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Silvestri F, Mellgard G, Goldstein J, Chennareddy S, Tang J, Tran M, Band I, Qian D, Fischer S, Castillo A, Jiang J, Skovran D, Thomas D, Meah YS. How Are We Doing? A Scoping Review of Published Patient-Centered Outcomes Research in United States Student-Run Free Clinics. TEACHING AND LEARNING IN MEDICINE 2023:1-13. [PMID: 37571960 DOI: 10.1080/10401334.2023.2245805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 07/02/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
Phenomenon: Student-run free clinics (SRFCs) serve an integral role in most United States (US) medical schools and contribute substantially to literature on the quality of care to uninsured persons. There has been substantial growth over the past decade of scholarly work produced by SRFCs as they have increased in size and number. Research on patient care outcomes informs better care structures for patients, however there is no current synthesis of patient care outcomes research among SRFCs. This article provides an overview of SRFC research on patient outcomes to understand current research domains and to identify gaps in the literature. Approach: We completed a scoping review by searching Scopus, PubMed, and Journal of Student Run Clinics in June 2021. All peer-reviewed, English-language articles focused on patient-centered outcomes at SRFCs in the US were included. Two independent reviewers performed title, abstract, and full-text screening of relevant works, and eight reviewers conducted data extraction. Descriptive data analysis was performed along with relevant content analysis of patient-centered outcomes. Findings: The search strategy identified 784 studies, of which 87 met inclusion criteria. Most studies were published within the last six years (81.6%), located in California, New York, or Florida (43.7%), and intervention based (33.3%). Many studies (46.0%) had a specific disease of focus of which diabetes was the most researched(19.5%). Patient-centered studies were the leading focus of the study aims (40.2%), where key findings demonstrated primarily improved outcomes in clinic metrics post-intervention (36.8%) or equivalent/better clinical performance than national metrics (20.7%). Insights: This review brings to light gaps in the literature reporting research in SRFCs and can be applied to other low-resource settings. Future efforts to expand SRFC outcomes research should focus on community relationship building, understanding institutional support, and ensuring education on best practices for research within SRFCs. Doing so informs patient care improvement as SRFCs continue to operate as safety net clinics for marginalized populations.
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Affiliation(s)
- Francesca Silvestri
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Mellgard
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, New York Presbyterian - Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan Goldstein
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susmita Chennareddy
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Justin Tang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michelle Tran
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Isabelle Band
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Qian
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Abigail Castillo
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joy Jiang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Skovran
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Thomas
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yasmin S Meah
- Icahn School of Medicine at Mount Sinai, Brookdale, New York, New York, USA
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Hopper W, Ruane P, DiMucci-Ward J, Ables AZ. A Multidisciplinary Quality Improvement Program to Improve Diabetes Care at a Free Clinic. Cureus 2023; 15:e36745. [PMID: 37123722 PMCID: PMC10132326 DOI: 10.7759/cureus.36745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of an intensive, multidisciplinary patient-centered approach involving a pharmacist and a dietician in a population of uninsured free clinic patients with diabetes and hypertension. METHODS A single-center retrospective chart review of a quality improvement project. All patients had diagnoses of diabetes and hypertension and a most recent hemoglobin A1c ≥ 9.0%. Patients met individually with a pharmacist and a dietician during 6 encounters over 12 months. The pharmacist made medication changes, encouraged lifestyle reflections, and helped patients create and track self-management goals. The dietician helped patients plan strategies for diet and exercise. The primary outcome was a change in mean hemoglobin A1c. RESULTS Of 30 enrolled patients, 17 completed three months of treatment, and seven completed 12 months. The 17 patients who completed three months of treatment had the following characteristics: mean age 55.5 years; mean hemoglobin A1c 11.5%; 82% were taking two or more antidiabetic medications; 59% were taking two or more antihypertensive medications. Significant reductions in mean hemoglobin A1c values were observed at three months (-3.4%, P<0.0001) and twelve months (-4.0%, P=0.0156). Reductions in systolic blood pressure were also observed at three months (-6 mmHg, P=0.1060) and twelve months (-17 mmHg, P=0.2188). CONCLUSIONS Large and significant hemoglobin A1c reductions were observed in free clinic patients with diabetes refractory to traditional medical management. Goal-oriented patient empowerment effectively improves a wide range of patient outcomes in the free clinic setting. Other free clinics can implement this collaborative, multidisciplinary model with access to similar personnel.
