schools to implement programming. Between 2018 and 2022, CFCC engaged 23 SRFCs representing all 6 Chicagoland schools, held 4 annual conferences, and distributed $15,423 in grants to 19 projects at 14 SRFC sites. A total of 176 students from 5 schools attended the 4 conferences. In 2022, 82 unique participants were surveyed, and 66% (54/82) responded. Eighty percent (43/54) reported they were "more likely to collaborate with other Chicagoland free clinics." In 2022, all grant sites were surveyed and 84% (16/19) responded. Most (87%,14/16) agreed the grant "allowed them to implement a project that would not have otherwise been accomplished" and 21% (4/19) were inter-institutional collaborations. To our knowledge, CFCC is the first student-led organization to promote sustained collaboration across SRFCs in a metropolitan area.

Evaluation and Optimization of Diabetic Retinopathy Screenings for Uninsured Latinx Patients in a Resource-Limited Student-Run Free Clinic.

Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient population, evaluated the performance, and conducted a needs assessment of DR screenings at the University of California, San Diego Student-Run Ophthalmology Free Clinic, which provides care to predominantly uninsured, Latino patients. Retrospective chart review was conducted of all patients seen at the free clinic since 2019 with a diagnosis of type II diabetes. Date and outcome of all DR-related screenings or visits from 2015 onward, demographics information, and DR risk factors such as A1c and insulin dependence were recorded. Predictors of diabetic retinopathy and frequency of DR screenings for each patient were analyzed using multiple logistic regression, t-test for equality of means, and Pearson's correlation. Of 179 uninsured diabetic patients receiving care at the free clinic, 71% were female and average age was 59. 83% had hypertension, 93% had hyperlipidemia, and 79% had metabolic syndrome. Prevalence of non-proliferative DR was 34% and that of proliferative DR was 15% in diabetic patients. The free clinic capacity in recent years plateaued at just under 50% of patients seen for DR screening or visit per year, though average wait time was over 2 years between visits. Patients with higher no-show rates had less frequent DR screenings. Chronic kidney disease and poor glycemic control were the strongest predictors of DR. The student-run free ophthalmology clinic has been effective in providing screening and follow-up care for DR patients. Creation of a protocol to identify which patients are at highest risk of DR and should be seen more urgently, addressing no-shows, and implementation of a tele-retina program are potential avenues for improving clinic efficiency in a resource-limited setting for vulnerable populations.

Assessing Educational and Attitudinal Outcomes of a Student Learner Experience Focused on Homelessness.

Patient navigation programs help guide vulnerable populations, such as those experiencing homelessness, through the health care system. Medical students developed the student-run Patient Navigator Program (PNP) to serve persons experiencing homelessness (PEH) in the Dallas area. The objective of this study was to build on previously published data to determine how medical student attitudes, knowledge, and confidence working with PEH changed during involvement in the PNP, particularly after participating as a patient navigator. Student fellows completed a survey prior to a training elective (time point 1), immediately after the training elective (time point 2), and after acting as a patient navigator (time point 3). The PNP survey, which intended to measure student attitudes and knowledge regarding PEH, included the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI) and the Student-Run Free Clinic Project (SRFCP) surveys. In our analysis, we compared responses among the different time points. Seventy-six of 88 students who completed the training elective chose to participate in the PNP fellowship. Skills, knowledge, and self-efficacy improved from time points 1 to 2, 1 to 3, and 2 to 3. Social advocacy also improved from time points 1 to 2 and 1 to 3. Improvements from time point 1 to 2 demonstrated the value of didactic learning, while further improvements from time point 2 to 3 demonstrated the added benefit of hands-on experiential learning. Our study illustrates the potential educational benefits that a PNP provides to medical students who may encounter or care for this population during their careers.

A Roadmap to Integrating Dermatologic Care at a Student-Run Free Health Clinic

Student-run free health clinics (SRFCs) play an important role in providing a safety net healthcare system for uninsured patients by offering primary healthcare or preventative medical services. Patients at free clinics may have to be referred out for medical complaints better managed with specialty care. Integrating these services at SRFCs can address barriers to accessing specialty care. Free dermatologic care offers an opportunity to provide care to patients who may otherwise ignore symptoms, which can lead to reduced quality of life and a worse prognosis in some conditions. We detail a roadmap to integrate dermatologic services at an SRFC by providing operational considerations such as assessing needs, developing a clinical workflow, engaging dermatologists and the community, and sustaining student involvement. We also discuss the potential for a dermatology clinic to foster interest in the specialty among students underrepresented in medicine, given the current call to action to increase racial and ethnic diversity in the dermatologic workforce.

