Quality of Mental Health Care at a Student-Run Clinic: Care for the Uninsured Exceeds that of Publicly and Privately Insured Populations

Abstract

Diagnosing and treating depression in a primary care practice is an important, yet difficult task, especially for safety-net practices serving the uninsured. In the United States healthcare system, there is a mismatch between the need for mental health care and access to services. This disparity is most striking among the uninsured. Mental health disorders are more prevalent among the uninsured, and even when diagnosed with mental illness, they are less likely to obtain necessary treatment than insured patients. Given the increasing burden of depression on society, growing numbers of uninsured and negative repercussions of untreated mental illness, improvements in screening and management protocols are becoming more important in primary care practices serving this population. The quality of depression treatment at commercial and public insurance plans in New York City (NYC) and New York State (NYS) were compared to that of the East Harlem Health Outreach Partnership (EHHOP), the student-run clinic of the Mount Sinai School of Medicine. Based on the comparison, the study made recommendations for an integrated, on-site mental health service program at the community health clinic. A cohort of 49 depressed patients were evaluated and treated at the EHHOP clinic. The quality of the mental health care was evaluated according to variables from the Healthcare Effectiveness Data and Information Set (HEDIS). Indicators of quality included demographics, method of diagnosis, type of pharmacological treatment, referral to specialty care, patient adherence to follow-up care and adherence to pharmacologic treatment. When compared to insured patients in NYS, more EHHOP patients had the appropriate number of physician contacts after being diagnosed with depression than patients with commercial health plans (P = 0.008) and Medicaid (P = 0.09). Similarly, a greater number of EHHOP patients had better acute phase (P = 0.001; P = 0.096) and continuous phase (P = 0.049; P = 0.88) pharmacologic treatment than patients with commercial health plans and Medicaid, respectively. EHHOP meets and, in some areas, exceeds the quality of depression treatment when compared to insured populations. Even though EHHOP already surpasses these indicators, the clinic can improve its diagnostic capabilities, prescription medication adherence, and referral care follow-through by creating an on-site mental health clinic.

Student-run clinics in Canada: an innovative method of delivering interprofessional education

“…Studies have consistently found that, compared to usual care, patients utilizing SRCs incur equal or superior outcomes (Liberman et al, 2011). The East Harlem Health Outreach Partnership (EHHOP), a student-run clinic in New York City at Mount Sinai School of Medicine, compared the mental health outcomes of their patients to those of publicly and privately insured patients in New York State (Liberman et al, 2011).…”

“…Studies have consistently found that, compared to usual care, patients utilizing SRCs incur equal or superior outcomes (Liberman et al, 2011). The East Harlem Health Outreach Partnership (EHHOP), a student-run clinic in New York City at Mount Sinai School of Medicine, compared the mental health outcomes of their patients to those of publicly and privately insured patients in New York State (Liberman et al, 2011). They found that more EEHOP patients experienced an appropriate number of physician contacts after being diagnosed with depression, and likewise more patients received superior pharmacologic treatments (Liberman et al, 2011).…”

“…The East Harlem Health Outreach Partnership (EHHOP), a student-run clinic in New York City at Mount Sinai School of Medicine, compared the mental health outcomes of their patients to those of publicly and privately insured patients in New York State (Liberman et al, 2011). They found that more EEHOP patients experienced an appropriate number of physician contacts after being diagnosed with depression, and likewise more patients received superior pharmacologic treatments (Liberman et al, 2011). The EEHOP clinic also compared the health indicators of patients with diabetes receiving care at the clinic to the health indicators of uninsured patients with diabetes (not receiving care at the clinic), and found superior health outcomes in those receiving care at EEHOP (Liberman et al, 2011).…”

“…They found that more EEHOP patients experienced an appropriate number of physician contacts after being diagnosed with depression, and likewise more patients received superior pharmacologic treatments (Liberman et al, 2011). The EEHOP clinic also compared the health indicators of patients with diabetes receiving care at the clinic to the health indicators of uninsured patients with diabetes (not receiving care at the clinic), and found superior health outcomes in those receiving care at EEHOP (Liberman et al, 2011). Evidence suggests that IPE and IPC contribute to such beneficial patient outcomes.…”

Medical students as teachers at CoSMO, Columbia University's student-run clinic: A pilot study and literature review

“…It also discusses models for student-run health care delivery (Der et al 2001;Bennard et al 2004;Beck 2005;Moskowitz et al 2006;Niescierenko et al 2006;Simpson & Long 2007;Rosenbaum et al 2008;Batra et al 2009;Dvoracek et al 2010;Strowd et al 2011), the ethics of SRCs (Buchanan & Witlen 2006), and patient demographics, satisfaction, and outcome data (Cadzow et al 2007;Ryskina et al 2009;Ellett et al 2010;Liberman et al 2011;Zucker et al 2011). We could identify no studies that describe SRCs as a place where medical students can learn how to teach.…”