bluuebunny/crossref_metadata_2025 huggingface dataset:
Fighting Health Care Provider Stigma: A Novel Approach to Understanding the Impact of Medical School Exposures
Authors: Brug Aaron Matthew , Nix Linda M. , Fitzgerald Claire B , Jones Catherine E , Counts Catherine R
Published: May 2023

Background: Attitudes of healthcare professionals towards vulnerable patient populations decline throughout their training, and these negative attitudes have been shown to influence health outcomes and access to care. Little is understood about the factors influencing the development of these attitudes. While service-learning has been a proposed solution, there is heterogeneity in curricula, and it is unknown how varying types of exposures affect providersâ€™ stigma towards vulnerable patients.

Methods: Allopathic medical students completed a survey assessing attitudes towards four vulnerable patient populations: people who suffer from schizophrenia, people who suffer from major depressive disorder, people experiencing homelessness, and people with a history of intravenous drug use. Students also rated their level of exposure to three conditions (mental illness, homelessness, and addiction or injection drug use) in clinical volunteer, nonclinical volunteer, and observational and personal capacities. Analysis was conducted using Chi-squared tests and linear regression to assess for association(s) between the self-reported exposure(s) and attitudes towards the vulnerable populations.

Results: There were 278 survey responses. Clinical and non-clinical volunteer exposures were associated with less stigma towards three of the four patient populations studied. Personal exposures to mental health illnesses as well as addiction or injection drug use were also associated with a reduction in stigma towards vulnerable populations. When controlling for gender, year in school, and race, exposure to persons with a mental illnesses or addiction were each associated with less stigma towards multiple vulnerable populations.

Conclusions: Development of curricula for future health care providers should include, if not emphasize, opportunities for students to volunteer in a clinical capacity with vulnerable populations.
The Use of Personalized Health Reports in a Student-Run Free Clinic
Authors: Darian Talin , Ma Pei Chan , Su Lydia , Mendez Jennifer
Published: May 2023

My Health Report (MHR) is a computer program that prints out personalized health reports for patients based on their basic health data and laboratory test results. Reports are available in four languages. The goal of MHR is to improve health communication and education. This program has been used by medical students in a student-run free clinic in Madison Heights, Michigan, since 2011 and supports studentsâ€™ efforts in providing patient-centered communication and education materials to an underserved population across multiple languages. Given its simplicity and portability, MHR may add value to student-run clinics elsewhere.
A Tale of Two Sister Clinics: Comparing the Use of Online Scheduling Tools to Reduce Patient Wait Times
Authors: Ku Seul , Liu Monica , Rea Sheridan , Mulumba Kabungo , Chen Annabel , Dutta Ritika , Kakusa Bina , Caceres Wendy , Singh Baldeep , Charon Mina , Montacute Tamara
Published: May 2023

Background: The Cardinal Free Clinics, Arbor Free Clinic (Arbor) in Menlo Park and Pacific Free Clinic (PFC) in San Jose, are student-run free clinics affiliated with Stanford operating since 1990. Patients are seen on a walk-in basis only, and on average, patients may wait more than an hour to be seen, decreasing patient satisfaction. In this study, we looked at whether we could improve patient wait times by administering a free online self-scheduling tool. 

Methods: The free version of Acuity Online Scheduling Tool was used to set up 6 online appointment slots for patients at Arbor and 12 at PFC, and walk-in services were provided concurrently. On clinic days, patients with appointments were given priority over walk-ins. Wait times were calculated from time points collected by hand or through the electronic health record system. The Mann Whitney U test was used to compare wait times between patients with and without appointments in each clinic.

Results: The total number of patients being seen on a given day and whether or not patients had online appointments were significant determinants of wait times. Patients at Arbor with appointments had a median wait time of 35 minutes (N=46) compared to 60 minutes (N=231) without appointments (p<0.05). At PFC, patients with appointments waited 22 minutes (N=123) compared to 26 minutes (N=193) without appointments (p=0.09).

Conclusion: Free online scheduling tools can be customized to significantly decrease patient wait times and spread out patient arrival. Given the lack of resources often available for free clinics, it is important to explore the use of free tools to create a better patient experience.
Creation and Expansion of a Multisite Tuberculosis Screening Initiative
Authors: Andrew Crawford  , Sophia Foroushani  , Alexandra Woodbridge  , Katherine Carsky  , Megan Daniele  , Robert Drury  , Rebekah Bryne  , Juzar Ali
Published: May 2023

The Tulane School of Medicine Student-Run Tuberculosis (TB) Program provides TB testing at six sites located in homeless shelters and rehabilitation facilities throughout New Orleans, Louisiana. The program indirectly assists in ensuring housing, as sites require proof of TB testing to maintain residence. The program was created and is operated by medical students. To date, there has not been a comprehensive description of the programâ€™s organization, operation, and expansion. The program has the following goals: (1) provide evidence-based screening and testing for TB in high-risk populations; (2) provide connections to higher care when indicated; (3) allow individuals to maintain residence in the facilities served. Student leaders and physician advisors developed program protocols, an evidence-based TB screening questionnaire, and a referral system with a state-run TB clinic. Since January 2017, 6,198 patients have been evaluated for TB and 693 have been referred to higher care. Additionally, the program provides medical students with the opportunity to gain valuable early clinical exposure. Using this model, future program goals include expansion to provide testing at all similar facilities in New Orleans. In addition, this model may be of use to other medical schools and students who aim to develop and implement similar initiatives.
Assessment of Vaccination Rates among Smokers and Non-Smokers at a Student-Run Free Clinic
Authors: Harnish-Cruz Carissa , Silver Jeremy , Veldheer Susan , Jeong Seong Ho , Reedy-Cooper Alexis
Published: May 2023

