Uninsured Free Clinic Patients Research Articles

Covid-19 Vaccine Perception and Hesitancy Among Uninsured Free Clinic Patients

Covid-19 Vaccine Perception and Hesitancy Among Uninsured Free Clinic Patients

Perceived Stress, Cortisol Responses, and the Effect of Social Networks among Uninsured Free Clinic Patients.

Stress among free clinic patients is an important issue to address in health care. Evaluating the differences between perceived stress and physiological stress will help healthcare professionals to better understand the stress and coping management skills that will improve health outcomes for underserved populations. The aim of this study was to accelerate research to better understand the biological and psychological aspect of stress in health disparities. This was a cross-sectional study using a convenience sample of free clinic patients aged 18 years and older who spoke English and/or Spanish. Multiple modals of data were collected from 178 participants during summer 2019, including a self-administered paper survey and a biomedical saliva sample. Descriptive statistics were used to present the characteristics of the participants, and a correlation heatmap was used to show a graphical representation of the main variables. Two models of multivariable regression were performed to understand factors associated with cortisol and perceived stress. Higher levels of perceived stress were not significantly more prevalent than higher levels of salivary cortisol among free clinic patients; however, higher levels of social networking were significantly associated with lower levels of perceived stress. Our analysis revealed that having more friends in a social network was slightly more associated with lower levels of perceived stress than having more family members. The result of this study provides awareness to healthcare promoters and educators concerning the health of uninsured patients. More specifically, this study provides a foundation to understand the salivary cortisol levels and the relation to perceived stress among this population. Further studies are needed to measure salivary cortisol repeatedly during a period of time among a larger population to better understand the reasons behind normal cortisol level manifesting along with chronic stress.

A Multidisciplinary Quality Improvement Program to Improve Diabetes Care at a Free Clinic.

To evaluate the effectiveness of an intensive, multidisciplinary patient-centered approach involving a pharmacist and a dietician in a population of uninsured free clinic patients with diabetes and hypertension. A single-center retrospective chart review of a quality improvement project. All patients had diagnoses of diabetes and hypertension and a most recent hemoglobin A1c ≥ 9.0%. Patients met individually with a pharmacist and a dietician during 6 encounters over 12 months. The pharmacist made medication changes, encouraged lifestyle reflections, and helped patients create and track self-management goals. The dietician helped patients plan strategies for diet and exercise. The primary outcome was a change in mean hemoglobin A1c. Of 30 enrolled patients, 17 completed three months of treatment, and seven completed 12 months. The 17 patients who completed three months of treatment had the following characteristics: mean age 55.5 years; mean hemoglobin A1c 11.5%; 82% were taking two or more antidiabetic medications; 59% were taking two or more antihypertensive medications. Significant reductions in mean hemoglobin A1c values were observed at three months (-3.4%, P<0.0001) and twelve months (-4.0%, P=0.0156). Reductions in systolic blood pressure were also observed at three months (-6 mmHg, P=0.1060) and twelve months (-17 mmHg, P=0.2188). Large and significant hemoglobin A1c reductions were observed in free clinic patients with diabetes refractory to traditional medical management. Goal-oriented patient empowerment effectively improves a wide range of patient outcomes in the free clinic setting. Other free clinics can implement this collaborative, multidisciplinary model with access to similar personnel.

The Impact of Patient Autonomy Among Uninsured Free Clinic Patients.

Uninsured primary care patients tend to experience barriers to autonomy in clinical decision-making due to limited choices of healthcare facilities and low health literacy. This study examined whether certain factors, including the component of patient-centeredness, are associated with patient autonomy among these populations and contribute to reducing disparities in healthcare. This was a cross-sectional study using a convenience sample of free clinic patients aged 18 years and older who spoke English and/or Spanish. Multiple regression analyses were performed to understand factors associated with Ideal Patient's Autonomy. Data were collected from September to December 2019. Findings conclude that Spanish-speaking patients at the free clinic have a stronger belief in a paternalist model of the provider-patient relationship (P < .01). Better communication between patients and providers results in higher levels of autonomy (P < .01). Higher levels of educational attainment and better communication partnership were associated with higher levels of a free clinic patient's understanding of treatment risks (P < .01). This research study found that components of patient-centeredness are important considerations for improving patient autonomy among free clinic patients.

Patient Adherence to Health Care Provider Recommendations and Medication among Free Clinic Patients.