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Jones NC, Fusani AU, Cox KM, Martinez VP, Guerra L, Gonzalez E. Assessing Spanish Health Literacy and Cervical Cancer Knowledge, Attitudes, and Behaviors in a Student-Run Free Clinic. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023:10.1007/s13187-023-02278-9. [PMID: 36884133 DOI: 10.1007/s13187-023-02278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
While the incidence of cervical cancer continues to decrease, there is a significant discrepancy in incidence rates and screening behaviors among Hispanic and non-Hispanic white patients in the USA. This project examines the relationship between Spanish health literacy and cervical cancer screening knowledge, attitudes, and practices among native Spanish-speaking patients at risk for cervical cancer at the USF BRIDGE Healthcare Clinic, a student-run free clinic in Tampa, FL. Spanish-speaking patients ≥21 years (n = 34) participated in a quality improvement project that included an assessment of Spanish health literacy and a written survey on cervical cancer knowledge. Chi-squared tests were performed to assess potential relationships between health literacy and cervical cancer knowledge, attitudes, health behaviors, and demographics. Seven participants (20.6%) scored between 0 and 14 on the SAHL-S, indicating inadequate health literacy. A significant difference in cervical cancer health knowledge was found between patients with adequate health literacy compared to patients with inadequate health literacy (p = 0.002). There is a potential association between low Spanish health literacy and subsequent poorer understanding of cervical cancer in BRIDGE patients. This implies that patients of low health literacy may have poorer comprehension of other aspects of their care beyond cervical cancer screening. Strategies are discussed to improve communication with BRIDGE patients of low Spanish health literacy that may be applicable to other patient populations.
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Affiliation(s)
- Nat C Jones
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA.
| | - Anna Ulyanenkova Fusani
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Kaitlyn Maria Cox
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Valeria Pereira Martinez
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Lucy Guerra
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Eduardo Gonzalez
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr, Tampa, FL, 33602, USA
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Bastani M, Chiuzan C, Silvestri G, Raoof S, Chusid J, Diefenbach M, Cohen SL. A predictive model for lung cancer screening nonadherence in a community setting health-care network. JNCI Cancer Spectr 2023; 7:pkad019. [PMID: 37027213 PMCID: PMC10097452 DOI: 10.1093/jncics/pkad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Lung cancer screening (LCS) decreases lung cancer mortality. However, its benefit may be limited by nonadherence to screening. Although factors associated with LCS nonadherence have been identified, to the best of our knowledge, no predictive models have been developed to predict LCS nonadherence. The purpose of this study was to develop a predictive model leveraging a machine learning model to predict LCS nonadherence risk. METHODS A retrospective cohort of patients who enrolled in our LCS program between 2015 and 2018 was used to develop a model to predict the risk of nonadherence to annual LCS after the baseline examination. Clinical and demographic data were used to fit logistic regression, random forest, and gradient-boosting models that were internally validated on the basis of accuracy and area under the receiver operating curve. RESULTS A total of 1875 individuals with baseline LCS were included in the analysis, with 1264 (67.4%) as nonadherent. Nonadherence was defined on the basis of baseline chest computed tomography (CT) findings. Clinical and demographic predictors were used on the basis of availability and statistical significance. The gradient-boosting model had the highest area under the receiver operating curve (0.89, 95% confidence interval = 0.87 to 0.90), with a mean accuracy of 0.82. Referral specialty, insurance type, and baseline Lung CT Screening Reporting & Data System (LungRADS) score were the best predictors of nonadherence to LCS. CONCLUSIONS We developed a machine learning model using readily available clinical and demographic data to predict LCS nonadherence with high accuracy and discrimination. After further prospective validation, this model can be used to identify patients for interventions to improve LCS adherence and decrease lung cancer burden.