Background: While student-run free clinics (SRFCs) increasingly serve as part of the safety net for the uninsured and underinsured, it is unknown whether SRFCs consistently follow immunization guidelines in patients that smoke. This study characterized the preventative care in our clinic by evaluating the rate of adult immunizations and referrals of patients that smoke to cessation treatment.

Methods: We conducted a retrospective chart review of patients seen in 2016 at the LionCare Free Clinic. Data extracted included tobacco smoking status, desire to quit, smoking cessation treatment referrals, influenza and pneumococcal vaccination status, and demographics. Chi-square tests and Fisher Exact analysis were used to examine differences in influenza and pneumococcal vaccination rates in smokers versus non-smokers. We assessed the rate of interested smokers who received a referral to cessation therapy.

Results: In 2016, 498 patients were evaluated, of whom 67% were smokers. Among smokers, 21% reported receiving the influenza vaccination compared to 20% of non-smokers (p=0.85). Seven percent of patients who smoke received the pneumococcal vaccine compared to 5% of non-smokers. Of the total patients who were vaccinated, a small percentage received the vaccines in the clinic. Although 66% of smokers reported interest in quitting during the first clinic visit, only 3% were referred to a smoking cessation program.

Conclusion: SRFCs face challenges in providing preventative health care for the underserved population. Despite guidelines recommending smokers receive the pneumococcal vaccine before age 65, few patients received it. Quality improvement interventions are needed to improve preventative health services to this vulnerable population.
Increasing Patient Activation at a Student-Run Free Clinic: Effectiveness of a Health Education Intervention
Authors: Dutta Ritika , Shearer Emmy , Garcia Luis , Liu Helen , Swee Joshua , Ku Seul , Lai Cara , Lin Steven , Montacute Tamara , Charon Mina
Published: May 2023

Background: Free clinics can serve as an important source of health information among underserved populations; however, it is difficult to track the effectiveness of health education interventions for these patients.  Thus, the objective of our study was to develop and assess the impact of a health education intervention in a student-run free clinic setting.

Methods: A quality improvement project was implemented in which surveys were used to assess four confidence and knowledge measures among patients who did or did not receive health education from undergraduate volunteers. Statistical significance was determined using studentâ€™s t-tests.

Results: Patients who received health education from undergraduate volunteers during clinic visits reported increased confidence in their ability to manage health conditions (p<0.01), knowledge of their prescribed medications (p<0.05), and ability to manage their symptoms (p<0.05) after clinic visits compared to before their clinic visits.

Discussion: Dedicated health education interventions by undergraduate volunteers during free clinic visits can lead to increased patient confidence and knowledge of their health conditions. Due to their iterative nature and ease of implementation, quality improvement frameworks may be a useful way to track the efficacy of health education programs in the free clinic setting.
Impact of a Checklist on Clinic Flow and Patient Visit Times at a Student-Run Free Clinic
Authors: Scott Alyssa , Patel Dolly , Hughes Alexa , Reedy-Cooper Alexis
Published: May 2023

Background: While student-run free clinics are a valuable resource to the community, there are limitations leading to challenges with clinic flow. Previous research has identified checklists as a useful intervention in medicine. This project sought to evaluate the efficacy of a checklist on student volunteer accuracy and adherence to clinic flow, and patient visit times.

Methods: From June 2019 to February 2020, volunteers at select clinics received a checklist listing important steps of a patient encounter. The authors sent surveys to volunteers following all clinics and recorded patient visit times. The outcomes measured were: volunteer accuracy (number of steps completed); volunteer adherence (order of steps); perceived helpfulness of the checklist; and patient visit times. The first three outcomes were assessed via self-reported survey data and the last outcome was assessed via collection of time data. Fisherâ€™s exact tests to assess statistical significance (p<0.05).

Results: Thirty-eight student volunteers completed surveys, for a response rate of 67.9%. Eighteen (47%) of those who completed surveys were part of the experimental group (received checklist), while the remaining 53% were part of the control group (did not receive checklist). Nine (50%) of 18 volunteers with a checklist spoke to patient navigation and/or lifestyle educators before presenting to an attending, compared to 1 (5%) of 20 volunteers without checklist (p=0.0025). Of the 18 volunteers who received a checklist, 16 (89%) found the checklist helpful.  There was no significant difference between mean visit time pre-checklist (74 minutes, SD= 29.6) and post-checklist (79 minutes; SD=28.3; p=0.46, n=134).