Patient adherence is vital for the quality of health care outcomes and treatment efficacy, and reduces the economic burden on the healthcare system. The purpose of this study was to examine factors associated with levels of general adherence among uninsured free clinic patients. This was a cross-sectional study using a convenience sample of free clinic patients aged 18 years and older who spoke English and/or Spanish. Descriptive statistics and multiple regression were performed to understand sociodemographic characteristics and factors associated with higher levels of general adherence. A higher level of general adherence were significantly associated with younger age (P < .01), levels of adherence to lifestyle recommendations (P < .01), and medication (P < .01). Having attended health education classes and having a primary care provider were not associated with levels of general adherence.This study suggested that a lower level of general adherence exists among elderly patients of the free clinic. In this light, providers need to consider unique strategies to enhance the provider-patient relationship by understanding patient's characteristics and providing sufficient information and explanation for treatment and medication.

How Food Insecurity and Financial Difficulty Relate to Emotional Well-Being and Social Functioning.

Medically uninsured individuals living in poverty experience poor health and face social barriers that negatively affect their health. The purpose of this study was to examine the association between social barriers, particularly healthy food availability and financial difficulty, and well-being among uninsured free clinic patients in the United States. Data were collected using a self-administered paper survey at a free clinic from adult patients who spoke and read English or Spanish (N = 666) from January to April 2019. Better neighborhood healthy food availability is associated with better self-reported general health. Food security is related to better emotional well-being and social functioning. Having difficulty paying rent or a mortgage is linked to worse emotional well-being and social functioning. Providing health education programs may not be sufficient to promote healthy eating among underserved populations because of the social barriers that they experience, such as food insecurity and financial difficulty. Future research could be performed to determine how these social factors influence those of different social and cultural backgrounds than the participants in this study.

Household environmental safety and perceived stress among uninsured free clinic patients

The purpose of this research project is to examine the association between household environmental safety and stress among uninsured primary care patients who live in poverty. Data were collected from patients of a free clinic using a self-administered survey in Fall 2019. A total of 559 patients participated in the survey. Higher levels of concern regarding environmental issues at home are associated with higher levels of perceived stress. The following demographic characteristics were associated with higher levels of concern regarding household environmental safety issues— higher educational attainment, younger age, and better self-rated general health. Chronic stress concerning an unsafe environment can be a psychological burden and pose health risks to vulnerable populations. Interventions to improve household environmental safety have the potential to reduce the stress-load of uninsured primary care patients. Keywords: Environmental issues; free clinic; home; perceived stress; safety; social environment.

Patient Satisfaction With Telehealth and Experiences During the COVID-19 Pandemic Among Uninsured Free Clinic Patients.

The COVID-19 pandemic is a significant public health issue especially for underserved populations. Little is known about patient satisfaction with telehealth among free clinic patients or other underserved populations. The purpose of this study is to examine factors associated with patient satisfaction with in-person services and telehealth during the pandemic and describe the experiences during the pandemic among free clinic patients. Data were collected from 628 uninsured English- and Spanish-speaking patients of a free clinic using an online survey from June to August in 2020. Free clinic patients are satisfied both with in-person services and telehealth. Factors associated with satisfaction were slightly different for in-person services and telehealth. The major experiences during the pandemic were related to food/diet and physical inactivity. This study examined a new trend in patient satisfaction and is important because telehealth may be a stepping-stone on how to handle future doctor visits for underserved populations. Furthermore, as the pandemic rapidly develops and changes daily life experiences, the uninsured population faces imminent impacts in various aspects of their life experiences.

The Use of Complementary and Alternative Medicine Strategies, Opioids, and Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Among Patients Attending a Free Clinic.

The purpose of this study was to describe the use of opioids and complementary and alternative medicine (CAM) among uninsured free clinic patients. A self-administered paper survey was collected to describe the use of opioids, complementary, and alternative medicine, and other pain relievers from 877 free clinic patients from January to April 2018. The US born English speakers are more likely to use CAM, nonprescription pain relievers, and prescription opioids, and to be more knowledgeable about opioids compared to non-US born English speakers and Spanish speakers. The main source of opioids for free clinic patients is a health care facility other than a free clinic as well as friends. Although nonprescription pain relievers are commonly used among free clinic patients, CAM is less common to use for pain control. More health education programs are needed to increase the knowledge of opioid risks among free clinic patients as well as other underserved population.

Continuity of Care: Perspectives of Uninsured Free Clinic Patients.

Background:Continuity of care is vital to the success of a health-care system because it improves patient satisfaction and health outcomes, and reduces hospitalizations and emergency room visits.Objective:The purpose of this study was to examine free clinic patients’ perspectives of continuity of care in the United States.Method:A convenience sample of free clinic patients who were the age of 18 or older and spoke English or Spanish participated in a self-administered survey from January to April in 2017 (N = 580).Results:Better instructions from providers were associated with higher levels of continuity of care (P < .01). Higher levels of stress and worse self-rated general health were related to lower levels of continuity of care (P < .05 for stress, P < .01 for general health). Being employed was associated with lower levels of continuity of care (P < .05). Non-US born English speakers and Spanish speakers rated continuity of care higher than US born English speakers (P < .01).Conclusion:Even if a patient is unable to see the same physician over time, quality instructions from a well-coordinated provider team may enhance continuity of care from patient perspectives. The social context of patients such as working poor individuals is very important for providers to understand in order to identify barriers to continuity of care.