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Affiliation(s)
- Mehrad Bastani
- Department of Radiology, Northwell Health, Manhasset, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Codruta Chiuzan
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Gerard Silvestri
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Suhail Raoof
- Department of Pulmonary Medicine, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | - Jesse Chusid
- Department of Radiology, Northwell Health, Manhasset, NY, USA
- Department of Pulmonary Medicine, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
| | | | - Stuart L Cohen
- Department of Radiology, Northwell Health, Manhasset, NY, USA
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Department of Pulmonary Medicine, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
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Xiao SY, Major CK, O'Connell KA, Lee D, Lin C, Sarino E, Chen K. Breast and cervical cancer screening rates in student-run free clinics: A systematic review. Int J Gynaecol Obstet 2023. [PMID: 36645328 DOI: 10.1002/ijgo.14675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess rates of breast and cervical cancer screening at student-run free clinics to understand challenges and strategies for advancing quality and accessibility of women's health screening. METHODS The authors performed a systematic search of publications in Ovid MEDLINE, PubMed, Web of Science, and Google Scholar databases from database inception to 2020. English-language publications assessing rates of breast and cervical cancer screening in student-run free clinics were included. Structured data extraction was completed for each publication by two reviewers independently. Risk of bias was assessed using a modified Agency for Healthcare Research and Quality checklist. Results were synthesized qualitatively because of study heterogeneity. RESULTS Of 3634 references identified, 12 references met study inclusion criteria. The proportion of patients up-to-date on breast cancer screening per guidelines ranged from 45% to 94%. The proportion of patients up-to-date on cervical cancer screening per guidelines ranged from 40% to 88%. CONCLUSION Student-run free clinics can match breast and cervical cancer screening rates among uninsured populations nationally, although more work is required to bridge the gap in care that exists for the underinsured and uninsured.
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Affiliation(s)
- Sophia Y Xiao
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Catherine Kendall Major
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katie A O'Connell
- Department of Internal Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - David Lee
- Department of Obstetrics & Gynecology, Beaumont Health System and Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Christine Lin
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Esther Sarino
- Brickell Medical Sciences Library, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Kevin Chen
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, New York, USA.,Department of Medicine, New York University, Grossman School of Medicine, New York, New York, USA
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Mesa AS, Tschoe M. Comparison of quality metrics in an education-centered medical home with local and national benchmarks. MEDICAL EDUCATION ONLINE 2022; 27:2073806. [PMID: 35543436 PMCID: PMC9103504 DOI: 10.1080/10872981.2022.2073806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 06/14/2023]
Abstract
The Education-Centered Medical Home (ECMH) is a longitudinal clerkship where students provide care to patients at one clinic site for the entirety of medical school. Studies have demonstrated that ECMHs have higher completion rates of preventative measures than traditional student-run free clinics (SRFCs). However, data comparing ECMHs with licensed primary care provider clinics are limited. We performed a prospective chart review that examined vaccination and cancer screening rates of patients in an ECMH and those seen by primary care physicians (PCPs) at the same free clinic site. We then compared these groups with participants in the 2018 National Health Information Study (NHIS). A total of 62 ECMH patients, 3,515 PCP patients, and 25,045 NHIS participants were included in the study. Within the ECMH, 72.7% and 80.0% of patients were screened for breast and cervical cancer, respectively. These rates did not differ significantly from those of PCP patients or NHIS participants. While the percentage of ECMH patients screened for colon cancer was similar to that of PCP patients (78.9% vs. 65.8%, p = 0.09), it was proportionally greater than NHIS screening rates (78.9% vs. 63.3%, p = 0.043). In addition, the rate of influenza and pneumococcal pneumonia vaccination among ECMH patients (41.4% and 58.3%, respectively) did not differ significantly from the PCP and NHIS groups. Our study found that the ECMH model allows students to deliver preventative care comparable to licensed practitioners and national benchmarks. It reaffirms the ECMH as an effective method for students to provide high quality care to underserved patients.