Conclusion: The checklist improved clinic flow by increasing volunteer accuracy and adherence. The checklist was also perceived to be helpful, and did not increase patient visit times.
Strategic Planning in a Student-Run Clinic: Utilizing a Tiered Meeting Model to Evaluate Clinical Needs
Authors: Andronic Francesca , Goldstein Zachary , Lockard Rachel , Park Brian , Terndrup Christopher
Published: May 2023

The Bridges Collaborative Care Clinic (BCCC) is Oregonâ€™s first and only interdisciplinary, student-run clinic that provides free health and social services to underserved populations. The hierarchical leadership structure utilized by the clinic since its inception in 2016 worked effectively in the early stages of development. As the clinic matured, increasing complexity of programs and administrative duties led to lapses in communication and loss of information between teams, resulting in decreased efficiency and impact as measured by clinical output. Student volunteers and the BCCC Board of Directors recognized the need for organizational change and proposed developing a strategic plan. This paper describes the process, outcomes, and limitations faced by BCCC throughout its strategic planning. The Quality Function Deployment (QFD) model was implemented because of its collaborative approach of involving the customersâ€”people who receive the servicesâ€”in order to shape future initiatives for the organization. In this case, the QFD defines the customers as the participants who are seeking care at the clinic. The outcomes of the strategic planning process are expected to help the clinic function more efficiently and include a prioritized list of participant-defined needs, a list of solutions, and a timeline to guide new projects. By illustrating the implementation of QFD and its potential complications, other student-run clinics that are seeking improvement can replicate or adapt this method to develop their own strategic planning processes.
Remotely Maintaining and Modifying a Student-Run Tuberulosis Clinic During the COVID-19 Pandemic
Authors: Santoro Taylor , Woodbridge Alexandra , Foroushani Sophie , Crawford Andrew , Sylvies Fiona , Belnap Andrew , Byrne Rebekah , Ali Juzar
Published: May 2023

The 2019 novel coronavirus pandemic challenged many aspects of the medical system, including student-run clinics. The Tulane University School of Medicine Tuberculosis (TB) Testing program offers risk evaluation and testing at six clinics in various facilities throughout New Orleans, Louisiana, and sees approximately 2,000 patients annually. Due to temporary removal of medical students from all clinical and volunteer activities, the program rose to the challenge to temporarily restructure operations in order to continue to provide resources and support at a time when physical contact was impossible. Medical student leaders took initiative in developing a TB screening questionnaire to be administered by non-medically trained essential facility staff, in addition to maintaining regular communication and providing off-site support. Although challenging, circumstance necessitated a temporary modification of student-run clinic models of care in order to protect safety and well-being of both students and the vulnerable populations served by the clinics. Anticipated repercussions from this temporary clinic model include rebound strains on clinic capacity at the time of reopening, in addition to a nationwide dearth of medical resources. However, the proactive response and flexibility of the student-run TB clinics will assure that this important aspect of care does not suffer needlessly during a time when all focus is on the pandemic.
Improving Student EHR Accuracy: An Analysis of Training Methods to Better Prepare Students to Volunteer at Student-Run Clinics
Authors: Sega Annalisa , Bossan Alexia , Abrams Matthew , Cendan Vincent , Gartland Alexander , Nguyen Dang-Khoa , Simms-Cendan Judith
Published: May 2023

Background: As many students do not have previous experience with electronic health records (EHRs), the Comprehensive Medical Care Outreach Team at the University of Central Florida repeatedly struggled to maintain an accurate and consistent record of patient visits, despite all volunteers attending a lecture-based training session prior to clinic day. This study evaluated changes in student EHR accuracy at this student-run clinic using alternative training methods. We hypothesized that small-group interactive learning would result in higher EHR accuracy than lecture-style learning.

Methods: This study examined EHR accuracy through one year (2019) of data over four clinic sessions. EHR accuracy was defined as completion and correctness of various EHR parameters, consisting of electronically signing notes, medications, allergies, diagnoses, vital signs triage, and subjective, objective, assessment, and plan notes. For the first two clinics, students were trained using large group lecture-style learning, with a lecturer to volunteer ratio of 1:70. For the latter two clinics, students were trained in small-groups based on clinic role, in rooms with an average lecturer to volunteer ratio of 1:8. In these sessions, students then actively utilized the EHR by annotating a standardized patient case before the clinic.

Results: Data shows significant differences (p<0.05) in EHR accuracy of large-group versus small-group training for 11 of 18 parameters, with all parameters demonstrating an increase in accuracy in the experimental groups.

Conclusions: These results indicate that small-group, interactive learning affords greater EHR accuracy than large group lecture-style learning, suggesting more efficient ways to perform EHR training.
An Evaluation of Hemoglobin A1c Monitoring at a Student-Run Free Clinic in Kansas City, Missouri
Authors: Murali Madhavi , Bodepudi Alaya , Casubhoy Imaima , Kraemer Edwin
Published: May 2023

Background: The hemoglobin A1c is critical for monitoring and managing type II diabetes and providing clinicians with a framework for a treatment plan. Our study analyzes compliance to the American Diabetes Association (ADA) standards of appropriate A1c monitoring and encourages other clinics to monitor the same information within their own clinics.