Social determinants of health correlations and resource usefulness at a Milwaukee free clinic for uninsured individuals: A cross-sectional study.

Addressing social determinants of health (SDOH) is fundamental to improving health outcomes. At a student-run free clinic, we developed a screening process to understand the SDOH needs and resource utilization of Milwaukee's uninsured population. In this cross-sectional study, we screened adult patients without health insurance (N = 238) for nine traditional SDOH needs as well as their access to dental and mental health care between October 2021 and October 2022. Patients were surveyed at intervals greater than or equal to 30 days. We assessed correlations between SDOH needs and trends in patient-reported resource usefulness. Access to dental care (64.7%) and health insurance (51.3%) were the most frequently endorsed needs. We found significant correlations (P ≤ 0.05) between various SDOH needs. Notably, mental health access needs significantly correlated with dental (r = 0.41; 95% CI = 0.19, 0.63), medications (r = 0.51; 95% CI = 0.30, 0.72), utilities (r = 0.39; 95% CI = 0.17, 0.61), and food insecurity (r = 0.42; 95% CI = 0.19, 0.64). Food-housing (r = 0.55; 95% CI = 0.32, 0.78), housing-medications (r = 0.58; 95% CI = 0.35, 0.81), and medications-food (r = 0.53; 95% CI = 0.32, 0.74) were significantly correlated with each other. Longitudinal assessment of patient-reported usefulness informed changes in the resources offered. Understanding prominent SDOH needs can inform resource offerings and interventions, addressing root causes that burden under-resourced patients. In this study, patient-reported data about resource usefulness prompted the curation of new resources and volunteer roles. This proof-of-concept study shows how longitudinally tracking SDOH needs at low-resource clinics can inform psychosocial resources.

The Time for Specialty Care Collaboration is Now: How the Consortium of Student-Led Eye Clinics Makes the Case

The Consortium of Student Led Eye Clinics (CSLEC) was founded in 2021 as a part of the Editorial Fellowship offered by the Journal of Student Run Free Clinics (JSRC), to increase collaboration between vision screening programs in the United States. So far, the CSLEC has recruited over a dozen programs, initiating a mentorship process to pair new organizations with long-established clinics. The CSLEC has also worked to generate bi-monthly workshops highlighting different operational strategies and insights from member institutions. With a multi-institution research team, a comprehensive survey has been an ongoing priority to assess baseline characteristics of vision screening programs, including from non-CSLEC member institutions. Ultimately, to further optimize and standardize operations across vision screening programs, the CSLEC seeks to incorporate the expertise of all member institutions to integrate consensus-based decision making to serve as a legitimate source of access to eye care, ultimately to identify and treat vision-threatening illness in populations without stable access.

Advanced Trainees in Student-Run Free Clinics: Potential Bridges to Critical Gaps in Knowledge

Background: Student-run free clinics (SRFCs) are increasingly becoming multidisciplinary care centers for underserved and uninsured patients across our communities. While SRFCs continue to advance research on various fronts to improve the quality of patient care provided, there remains scant literature on the involvement of resident and fellow physicians, or rather advanced trainees across disciplines in general, in the SRFC setting. As a result, there is a limited understanding of how best to include them and their skillsets within SRFCs and to design opportunities mutually beneficial for both SRFCs and advanced training programs.
 Purpose: To initiate a call-to-action for SRFCs to invest resources toward better characterizing the involvement of advanced trainees across SRFCs and the impacts they can potentially impart upon both the SRFC’s educational and patient care experiences.
 Summary: There remains limited information available pertaining to the involvement and impact of advanced trainees in SRFCs. As a result, these remain suboptimally-tapped areas of research and SRFCs are well-positioned to potentially bridge critical gaps in knowledge. Potential approaches to this include 1) querying advanced trainees currently involved in SRFCs on their motivations for being involved, 2) encouraging advanced trainees to discuss how other trainees may similarly become involved and to help with securing their participation, and 3) surveying training program leadership at institutions with SRFCs on how mutually beneficial partnerships between SRFCs and training programs might be established. In better characterizing their roles, SRFCs have an opportunity to fuel significant changes in health education and patient care.