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Affiliation(s)
- Ana Sofia Mesa
- Department of Family Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Marianne Tschoe
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Rupert DD, Alvarez GV, Burdge EJ, Nahvi RJ, Schell SM, Faustino FL. Student-Run Free Clinics Stand at a Critical Junction Between Undergraduate Medical Education, Clinical Care, and Advocacy. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:824-831. [PMID: 34817408 PMCID: PMC9678019 DOI: 10.1097/acm.0000000000004542] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Student-run free clinics (SRFCs) act as primary care providers that bring health care to populations in need and are an important source of undergraduate medical education (UME), guiding trainees through the art of history taking and physical examination. However, they are also social justice and advocacy initiatives-addressing disparity in access to care and educating medical trainees with firsthand exposure to socioeconomic determinants of health as well as language and medical illiteracy barriers. Here, the authors review academic literature examining the impact of SRFCs in their 3 roles: as medical care providers, as components of medical education, and as advocacy organizations. Based on the evidence of that literature and decades of direct SRFC leadership experience, the authors make the case that SRFCs are an undersupported means by which UME institutions contribute to correcting health care disparities and to serving social justice reform.
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Affiliation(s)
- Deborah D Rupert
- D.D. Rupert is a seventh-year MD-PhD student, Medical Scientist Training Program, Stony Brook University, Stony Brook, New York, and Department of Neuroscience, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York; ORCID: https://orcid.org/0000-0002-3426-3912
| | - George V Alvarez
- G.V. Alvarez is resident physician, Department of Family Medicine, Northwell Glen Cove Hospital, Glen Cove, New York
| | - Eric J Burdge
- E.J. Burdge is a fourth-year medical student, Long Island School of Medicine, New York University, Mineola, New York; ORCID: https://orcid.org/0000-0002-4724-0226
| | - Roxanna J Nahvi
- R.J. Nahvi is a sixth-year MD-PhD student, School of Medicine and Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York; ORCID: https://orcid.org/0000-0002-7512-9736
| | - Spencer M Schell
- S.M. Schell is resident physician, Department of Family Medicine, OhioHealth Grant Medical Center, Columbus, Ohio; ORCID: https://orcid.org/0000-0002-2212-3760
| | - Francis L Faustino
- F.L. Faustino is assistant professor and chair, Department of Family Medicine, NYU Langone Hospital-Long Island, Mineola, New York
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Broman P, Tokolahi E, Wilson OWA, Haggie M, Andersen P, Brownie S. Patient Outcomes from Student-Run Health Services: An Integrative Review. J Multidiscip Healthc 2022; 15:641-665. [PMID: 35387392 PMCID: PMC8979421 DOI: 10.2147/jmdh.s348411] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Student-run clinics (SRCs) offer an innovative approach to expand healthcare access and equity and increase clinical placement opportunities for students. However, research on the health benefits and/or outcomes of such clinics is currently fragmented. Methods An integrative review was conducted to capture and synthesize findings across a range of study types involving varied student disciplines, student delivered intervention types, and health conditions addressed or care areas of focus. Only published and peer reviewed studies were included. Studies needed to report outcomes in a defined study group measured over time, or report SRC data with explicit comparisons to non-SRC settings. Data were analyzed using inductive content analysis to identify major themes and natural clustering of health outcomes measured. Results Fifty-one articles were selected for review based on the eligibility criteria. Studies were predominantly from the United States, and most (n = 34, 67%) adopted a case review methodology for measuring outcomes. Health outcomes were evaluated in relation to a range of health conditions that, for the purposes of this review, were considered to naturally cluster into eight categories: diabetes, hypertension, functional health/quality of life, depression, hospital utilization, substance use, weight, health screening/vaccinations, and others. Conclusion This integrative review sought to evaluate the health outcomes accrued by patients in student-run health clinics. Taken as a whole, the literature suggests positive health outcomes resulting from student-run clinics across a range of health conditions. Greater confidence in care-related findings would be achieved from future research utilizing more robust and prospective study designs.