Methods: A retrospective chart review was conducted on all patients who visited the Sojourner Health Clinic between January 2017 and November 2019. All patients who had met the criteria for A1c screening based on recommendations from the ADA were included in the study, as well as patients who were charted as diabetic or pre-diabetic. A total of 88 patients met the criteria for this study. Data collected included patient documentation as diabetic or pre-diabetic and patientsâ€™ three most recent A1c values with corresponding dates. Based on this data, these patients were categorized as diabetic, pre-diabetic, or non-diabetic, and were evaluated on whether their A1c was monitored at appropriate intervals.

Results: A total of 21.6% of patients were monitored appropriately for their diabetic status determined by their A1c values. Only 18.2% of diabetic patients were accurately monitored. Patients with an unknown diabetic status had the lowest rate of appropriate monitoring.

Conclusions: Most patients at the Sojourner Health Clinic are not properly monitored for diabetes using the clinic's modified A1c monitoring guidelines. The clinic can make several improvements to strengthen adherence to these guidelines with the implementation of new protocols for better A1c monitoring. Further studies should be made to assess the efficacy of these changes.
Establishing a Model for Free Dental Care for Uninsured Patients Served by a Student-Run Clinic
Authors: Nguyen Eliza , Stewart Heather , Maldonado Marissa , Cook Elizabeth , Arboleda Bianca , Simoneit Elizabeth , Palakurty Sri Harsha , Shahin Alexander , Gonzalez Eduardo
Published: May 2023

Background: This paper details the establishment of a free dental clinic within the Building Relationships and Initiatives Dedicated to Gaining Equality (BRIDGE) Healthcare Clinic, a student-run free clinic, in Hillsborough County, Florida through collaboration with Hope in Health Project (HHP), and local dental volunteers. The purpose of the clinic is to provide general dental service to BRIDGE patients. It notes the patient demographics, procedure types, and total cost of care provided at the first dental clinic.

Methods: Nine dentists, two dental hygienists, and one dental assistant were recruited through HHP as well as 29 local volunteers to participate in the clinic. BRIDGE Clinic patients were contacted via text message informing them of the opportunity to receive dental care. A triage event was held for initial evaluation and to determine services needed. The following week, triaged patients returned to receive dental services. Procedures offered included prophylaxis with fluoride varnish, extractions, and fillings.

Results: 71 patients were triaged and 62 received a procedure. The average age was 49Â±10 years. Of patients triaged, 87% (62) received at least one procedure, 72% (51) received prophylaxis with varnish, 18% (13) received extractions, and 39% (28) received fillings. Total number of procedures completed was 126, which included 51 prophylaxis, 28 extractions, and 47 fillings. The total cost for the services provided was 31,065 United States Dollar (USD) with an average cost per patient of 438 USD.

Conclusion: This project demonstrates the successful implementation of a pilot free dental clinic in the context of an established free, primary healthcare clinic. It provides information on the structure and cost of a free dental clinic and how it can be implemented to provide dental care to uninsured patients.
The Transition to Telehealth: A Pilot Model in a New York City Student-Run Free Clinic During the COVID-19 Pandemic
Authors: Glassberg Brittany , Weiss Kevin , Hughes Terence , Meyers James , Kamat Samir , Pan Jonathan , Blum James , Carter James , Luo Cynthia , Powell Samuel , Krystal Hannah , Thomas David , Skovran David , Meah Yasmin
Published: May 2023

Here we describe the development and implementation of a telehealth model for vulnerable, uninsured residents of East Harlem in New York City during the coronavirus disease 2019 (COVID-19) pandemic at a student-run, physician-supervised free clinic. The East Harlem Health Outreach Partnership completed 43 primary care follow-up and 78 urgent telehealth encounters during a six-week trial period during the COVID-19 outbreak, and 40 patients were managed for either suspected or confirmed COVID-19 diagnoses. Telehealth is a useful tool to provide rapid, high-quality care to a large patient population during a pandemic. Challenges include the lack of access to updated technology among patients of lower socioeconomic status and rapidly evolving management guidelines for COVID-19. Telehealth is essential for supporting vulnerable populations during times of reduced physical contact, including the COVID-19 pandemic, but can be applied broadly to all free clinics to augment access.
Impact of Student-Run Free Clinic Participation on Medical Student Attitudes Towards the Underserved: A Mixed-Methods Approach
Authors: Enich Michael , Hawes Meagan , Lavadera Paul , Lin Karen Wei-Ru
Published: May 2023

Background: Student-run free clinics provide an opportunity to shape medical student practices with and attitudes towards the medically underserved. Previous literature has shown mixed results on how student attitudes change over the course of medical education. The purpose of this mixed-method study is to determine the effect that participation in a student-run free clinic has on medical student attitudes towards the underserved as compared to attitudes of non-participating students.

Methods: The validated Medical Attitudes Towards the Underserved (MSATU) survey was administered in cross-sectional study to student participants in a student-run free clinic and to non-participating medical students (n = 122). Additionally, first and fourth year participant students were interviewed via semi-structured interviews about results.