Pilot Study of Animal Assisted Therapy Provided in a Student Run Pro Bono Clinic

Background: Animal assisted therapy (AAT) is therapeutic intervention designed to help patients engage in meaningful life activities.1 Therapy dogs are used in healthcare settings to engage patients in motion, self-care, mental health, motivation, social responses, pain management, and fine motor skills.2 While there is research on the benefits of AAT with children and adults in inpatient settings, there is a lack of information on the benefits and satisfaction of AAT in student-run free clinics (SRFC).
 Methods: Occupational therapy (OT) students, volunteer clinicians, trained therapy dog teams, and patients receiving OT services at the Community Aid, Relief, Education & Support (CARES) SRFC participated in a pilot AAT program. All participants completed a specially designed survey via REDcap immediately following AAT sessions. Surveys focused on the patient’s pain and stress levels, benefits of AAT, and patient satisfaction.
 Results: Ten patients participated in the AAT pilot program alongside thirty-seven students and 4 therapy dog teams. 100% of patients responded therapy dogs helped them reach their goals, 93.8% of handlers and clinicians agreed the dog was a valuable addition to therapy sessions, and 100% of OT students agreed AAT is an important tool for therapists to use in clinical settings. 67.6% of patients reported a decrease in stress and 41.2% of patients who were experiencing pain reported a decrease in symptoms. Students, handlers, and clinicians reported benefits with AAT including range of motion (79.7%), fine motor skills (68.1%), and motivation (68.1%).
 Conclusion: AAT was successfully integrated into CARES SRFC based on feedback and data collected from participants. AAT had a visible impact on patients, students, handlers, and clinicians. Future research on the use of AAT in a SRFC should include a larger sample size and consider how to better define the specific impact of AAT on populations and conditions commonly seen in a SRFC.

Patient-Level Characteristics Associated with Tobacco Users and Nonusers at a Student-Run Free Clinic.

Many tobacco users are motivated to quit but lack the resources to do so. To date, studies characterizing tobacco users at student-run free clinics have used small sample sizes, which may not be large enough to detect differences across key variables. As such, we assessed sociodemographic differences between tobacco users and nonusers at a student-run free clinic using a pooled cross-sectional design. We used patient-level data from the electronic health records for all of the patients who were seen during January 2012 to February 2020 inclusive. Our dependent variable was whether patients self-reported tobacco use. We assessed for differences across age, sex, race/ethnicity, and education level using a multivariable logistic regression model. Across 4264 patients, 28.7% reported tobacco use. When controlling for other factors, greater odds of tobacco use were observed in this cohort for patients who were male (odds ratio [OR] 1.690, 95% confidence interval [CI] 1.468-1.944), those with educational attainment of 9th to 11th grade (OR 2.291, 95% CI 1.558-3.369), and those who were high school graduates/completed the General Education Development test (OR 1.849, 95% CI 1.295-2.638) compared with those with less than a high school education. Similarly, patients of older age had greater odds of tobacco use. Our study found patient-level differences that may need to be integrated into improving the reach of intervention methods. Future research should look at a broader set of metrics (eg, geographic location, socioeconomic status) and ascertain reasons for sociodemographic differences observed.

Hepatitis C Treatment for Patients Without Insurance in a Student-Run Free Clinic: Analysis of Demographics, Cost, and Outcomes

Background: Hepatitis C virus (HCV) predominantly affects marginalized patients, who have been reported to lack access to effective treatment. A high overlap exists between those at risk for HCV and those cared for by student-run free clinics. The purpose of this study is to present how one student-run free clinic provides accessible HCV care to patients as a model for other free clinics to offer similar services.
 Methods: Data was reviewed from the electronic medical record and MedData Services, a software for management of patient assistance program (PAP) applications. Data collected included information regarding HCV diagnosis, treatment, and medication access process.
 Results: At our clinic, there were 23 patients with a documented diagnosis or prior history of HCV infection. Treatment was initiated in 83% (n = 19) of patients, and 89% (n = 17) of these patients completed treatment. Most patients (84%, n = 16) received HCV medications directly through Shade Tree Clinic. All but three patients were treated with Harvoni®. All patients with available laboratory data (n = 13) at >12 weeks status-post treatment had achieved sustained viral response. PAP applications were successfully approved for 89% (n = 17) of submitted applications (n = 19), representing the primary avenue for our clinic to access HCV treatments.
 Conclusions: Our experience with HCV demonstrates that effective HCV treatment is feasible in a student-run free clinic setting.