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Affiliation(s)
- Patrick Broman
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
| | - Ema Tokolahi
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
- School of Occupational Therapy, Otago Polytechnic, Hamilton, New Zealand
| | - Oliver W A Wilson
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
- Department of Kinesiology, Pennsylvania State University, University Park, PA, USA
| | - Marrin Haggie
- Centre for Sport Science and Human Performance, Waikato Institute of Technology, Hamilton, New Zealand
| | - Patrea Andersen
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
- School of Nursing, Midwifery and Social Science, Central Queensland University, Rockhampton, QLD, Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Sharon Brownie
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
- School of Nursing, Midwifery & Public Health, University of Canberra, Canberra, ACT, Australia
- School of Medicine & Dentistry, Griffith University, Southport, QLD, Australia
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MacDonald M, Mirza AS, Mhaskar R, Ewing A, Chen L, Robinson K, Lu Y, Ayoubi N, Gonzalez E, Guerra L, Roetzheim R, Woodard L, Pabbathi S. Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors. Cancer Control 2022; 29:10732748211072983. [PMID: 35245986 PMCID: PMC8902193 DOI: 10.1177/10732748211072983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background There is limited research on screening rates among uninsured cancer
survivors. Uninsured cancer survivors are at higher risk of poorer health
outcomes than the insured due to limited access to preventative screening
for secondary cancers. This study examines the rates of surveillance and
screening of uninsured cancer survivors and compares to uninsured patients
without a cancer history seen in free clinics. Methods Data were collected retrospectively from electronic medical records and paper
charts of patients from 10 free clinics between January 2016 and December
2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics,
cancer diagnoses, and screening practices were compared for cancer survivors
and free clinic patients without a history of cancer. Study participants
were determined to be eligible for cancer screenings based on the United
States Preventive Services Task Force guidelines. Results Out of 13 982 uninsured patients frequenting free clinics between 2016 and
2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible
cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer
screening. Among the 170 female cancer survivors, 75 (44.1%) had completed
breast cancer screenings, and only 5.9% (59/246) had completed cervical
cancer screenings. After adjusting for age, gender, race, salary, employment
status, and household size, cancer survivors were more likely to undergo
colorectal cancer screening (OR: 3.59, 95% CI: 2.10–6.15) and breast cancer
screening (OR: 2.13, 95% CI: 1.30–3.84) than patients without a cancer
history. This difference was not seen for cervical cancer screening (OR:
0.99, 95% CI: .62–1.58). Conclusions Uninsured cancer survivors frequenting free clinics represent a unique
population that is underrepresented in the medical literature. Our results
suggest that uninsured survivors use screening services at higher rates when
compared to uninsured patients without a reported cancer diagnosis. However,
these rates are suboptimal when compared to national screening rates of
insured cancer survivors.