Results: There was no statistically significant difference in overall MSATU scores between participant and non-participant medical students using Mann Whitney tests. In sub-score analyses, Mann Whitney tests demonstrated significantly higher scores among participants in the total services score (U = 1344.0, df = 115, p = 0.013) and the expensive procedures services sub-score (U = 1401.0, df = 115, p = 0.019). Interviews revealed that positive attitudes towards the underserved are not specific to student-run free clinic participants. Participants did not describe changes in their attitude from clinic participation, believing all medical students had a baseline positive attitude towards the underserved. They did, however, highlight that witnessing the reality of these patients influenced their perspective and future practice.

Conclusions: There were limited significant differences in MSATU survey scores between participant and non-participant students. Interview results suggest that the survey tool was unable to capture changes in the perspectives of participant medical students or the changes in their projected practices but that, participation in a student-run free clinic had an overall positive effect on understanding of the barriers to care and empathy towards the underserved.
Demonstrating Value, Improving Education and Doing Right by Patients: The Role of Patient-Reported Outcomes in Student-Run Free Clinics and Recommendations for Implementation
Authors: Staples Trevor , Neuman Anndee , Thackeray Anne
Published: May 2023

Emphasis has been placed on patient-reported outcomes as a means to improve quality in healthcare. Likewise, patient-reported outcomes have the potential to benefit student-run free clinics in several important ways. Unfortunately, student-run free clinics infrequently incorporate patient-reported outcomes into the care process. This perspective article highlights the need for routine collection of patient-reported outcomes in student run free clinics and recommends resources and future directions to promote widespread use of patient-reported outcomes in student-run free clinics.
Impact of an Additional Immunizing Pharmacist at an Interprofessional Student-led Clinic for the Underserved
Authors: Patel Khyati , Candelario Danielle , Rahman Ateequr , Chen Melissa
Published: May 2023

Background: To streamline workflow during peak influenza season in our weekly student-led free Interprofessional Community Clinic (ICC), an additional pharmacist shift solely responsible for providing immunization services was implemented from October 2018 to February 2019. The objective of this study was to determine the impact of adding an immunizing pharmacist, in addition to a clinical pharmacist, on adherence to Centers for Disease Control and Prevention (CDC) vaccine recommendations and overall immunization rates at ICC.

Methods: A retrospective chart review of patient visits from October 2017 to February 2019 was conducted. Vaccination rates and CDC recommendation adherence were compared to a historical control when an immunizing pharmacist was not scheduled. Chi-square analysis was performed on categorical data; Fisher’s exact test was used to assess impact of an immunizing pharmacist on vaccination rates and adherence to CDC recommendations. A p-value of <0.05 was considered statistically significant. 

Results: A total of 78 patient visits and 58 unique patients were included. There was a significant increase in the adherence to CDC recommendations for pneumococcal vaccine when an immunizing pharmacist was present (p=0.02). There was no significant difference in the adherence to CDC recommendations for all other vaccines and overall vaccine rate between the two groups (p>0.05). 

Conclusion: Implementation of an immunizing pharmacist in an interprofessional clinic significantly impacts the adherence to CDC recommendations for pneumococcal vaccine without significantly impacting the overall vaccine rate. Benefit of an additional pharmacist dedicated to vaccinations should be weighed for workflow improvement versus impact on vaccine adherence and rate.
Delivering Comprehensive Social Services during a Pandemic: Experience of a New York City Student-Run Free Clinic
Authors: Dias Jennifer , Lui Madeline , Goldberger Cody , Stewart O'Jay , Deeb Stephanie , Orozco Scott Paloma , Berger Natalie , Hughes Terence , Weiss Kevin , Carter James , Pan Jonathan , Paul Megan , Kim Eliott , Ramos Ezequiel , Raja Aishwarya , Barazani Sharon , Pruzan Alison , Glassberg Brittany , Skovran David , Thomas David , Meah Yasmin
Published: May 2023

Background: We describe the implementation of a remote operational model to provide targeted, multi-faceted social services during the coronavirus disease 2019 (COVID-19) pandemic at the East Harlem Health Outreach Partnership (EHHOP), a student-run, physician-supervised free clinic (SRFC) that serves uninsurable residents of East Harlem in New York City (NYC). The model attempts to mitigate the economic consequences of the pandemic while also safely meeting the needs of patients who were quarantined or otherwise medically vulnerable. 

Methods: We outline a step-by-step approach required to transition social services to a remote model, across six key workflows: (1) student volunteer recruitment, (2) fundraising, (3) grocery and financial grant allocation, (4) medication delivery, (5) mask delivery and patient education, and (6) broader community engagement.

Results: Within 20 days of the first known case of COVID-19 in NYC, we established a protocol for remote care and expanded social services. From March to July 2020, EHHOP volunteers made 221 medication and 172 mask kit no-contact deliveries. To address food and housing insecurity, 140 patients were provided financial grants and an additional 109 received food deliveries. This comprehensive response was supported through emergency fundraising efforts that generated $66,690.

