The Health Status of Patients of a Student-Run Free Medical Clinic in Inner-City Buffalo, NY

Abstract

Methods: Clinic staff asked patients to fill out a Health Risk Assessment questionnaire that addressed their chronic disease and illness history, mental health, social support, substance use, income, education, and housing. Through statistical analysis of 469 anonymous patient questionnaires, we identified prevalent health conditions in this patient population and compared these rates to regional and national data.Results: Of those patients 20 years of age and older, 70% earned less than US $10,000 a year. The rates of obesity, hypertension, asthma, diabetes, anxiety, and depression were higher in this population than in the Buffalo, NY, region and the general United States population. Conclusion:The data reflect the health disparity experienced by low-income minority populations in the United States and emphasize a need to plan additional services that target hypertension, heart disease, obesity, diabetes, and mental health disorders such as anxiety and depression. When it comes to health, the United States ranks 24th among 191 nations.1 The United Kingdom, Canada, and Japan, to name a few, have higher health rankings, higher life expectancies, lower infant mortality rates, and lower health expense per capita. 1,2 These nations provide health care coverage universally, whereas 46.6 million United States residents (15.9%) are without health insurance.3 This is equivalent to more than 2 times the population of New York state. 4 Among the uninsured, African-Americans are disproportionately represented, with 19.6% lacking health insurance. 5Social safety net services such as Medicaid and Medicare provide free or reduced-cost insurance to some people who lack employment, are disabled, or whose jobs do not provide health insurance. There are many other people, though, who exceed the income limits to receive free health care coverage but make an insufficient income to pay out-of-pocket for their health insurance. 6 Among those uninsured, nearly 70% come from a family with at least one full-time worker. 5,7 Twenty-eight percent of the uninsured are parttime workers.5,7 Free clinics across the UnitedStates have functioned to partially patch this hole in the safety net by providing care to the underand uninsured. 8,9 Free medical clinics are typically staffed by volunteer physicians, nurse practitioners, and nurses, and often also include a dental care component. Most offer standard triage care and physical exams; some offer services such as screening for sexually transmitted diseases. The importance of free medical clinics as part of the health care safety net was underscored by a survey of 106 free clinics in the Midwestern United States that showed they cared for over 200,000 patients in a single year. Recently, free medical clinics have been established by students in medical schools or by the schools themselves. Student-run clinics operate with a variety of underserved populations, including migrant workers, rural Appalachian communities, and the homeless.11-13 Some student initiatives take place outside of the cli...

Student‐Run Health Clinic: Novel Arena to Educate Medical Students on Systems‐Based Practice

“…Cadzow and colleagues 29 offered the most compelling example of the efforts of an SRC to understand the population it serves. Through a health-risk questionnaire, students obtained comprehensive demographic, chronic disease, and mental health data on their patient population.…”

“…On the contrary, the literature supports the efforts of students to understand and equalize if not exceed traditional standards of care. 28,29,31 Students who are in positions of managing an SRC may have a more problem-based understanding of the limitations of cost and resources, may have a more potent understanding of how to overcome barriers in order to equalize healthcare, and may thus be in more informed and decisive positions to navigate and direct a healthcare system in crisis when they ultimately embark on their careers. Under proper guidance and with mindful managing, SRCs can be an arena for socially conscious and responsible education where the best standards of care, in the face of limitations in resources, are understood, promulgated, and advocated for all patients regardless of socioeconomic status and setting of care.…”

Students learn systems-based care and facilitate system change as stakeholders in a free clinic experience

“…Moskowitz et al (2006) described a free clinic project at a transitional housing facility in Seattle which offered medical students unique inter-professional experiences; SBP did not appear to be a focus of the curriculum. Other free clinic articles have focused upon patient outcomes (Cadzow et al 2007;Der et al 2001;Niescierenko et al 2006); descriptions of free clinic projects, including a transdisciplinary health professional curriculum (Beck 2006); and clinic formation (Smego and Costante 1996). Medical student outcomes related to communication skills and patient care (pharmacologic issues) were the focus of a study examining a free smoking intervention clinic (Der et al 2001).…”

“…Free clinic rotations in medical school As of 2007, approximately 30 US medical schools were associated with as many as 111 free clinics (Cadzow et al 2007;Moskowitz et al 2006). Moskowitz et al (2006) described a free clinic project at a transitional housing facility in Seattle which offered medical students unique inter-professional experiences; SBP did not appear to be a focus of the curriculum.…”

Globalization, the Underserved, and Poverty: An Interactive and Deadly Triad

“…They report that the number of primary care visits is very important to receipt of services, and that the key characteristic determining receipt of preventive services is poverty, not ethnicity. Cadzow et al 12 found that individuals who come to a student-run free medical clinic were mostly uninsured and had many medical problems in need of significant amounts of ongoing chronic disease health care. Hicks et al 13 report that reminder cards can be useful to increase immunization rates among Latinos and the rural poor.…”