Home Dental Care Education for Uninsured Free Clinic Patients in the United States

Objective: Oral health disparities are a significant public health issue in the United States (US). Individuals utilizing a free clinic for underserved populations are one of the at-risk populations for poor oral health. The purpose of this study was to describe and evaluate home oral health education classes provided at a free clinic. Methods: Data were collected by a pre-oral health class survey, field notes during a home dental health class and a post-oral health class survey at a free clinic from September to November 2017. Results: Twenty-three oral classes were offered. There were 61 participants in the classes in total. Among the class participants, 49 patients filled out the survey. Although the majority of the participants brushed their teeth regularly, they did not have much knowledge about the correct manner of brushing, including which tooth brushes and pastes were best to use. Flossing seemed to be less commonly practiced than brushing. Showing visual images and connecting oral health with overall body health seemed to be effective in providing the motivation for better oral health practices. Conclusions: Brief informal classes on home oral health practice seem to be feasible solutions and have potential to improve the oral health of patients of free clinics.

Stress Management Classes for Uninsured Free Clinic Patients in the United States

Objective: Stress has become a growing public health concern in the United States (US). Uninsured, low-income or minority patients utilizing a free clinic are exposed to stress disproportionately across various areas of life. Health promotion programs regarding stress management have the potential to benefit vulnerable, low income populations by reducing stressrelated health issues. The purpose of this study was to describe and evaluate the “stress-management” education class taught at a free clinic that provides healthcare to uninsured patients. Methods: Data for this study were collected by a prestress management class survey, field notes during the stress management class, and post-class survey at a free clinic for low-income, uninsured patients. The surveys and class took place in June 2018. Direct observations were based off the Theory of Planned Behavior (TPB). Results: Fifty-five stress management classes were offered with a total of 83 participants. Among the class participants, 71 filled out the survey. Free clinic patients experience cumulative negative situations. One strategy to cope with stress is to organize participant responsibilities. Main stressors among the participants included finances, family, emotions, work, health, social relationships, and a sense of not belonging. Conclusion: Providing resources regarding stressors would be a feasible solution for patients at free clinics. Future projects should work to develop stress management class which responds to the results of this study.

English Classes for Foreign-born Uninsured Free Clinic Patients in the United States: A Qualitative Study

In an effort to reform patient-provider communication, most notably in underrepresented populations, a series of English classes were offered to patients of a metropolitan free clinic in the intermountain region of the United States (U.S.). A cohort of sociological studies undergraduates, graduate students and professors from a local university assembled to conduct research in the summer of 2018. Fifty-two participants enrolled in 39 classes, with 35 participants completing a comprehensive survey. In addition, pre-class surveys, field notes and class satisfaction surveys were collected to accurately capture participant characteristics, evaluate class quality and identify participants’ motivation, needs/challenges, or barriers to learning English in their U.S. community. The classes elicited mostly positive feedback with the majority of participants showing excitement, motivation to continue, and inquiry as to future classes at the clinic. Field note findings indicated that language proficiency is essential to communication in clinical and communal settings. Due to the qualitative nature of this study, participants were able to express personal recounts of barriers and challenges to learning English. The study also resulted in several implications for holistic improvements in future classes offered to the free clinic patients.

Uninsured free clinic patients’ experiences and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act

Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. There has been a paucity of free clinic research with the few studies employing a quantitative design. The purpose of this study is to conduct an in-depth qualitative exploration of free clinic patients’ experience and perceptions of healthcare services, community resources, and the Patient Protection and Affordable Care Act (ACA). Free clinic adult patients (n=35) participated in four focus groups between June and July 2014 (one Spanish group in June, and two English groups and one Spanish group in July) in a classroom of a free clinic. More than 80% of the participants were non-US born from Mexico, Central/South America, South or East Asia, Pacific Islands, or Western Europe. While participants reported being satisfied overall with free clinic services, they indicated that they desire more specialty services and health education programs. Furthermore, they reported being frustrated by long waiting times- both in the waiting room and when making an appointment, phone communication, and interpreter services. It is necessary to find effective ways to provide information about health education opportunities and the ACA to free clinic patients because participants appeared not to have received sufficient information about available resources. Health education programs for free clinic patients should not only focus on increasing knowledge but also changing behaviors.