Conclusions: By focusing on support for basic needs including food, medication, personal protective equipment, and patient education, EHHOP was able to bolster the safety-net for marginalized patients otherwise excluded from national economic recovery efforts and ensure continuous care for patients with chronic medical illness. EHHOP’s operational model for safe, remote delivery of social services provides other clinics with a framework to guide current and future emergency responses.
Evaluating Patient Profile, Follow-Up Rates and Barriers to Follow-Up at a Student-Run, Community-Based Tuberculosis Testing Program
Authors: Foroushani Sophia , Crawford Andrew , Woodbridge Alexandra , Frechtling Dan , Ali Juzar
Published: May 2023

Background: The Tulane Student-Run Tuberculosis (TB) Program provides TB risk evaluation, skin testing (TST), and referrals at six homeless shelters and rehabilitation facilities. To date, there has been no evaluation of the programâ€™s patient profile. The objective of this study was to determine the symp-toms and risk factors for TB present in the program's clients, calculate follow-up rates for TST reading, and determine factors associated with an increased rate of missing reading appointments. 

Methods: This retrospective chart review examines the prevalence of risk factors and TB symptoms, evaluates risk stratification, and determines barriers to follow-up for TST over a 33-month period. Rel-ative risks (RR) were calculated to determine the association between risk stratification, positive TST, and loss to follow-up. Z-values were calculated, and p-values were determined as the area of the dis-tribution outside of +/- z. P-values <0.05 were considered statistically significant. 

Results: Of 6,198 individuals seen, 479 were referred to higher care, 238 received 30-day clearances, 34 deferred testing, and four were sent to the hospital. Of 5,443 TSTs placed, 4,155 were read and 214 were positive. Individuals who had any risk factors were at significantly increased risk of not attending TST reading (RR 2.14, 95% Confidence interval [CI] 1.96-2.34, p<0.01) and, for those who did attend, of having a positive TST (RR 1.52, 95% CI 1.17-1.98, p<0.01). Higher risk of no-show and positive TST was also seen in homeless individuals (RR 3.44, 95% CI 2.92-4.07, p<0.01 and RR 2.10, 95% CI 1.52-2.90, p<0.01, re-spectively) and those with intermediate-risk stratification (RR 1.25, 95% CI 1.11-1.41, p<0.01 and RR 1.32, 95% CI 1.01-1.72, p=0.04, respectively). 

Conclusions: Individuals experiencing homelessness and those with intermittent TB risk stratification are at increased risk for positive TST. Both homelessness and the presence of any TB risk factors in-crease the risk of loss to follow-up.
Employing a Quality Improvement Database to Observe the Gaps in Care at a Student-Run Free Clinic
Authors: Grimmond Jessica , Menning Melanie
Published: May 2023

The Student Health Alliance Reaching Indigent Needy Groups (SHARING) clinics are student run freeclinics (SRFCs) at the University of Nebraska Medical Center that serve low income, uninsured adultsin Omaha, Nebraska. Like many other SRFCs, they face multiple barriers to providing high quality care.To address this, the SHARING Quality Improvement (QI) Database was created. QI has many definitions,but, overall, it is a method of analyzing clinic performance and the changes made to improvethe clinic. Before this database, there was no way of continuously tracking clinic metrics over time, soprevious QI projects required timely data abstraction that often only evaluated retrospective outcomeswith limited real-time data to track clinical outcomes as changes were implemented therebylimiting our ability to implement further changes to improve patient health. A review of SRFC literaturereveals a lack of a model or guide on how to assess quality of care in SRFCs and track patient dataover time. This study seeks to fill this gap. Our database consists of a patient list of electronic medicalrecords that were compiled in the charting system Epic. The patient data is exported into a MicrosoftExcel document each month and clinic metrics are analyzed, thus providing a real-time dashboard ofquality metrics for the clinic. This database will be utilized to inform decisions regarding the reform ofclinic processes. This database model can be used at other SRFCs to monitor quality of care providedat their clinics and implement QI measures accordingly.
Utilization of a Ride-Share Application and Patient Navigation Program for Promoting Colonoscopy Among High-Risk Adults
Authors: Miyfa Zumana , Ho Lisa , Khristov Vladimir , Palisoc Maryknoll , Bennett Hannah , Roy Siddhartha , McGarrity Thomas , Mendez-Miller Megan
Published: May 2023

Colonoscopy screening starting at age 50 is key for the early detection and prevention of colorectal cancer (CRC). Barriers to care, such as lack of insurance, transportation, and healthcare literacy, can deter a patient from completing a screening colonoscopy. Delayed CRC screening results in missed opportunities for detecting disease at an earlier stage, ultimately leading to increased healthcare costs and morbidity. We implemented a pilot program that combines student-led patient navigation with ride-share services to promote colonoscopy screening among at-risk populations in Harrisburg, Pennsylvania, United States, at no cost to patients. During the first year of the program, the rate of adequate colonoscopy preparation was 77% (10 out of 13 patients), and the attendance rate was 100% for all scheduled appointments. While this study analyzed a small cohort of participants, it demonstrates how a colonoscopy screening program can be organized and conducted successfully through collaboration among multiple stakeholders. Future aims include expanding the program and assessing its receptiveness via post-procedure surveys for patients, patient navigators, and healthcare providers.
Bridging the Language Gap in Medicine: Quality Improvement for Interpreter Services at JayDoc Free Clinic
Authors: Trieu Skyler , Bajpai Shilpika
Published: May 2023

Background: JayDoc Free Clinic (JayDoc) is run by medical students at the University of Kansas School of Medicine. Many patients seen at the clinic have limited English proficiency (LEP) and are assisted by volunteer medical interpreters. Formal training for working with interpreters has not previously been part of JayDoc’s volunteer orientation.

