Evaluating the Impact of a Student-Run Clinic on Expanding Access to Gynecologic Care for Uninsured Patients [36G]

Abstract

INTRODUCTION: Significant disparities in access to gynecologic services persist for uninsured women, who are far less likely to obtain preventive screenings against breast or cervical cancer than insured women. Safety net institutions reduce health disparities, but gaps in service provision for gynecologic services remain. Student-run clinics, or clinics coordinated and staffed by medical students that are supervised by licensed physicians, provide preventive services at rates similar to other safety net institutions. METHODS: A retrospective chart review examined the prevalence of gynecologic issues addressed by a student-run women's clinic at a free clinic in Providence, Rhode Island and quantified the service provision provided to this population of uninsured, predominantly Latina women. RESULTS: Between May 2015 and 2017, the women's clinic saw 138 patients over 171 encounters during 48 clinics. Most visits included Pap smears or mammograms (85.2%). Other prevalent issues were abnormal uterine bleeding (23.9%), contraception (13.0%), abnormal vaginal discharge (12.3%), and infertility (11.6%). The clinic provided 83 Pap smears, 35 STI tests, 19 vaginitis screens and referrals for mammograms (n=42), colposcopy (n=7), and sub-specialists (n=14). Culturally sensitive interventions were designed to address linguistic and social barriers to care for patients seeking subspecialty care. CONCLUSION: Student-run clinics can effectively deliver gynecologic services to safety net populations. With their unique access to faculty preceptors and funding, medical students can play a significant role in expanding the specialty services available to uninsured patients. Safety net institutions should consider empowering medical students to create student-run specialized clinics under appropriate supervision to address the needs of their patient populations.

A Three-Year Analysis of the Impact of a Student-Run Gynecology Clinic on Access to Reproductive Health Care for Uninsured Women in East Harlem

“…We note that patients at WHC have lower missed encounter rates and higher follow-up rates than other student-run clinics and even non-student-run gynecology clinics [15,16]. The fact that 100% of patients followed-up on any abnormal Pap smears and all women aged 50 or older received screening mammograms may be due to a number of factors, including a robust clinic management and an Access to Care Team that scheduled referrals and ensured minimal or no cost to patients.…”

Understanding Student-Run Health Initiatives in the Context of Community-Based Services: A Concept Analysis and Proposed Definitions

“… 51 , 71 , 72 , 74 , 90 , 96 , 97 Volunteerism also extended to practitioners, particularly where there was a requirement for professional oversight in services being delivered or need for alternative service, such as interpretation and laboratory skills. 42 , 45 , 61 , 68 , 78 , 98 , 99 There were also numerous circumstances where practitioners and other staff complement (eg, social workers), including faculty members, were employed by academic institutions or affiliated agencies and supported student-run initiatives. 5 , 20 , 30 , 43 , 56 , 57 , 74 , 78 , 83 , 99 …”

“… 42 , 45 , 61 , 68 , 78 , 98 , 99 There were also numerous circumstances where practitioners and other staff complement (eg, social workers), including faculty members, were employed by academic institutions or affiliated agencies and supported student-run initiatives. 5 , 20 , 30 , 43 , 56 , 57 , 74 , 78 , 83 , 99 …”

Student-Run Free Clinics Stand at a Critical Junction Between Undergraduate Medical Education, Clinical Care, and Advocacy

“…SRFCs provide preventive and primary care services with an efficacy similar to that of typical primary care providers, as reflected in the national averages. 16 The scope and impact of this health care are statistically equivalent to those of typical care providers as measured by outcomes following the implementation of screening interventions, e.g., HIV testing 17 ; care for sexually transmitted infections 18 ; fasting lipid panels 19 ; fasting blood glucose and hemoglobin A1c values 20 ; vaccinations 21,22 ; mammograms 23 ; Papanicolaou tests 24,25 ; prenatal care 26 ; and substance abuse, anxiety, and depression screenings. 13,27–29 Predictive models estimate such preventive care saves tens of thousands of lives.…”