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Affiliation(s)
- Madeline MacDonald
- 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Abu-Sayeef Mirza
- Department of Internal Medicine, 7831University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, 7831University of South Florida, Tampa, FL, USA
| | - Aldenise Ewing
- Health Outcomes and Behavior, 5301H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Liwei Chen
- Department of Medical Education, 7831University of South Florida, Tampa, FL, USA
| | - Katherine Robinson
- Department of Internal Medicine, 7831University of South Florida, Tampa, FL, USA
| | - Yuanyuan Lu
- College of Public Health, 7831University of South Florida, Tampa, FL, USA
| | - Noura Ayoubi
- 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Eduardo Gonzalez
- Department of Family Medicine, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Lucy Guerra
- Department of Internal Medicine, 7831University of South Florida, Tampa, FL, USA
| | - Richard Roetzheim
- Department of Medical Education, 7831University of South Florida, Tampa, FL, USA.,Department of Family Medicine, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Laurie Woodard
- Department of Medical Education, 7831University of South Florida, Tampa, FL, USA.,Department of Family Medicine, 33697University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Smitha Pabbathi
- Survivorship Clinic, 25301H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Nagel DA, Naccarato TT, Philip MT, Ploszay VK, Winkler J, Sanchez-Ramirez DC, Penner JL. Understanding Student-Run Health Initiatives in the Context of Community-Based Services: A Concept Analysis and Proposed Definitions. J Prim Care Community Health 2022; 13:21501319221126293. [PMID: 36164929 PMCID: PMC9520185 DOI: 10.1177/21501319221126293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Student-run health initiatives in the community setting have been utilized to provide practical experience for undergraduate students to develop professional competencies, gain exposure to diverse populations, and to engage in activities of social accountability. There is much literature on student-run health initiatives; however, there is no consensus on a definition of this concept or a comprehensive synthesis of the literature that describes student-run health initiatives offered by students in pre-licensure healthcare education programs. PURPOSE To provide a concept analysis of, and propose a definition for, student-run health initiatives that provide community-based services for students during pre-licensure health discipline education. METHODS A systematic literature search and review process was used to identify and synthesize peer-reviewed articles from 7 academic databases covering a range of pre-licensure health disciplines and education. Walker and Avant's framework for concept analysis was used to guide exploration of attributes, antecedents and consequences of student-run initiatives, and to inform development of a definition for this concept. RESULTS The review yielded 222 articles for data extraction and represented 17 distinct pre-licensure health disciplines, 18 health-related disciplines, and a range of other baccalaureate and graduate programs. Our analysis revealed 16 definitions, 5 attributes, 6 antecedents, and consequences identified for student-run health initiatives. Attributes were Provision of Service, Service is Free, Target Clientele, Volunteerism, and Student Governance. Antecedents included Purpose/Rationale, Affiliation with Academic Unit, Location and Partnerships, Funding and Resources, Professional Oversight, and Preparation for Student Role. Consequences were improved access to services and outcomes for clients; competency development, personal gains and interprofessional learning for students; and positive outcomes for broader systems, such as decrease of service utilization and cost/benefit. CONCLUSIONS There was no clear conceptual definition for student-run health initiatives, but many defining characteristics and well-described exemplars in the literature. Given the variations in purpose and scope of these initiatives, particularly to distinguish degree of students' roles in operations and the involvement of academic institutions, we propose 3 distinct conceptual definitions: student-run, student-led, and student-infused health initiatives.
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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. J Community Health 2021; 46:1132-1138. [PMID: 33987784 PMCID: PMC8118096 DOI: 10.1007/s10900-021-01001-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/02/2022]
Abstract
The East Harlem Health Outreach Partnership (EHHOP) is a medical student-run and attending-supervised clinic that provides primary care to predominantly Spanish-speaking, uninsured patients living in East Harlem, New York. In 2010, the clinic launched a Women's Health Clinic (WHC), to offer comprehensive gynecologic and reproductive healthcare under the guidance of faculty gynecologists. In this cross-sectional study, we analyzed WHC data from January 2018 to March 2021. Over this period, 59 individual patients were seen over 39 clinical sessions through a total of 164 clinical encounters staffed by 43 medical students and 19 faculty preceptors from the Department of Obstetrics and Gynecology at Mount Sinai. The most common reasons for referral to the EHHOP WHC were abnormal uterine bleeding, contraception counseling, and management of abnormal Pap smears; the most common procedures performed were Pap smears, long-acting reversible contraception placements and removals, and colposcopies. We discuss the critical role that student-run, physician-supervised reproductive health clinics play in reducing disparities in gynecologic care for uninsured women.
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