Methods: An intervention emphasizing education in interpreter standards of practice, effective use of interpreter services, and culturally competent communication were presented to all incoming JayDoc volunteers (i.e., first-year medical students [MS1s]) during their volunteer orientation. Three months post-intervention a voluntary online survey was distributed to assess perceived improvement in effective interpreter partnerships and cultural communication. The survey was administered to MS1s and second-year medical students (MS2s). Responses were stratified using a two-tailed t-score distribution to analyze the impact of the educational intervention on the MS1 group in comparison to the MS2 group that did not receive the intervention.

Results: There were one hundred and five respondents (52 MS1s, 53 MS2s). MS2s had a significantly higher average number of interpreter-facilitated patient encounters (MS2 6.38; MS1 2.54; p=0.001). MS1s had a significantly higher average of perceived importance of interpreter training (MS2 4.56; MS1 4.81; p=0.031). All other survey parameters of cultural competency and interpreter-provider best practices were ranked as important by both MS1s and MS2s, without a significant difference between the responses of the two groups.

Conclusions: An educational intervention focused on interpreter-provider partnerships and cultural competency resulted in the higher perceived importance of the training session among students.
Pivoting to Respond to COVID-19: Lessons Learned from Health Initiatives of a Student-Run Clinic
Authors: Button Dana , Chen Bin , Nguyen Huong , Mah-Park Lisa , Hjelvik Alyssa , Lockard Rachel
Published: May 2023

Bridges Collaborative Care Clinic (BCCC) is a student-led, nonprofit organization providing no-cost health and social services to chronically marginalized populations in Portland, Oregon. In response to physical distancing measures during the early stages of the coronavirus disease 2019 (COVID-19) pandemic, health professions programs across the country suspended in-person clinical activities for students. As a result, BCCC clinical operations were canceled for the foreseeable future. In response, student leaders and volunteers started four health initiatives including the following: 1) organizing a mask-making network to create homemade masks for local organizations in need; 2) forming a real-time capacity needs assessment for local safety net organizations for people with substance use disorders; 3) collaborating with a local Asian health services nonprofit to organize a multilingual volunteer and translator network to deliver food and health supplies to Vietnamese, Korean, Cantonese, and Mandarin speaking elders; and 4) organizing a virtual 5K run/walk fundraiser for an organization that provides temporary housing and other services for the houseless community in Portland. The lessons learned from these pandemic response initiatives are summarized here for student-run clinics, educators, and others interested in starting similar initiatives.
Efficacy of a Student-Run Ophthalmology Service in Managing Diabetic Retinopathy: A Five-Year Retrospective Review
Authors: He Jody , Goté John , D'Souza Haley , Barmas-Alamdari Daniel , DiSandro Giovanni
Published: May 2023

Background:

Diabetic retinopathy is one of the leading causes of blindness in the world, and its development and progression can be prevented with appropriate glycemic control. The Health Outreach Partnership of EVMS Students (HOPES) Student-Run Free Clinic at Eastern Virginia Medical School (Norfolk, VA) provides both primary care and ophthalmology care to patients from underserved backgrounds. The purpose of this retrospective chart review is to assess whether a student-run free clinicâ€™s primary care and ophthalmology services are effective in preventing the development and progression of diabetic retinopathy.

Methods:

Inclusion criteria were a diagnosis of Type 2 Diabetes Mellitus (T2DM), two or more HOPES Ophthalmology Clinic appointments separated by at least 4 months between January 2015 and July 2019, and medical management of T2DM by the HOPES Primary Care Clinic. Objective patient data collected were HbA1c, visual acuity, and documented dilated fundus examination findings.

Results:

There were 174 HOPES Ophthalmology visits and 66 diabetic eye exam appointments in this five-year time period. The average HbA1c for patients at the initial appointment with the Ophthalmology Clinic was 7.77% Â± 1.65% and the average HbA1c at the most recent appointment was 7.4% Â± 2.28%. Among all patients, there was no statistically significant change in visual acuity in either eye from baseline to the most recent visit. There was no change in fundus examination findings in any of the patients from their initial visit to their most recent visit.