The association between tobacco, alcohol, and drug use, stress, and depression among uninsured free clinic patients: U.S.-born English speakers, non-U.S.-born English speakers, and Spanish speakers

ABSTRACTThe abuse of substances is a significant public health issue. Perceived stress and depression have been found to be related to the abuse of substances. The purpose of this study is to examine the prevalence of substance use (i.e., alcohol problems, smoking, and drug use) and the association between substance use, perceived stress, and depression among free clinic patients. Patients completed a self-administered survey in 2015 (N = 504). The overall prevalence of substance use among free clinic patients was not high compared to the U.S. general population. U.S.-born English speakers reported a higher prevalence rate of tobacco smoking and drug use than did non-U.S.-born English speakers and Spanish speakers. Alcohol problems and smoking were significantly related to higher levels of perceived stress and depression. Substance use prevention and education should be included in general health education programs. U.S.-born English speakers would need additional attention. Mental health intervention would be essential to prevention and intervention.

Impact of Neighborhood Environments on Health Consciousness, Information Seeking, and Attitudes among US-Born and Non-US-Born Free Clinic Patients.

This study examined the impact of neighborhood environments on health consciousness, information seeking, and attitudes among uninsured free clinic patients to better understand the specific needs of the population for health promotion and prevention efforts. US-born English-speaking, non-US-born English-speaking, and Spanish-speaking free clinic patients completed a self-administered survey using reliable measures in autumn 2014 (N = 769). The results of this study suggest that social cohesion is positively associated with health consciousness, information seeking, and attitudes. Lower levels of available healthy food in the community were associated with higher levels of health consciousness. Although Spanish speakers reported lower levels of the availability of healthy food, social cohesion, and access to the Internet or text messaging compared with US-born or non-US-born English speakers, they were more likely to be health conscious and have higher levels of health information seeking. Spanish speakers as well as non-US-born English speakers, were more likely to attend health education classes compared with US-born English speakers. Health education programs for free clinic patients should include strategies to increase social cohesion. Health education programs should consider the diverse needs of these individual populations to maximize the effectiveness of the programs for free clinic patients.

Why Uninsured Free Clinic Patients Don't Apply for Affordable Care Act Health Insurance in a Non-expanding Medicaid State.

Even after the introduction of the Patient Protection and Affordable Care Act (ACA), uninsured visits remain high, especially in states that opted out of Medicaid expansion. Since the ACA does not provide universal coverage, free clinics serve as safety nets for the un- or under-insured, and will likely continue serving underserved populations. The purpose of this study is to examine factors influencing intentions to not apply for health insurance via the ACA among uninsured free clinic patients in a state not expanding Medicaid. Uninsured primary care patients utilizing a free clinic (N = 551) completed a self-administered survey in May and June 2015. Difficulty obtaining information, lack of instruction to apply, and cost, are major factors influencing intention not to apply for health insurance through the ACA. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of perceived barriers to applying for health insurance through the ACA. Age is an important factor impacting individuals' intentions not to apply for health insurance through the ACA, as older patients in particular need assistance to obtain relevant information about the ACA and other resources. A number of unchangeable factors limit the free clinics' ability to promote enrollment of health insurance through the ACA. Yet free clinics could be able to provide some educational programs or the information of resources to patients. In particular, non-US born English speakers, Spanish speakers, and older adults need specific assistance to better understand health insurance options available to them.

The need for tobacco cessation in a free clinic population

IntroductionFree clinics are a unique safety net provider in that they exclusively serve the uninsured. Because free clinic providers are often volunteers, it is unclear whether uninsured patients seeking care in these clinics receive evidence-based tobacco cessation support. Here we report baseline data on prevalence and correlates of tobacco use and provider cessation advice among a sample of uninsured patients at six free clinics. MethodsPatient exit interviews were conducted after a healthcare provider visit. Logistic regression analysis was used to assess correlates of tobacco use. ResultsOf the 158 patients interviewed, 83 (53%) were tobacco users. Tobacco use was less likely among Hispanics (AOR 0.13 [95% CI 0.03–0.64]) and high school graduates (AOR=0.20 [95% CI 0.08–0.55]). Among tobacco users, 62% made at least one quit attempt in the past year and the majority were in the Contemplation (33%) or Preparation (39%) stage of readiness. 70% of all patients were screened in the past 3months, although screening was more likely among tobacco users than nonusers (AOR 3.56 [95% CI 1.47–8.61]). At the current visit, 18% of tobacco users were advised to quit and 16% were asked if they were willing to quit. ConclusionsThe prevalence of tobacco use among uninsured free clinic patients was more than twice the national average. There is substantial opportunity to increase tobacco screening among all patients and cessation advice among tobacco users. Free clinics present an untapped opportunity to reduce tobacco harm in a population at high risk for tobacco morbidity and mortality.