The Chicagoland Free Clinics Consortium: A Model for Collaboration to Improve Care Across Chicago's Student-Run Free Clinics.

The Chicagoland Free Clinics Consortium: A Model for Collaboration to Improve Care Across Chicago's Student-Run Free Clinics.

Complexity-Based Triaging and Scheduling for Reducing Clinic Wait Times in Student-Run Free Clinics

Student-run free clinics are a valuable resource for both patients who lack access to care and undergraduate medical education. Free clinics often face specific challenges, such as long clinic wait times, necessitating the development of strategies to minimize wait time and enhance patient satisfaction. We propose the use of a patient complexity score to facilitate patient scheduling and the proper assignment of students to complex patients based on training level. A numeric score estimating the complexity of each patient may provide valuable information to clinic organizers and ultimately reduce patient wait times.

Food Justice is Health Justice: Benefits and Barriers to Connecting Student-Run Free Clinics with Student-Run Organic Gardens

Food Justice is Health Justice: Benefits and Barriers to Connecting Student-Run Free Clinics with Student-Run Organic Gardens

Assessing social needs among patients with cardiovascular and psychiatric comorbidities in free community health clinics.

Community-related health assessments have been shown to improve several outcomes in socioeconomically disadvantaged populations with comorbid chronic health conditions. However, while it is recognized that modifiable social determinant of health (SDH) factors might be responsible for up to 60% of preventable deaths, it is not yet standard of care to routinely screen and address these at preventive health appointments. The objective of this study was to identify the social needs of socioeconomically disadvantaged patients. We performed a retrospective review of the socioeconomic screening questionnaires distributed to under- and uninsured patients seen at a medical student-run free primary care-based community clinic. This study included participants of all ages (0 and up), genders, languages, and ethnicities who filled out the social screening questionnaire. Socioeconomic screening questionnaires assessed the need for critical resources such as food, housing, utilities, finances, transportation, childcare, employment, education, legal support, companionship, health literacy, and community assistance. The primary study outcome was to identify unmet social needs of our medical student-run free clinic patients. We secondarily sought to identify associations between these needs and chronic health conditions. We hypothesized that patients with multiple chronic health problems and financial stressors would have the highest requests for resources. Our retrospective review identified 264 uninsured participants who were evaluated for social needs using a screening questionnaire. Participants who reported unmet social needs had significantly more cardiovascular risk factors than those who did not. Cardiovascular comorbidities and a history of psychiatric illness were the two most common medical problems significantly associated with several unmet social needs. This study provides support for the preemptive identification and appropriate management of physical, mental, and social care to improve disproportionate disparities in long-term health outcomes.

Decreasing Medication Delays: Maximizing the Efficiency of Patient Assistance Program Applications Through an Electronic System at a Student-Run Free Clinic

Patient outcomes are highly dependent on the accurate and timely receipt of medications. Patient assistance programs (PAPs) provide key medications to uninsured patients at little to no cost. In Texas and our county, nearly 1 in 5 people are uninsured. Approximately 3,500 uninsured patients over the past year have received care from our clinic. PAP applications require various administrative steps to obtain approval for medication assistance, resulting in delays for patients to receive their medications. To combat these delays, we implemented a new electronic system, which has significantly decreased all administrative steps in completing applications.

Training the Next Generation of Primary-Care Physicians: Are Student-Run Free Clinics (SRFCs) the Way to Go?

Training the Next Generation of Primary-Care Physicians: Are Student-Run Free Clinics (SRFCs) the Way to Go?

40673 Evaluation of a Monkeypox Educational Intervention in a LGBTQIA+ Student Run Free Clinic

40673 Evaluation of a Monkeypox Educational Intervention in a LGBTQIA+ Student Run Free Clinic

39999 Breaking Barriers in Underserved Communities and Improving Health Literacy Through a Student-Run Free Clinic

39999 Breaking Barriers in Underserved Communities and Improving Health Literacy Through a Student-Run Free Clinic

43199 Analyzing Follow-Up Rates and Barriers to Care in Student-Run Free Clinic

43199 Analyzing Follow-Up Rates and Barriers to Care in Student-Run Free Clinic