Conclusions:

The HOPES Clinic has been effective in preventing the development and progression of diabetic retinopathy in its patients who regularly follow up with both the primary care and ophthalmology clinics. This study highlights that a student-run free clinic is capable of making an impact in the community by preventing the development of a potentially blinding disease, but that further strategies to enable consistent patient follow-up are needed.
Clínica Comunitaria Esperanza Pediátrica: The Development and Early Outcomes of a Bilingual Medical Home for Uninsured Hispanic Children
Authors: Im Alex , Tosi Amanda , Taylor-Fishwick Jonathan , Sheehan Brynn , Sriraman Natasha , Leader Alexandra
Published: May 2023

The uninsured Hispanic pediatric population in the United States faces significant challenges in accessing medical care due to language barriers, citizenship status, and limited access to health insurance. Clínica Comunitaria Esperanza Pediátrica (CCE-P) is a bilingual student-run free clinic created to provide healthcare to the underserved population in southeastern Virginia. This study further details the creation, implementation, and early outcomes of CCE-P as well as barriers encountered throughout the process. It describes four critical steps in establishing CCE-P, including leveraging existing institutional partnerships, ensuring high standards of care, prioritizing community outreach, and implementing a quality improvement program. Study outcomes include a demographic characterization of the 46 pediatric patients served by CCE-P, a description of clinic services, and an analysis of gaps in care and strategies to provide more comprehensive health services. This publication serves as an outline to an adaptable model that other organizations may use to establish similar clinics in their own communities.
Experiences with a Student-Run, In-Clinic Food Donation Program for Uninsured Patients in Nashville
Authors: Nguyen Christian , McKeon Mallory , Ufuah Samuel , Lloyd Cooper , Weaver Eleanor , Fowler Michael , Miller Robert
Published: May 2023

Food insecurity (FI) is a dynamic and growing problem disproportionately impacting the health of minority and otherwise disadvantaged communities in the United States. Large healthcare systems address FI through screenings, community partnerships, and patient education programs. However, less has been reported on the role of small, student-run free clinics in responding to FI. Free clinics, including student-run free clinics, provide the opportunity to screen for and respond to FI with intimacy and continuity that large healthcare systems often fail to establish in these populations. Here, we aim to describe one clinic’s experience with an in-clinic, free food pantry for uninsured patients in Nashville, Tennessee. We outline the pantry’s evolution, improvement processes implemented, and data collected from July 2018 to June 2021. Data reveal that the burden of FI in our patient population is estimated as high as 80%, exceeding that of regional and national averages. While clinical associations have yet to be assessed, evidence supports the feasibility and utility of an in-clinic food pantry program for reducing the barriers to accessing healthy food in low-resource communities at high risk for FI.
Nutrition Assessment in Student-Run Clinics Serving Hispanic/Latinx Patients
Authors: Lilja Katherine , Walters Teal , Baumler Megan Dennis , Crusan Ambria
Published: May 2023

Background: The patients of student-run clinics, especially Hispanic/Latinx patients, are at a disproportionately high risk for chronic disease due to the negative impacts of the social determinants of health, including barriers to obtaining healthcare, ranging from lack of financial resources to fear of deportation. Nutrition services are pivotal in providing effective, holistic healthcare for this patient population seeking care at student-run clinics. The purpose of this review is to examine how nutrition assessment is conducted at student-run clinics and to determine if the nutrition assessments are culturally tailored.

Methods: Three scientific databases were searched using keywords focused on the concept of nutrition assessment in student-run clinics serving the Hispanic/Latinx population. The articles generated were reviewed by 4 independent reviewers to determine key elements related to nutrition assessment and/or nutrition services provided in student-run, free, or community clinics, with attention to addressing social and cultural barriers addressed by the clinic.

Results: A search of the literature related to nutrition services at student-run clinics yielded 3 results for nutrition assessment of the Hispanic/Latinx population in student-run, free, or community clinics. Several articles presented research on health behavioral counseling and food insecurity screening, but few studies were conducted specifically on nutrition assessment, especially for the Hispanic/Latinx population.

Conclusions: The current assessment tools have widespread use in nutrition assessment; however, they are insufficient for the distinctive characteristics of the Hispanic or Latinx population being served in a student-run clinic. Including dietetics students into a student-run clinic, if plausible, and/or a culturally sensitive guided nutrition assessment tool for students would be of benefit to adequately address the relevant social determinants of health in the nutrition assessment of patients at student-run clinics.
Establishing a COVID-19 Vaccine Clinic at a Student-Run Free Clinic
Authors: Moritz Brandon , Le Tram , Bratzler Dale
Published: May 2023

Coronavirus Disease 2019 (COVID-19) is a highly contagious infectious disease associated with significant rates of morbidity and mortality. With limited treatments for COVID-19, the most effective strategy developed to mitigate the effects of this disease is vaccination. Unity Clinic, an interdisciplinary, student-run free clinic (SRFC) at the University of Oklahoma Health Sciences Center (OUHSC), created a COVID-19 vaccine clinic that started in January 2021 to participate in the mass vaccination campaign in Oklahoma. Health profession students from seven different colleges present at OUHSC served in either non-clinical or clinical volunteer roles at the vaccine clinics. Between January 6 and July 16, 2021, Unity Clinic hosted 119 vaccine clinics, administered 39,665 vaccines, and had 16,830 student volunteer hours logged. The vaccines administered through Unity Clinic composed 1.2% of all vaccines administered in the state and 11.1% of all vaccines administered in Oklahoma County. This descriptive report demonstrates the effective use of an SRFC for large-scale COVID-19 vaccination events. Unity Clinic’s COVID-19 vaccine clinic has the potential to serve as a model for other SRFCs around the country to use for the current COVID-19 pandemic and adapt for other public health issues in the future.