What is the role of free clinics in the safety net?
ABSTRACT Free clinics play an important role in the safety net but little is known about what factors drive their existence within a given community. The anecdotal literature suggests that they exist due to growing numbers of uninsured and a lack of affordable care.
To determine whether unmet needs explain the existence of free clinics.
The relationship between demographics, Medicaid policy, and ambulatory safety-net care on the geographical distribution of all known free clinics (n=1007) across all metropolitan statistical areas (n=361) in the United States is investigated cross sectionally. Drawing from numerous secondary data sources and an original dataset of all known free clinics, a negative binomial model is used to examine whether free clinic prevalence is higher in communities with larger proportions of uninsured patients, poor adults, and African Americans and is lower in communities with greater availability of federally qualified health centers (FQHCs), FQHC look-alikes, and health departments, and more generous Medicaid eligibility for working parents and Medicaid beneficiary/provider payment levels.
None of the demographic variables has a positive, statistically significant relationship to the number of free clinics in a metropolitan statistical area. However, the number of FQHC grantees per 10,000 uninsured individuals [incidence rate ratios (IRR)=0.69, P<0.05], the number of FQHC look-alike sites per 10,000 uninsured individuals (IRR=0.46, P<0.05), Medicaid beneficiary payments (IRR=0.9998, P<0.05), and Medicaid eligibility levels (IRR=0.998, P<0.10) are negatively associated with the number of free clinics. Thus, free clinics seem to respond to particular gaps left by safety-net providers and Medicaid but do not seem to respond to direct need.
[Show abstract] [Hide abstract]
ABSTRACT: People of color with serious mental illnesses experience high rates of morbidity and mortality. Patient navigators, developed for cancer care, may help this group benefit from integrated care. This review examined patient navigators' key ingredients for cancer care for relevance to patients of color for application of peer services to psychiatric goals. Among cancer patients, navigators lead to greater treatment engagement and improved health outcomes for ethnic minority groups. Research also suggests peers can improve integrated care by providing effective psychiatric services to individuals with mental illness. Ongoing research examines peer navigators' impact on integrated care for patients of color.Social Work in Public Health 09/2014; 29(6):581-593. DOI:10.1080/19371918.2014.893854 · 0.31 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Free 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. Patient exit interviews were conducted after a healthcare provider visit. Logistic regression analysis was used to assess correlates of tobacco use. Of 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. The 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.Addictive behaviors 12/2012; 37(12):1299-302. DOI:10.1016/j.addbeh.2012.03.032 · 2.44 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: This study was designed to describe the implementation, utilization, and outcomes of an otolaryngology clinic for indigent patients employing a novel design. Pilot study. A tertiary-care academic otolaryngology department partnered with a nonprofit outpatient clinic for indigent patients in order to provide free subspecialty consultation services. A novel format was utilized in which the department provided on-site, scheduled outpatient multidisciplinary consultation on weekends, staffed by volunteer health care providers and ancillary staff. A review of the program was conducted using prospectively collected data. Clinic design, staffing, utilization, and feasibility were described, along with demographic and clinical data for all patients participating in the clinic from October 2010 through January 2012. Five clinics were held over 15 months, totaling 74 patient visits, with positive feedback regarding accessibility and quality of services provided. A total of 60 procedures were performed, including audiograms, endoscopies, otologic procedures, biopsies and/or excisions. The estimated value of medical services that were provided was $37,302. Four potentially life-threatening conditions were newly diagnosed. Twenty patients received conclusive evaluation and treatment at the time of their first visit. Eighteen patients required further subspecialty treatment and/or surgery that could not be provided in the outpatient setting, and were referred appropriately. The partnership between an academic otolaryngology department and a nonprofit clinic provided free on-site consultation for indigent patients. Such an arrangement is feasible, well utilized, and successful in delivering comprehensive specialized services to indigent patients who lack traditional access to medical care.The Laryngoscope 09/2013; 123(9). DOI:10.1002/lary.23880 · 2.03 Impact Factor