Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors.

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.

Chronic Disease Burden of the Homeless: A Descriptive Study of Student-Run Free Clinics in Tampa, Florida.

Variation between homeless populations due to socioeconomic and environmental factors necessitates tailoring medical, health policy, and public health interventions to the unique needs of the homeless population served. Despite the relatively large size of the homeless population in Florida, there is a paucity of research that characterizes the homeless population who frequent homeless clinics within the state. This project describes the demographics, disease prevalence, and other risk factors among homeless individuals in Tampa, Florida. We conducted a retrospective chart review on adult homeless patients seen in 2015 and 2016 at two free clinic sites operated by Tampa Bay Street Medicine, a medical student-run organization from the University of South Florida in Tampa, Florida. Rates of diseases and substance use were recorded and Charlson Comorbidity Index (CCI) was calculated to assess mortality risk. Of the 183 homeless patients in this study, 34.4% reported hypertension, 13.7% reported diabetes, 27.1% reported a respiratory disease, 5.6% reported hyperlipidemia, and 32.8% reported a psychiatric disorder. Tobacco use was reported by 65.6% of patients, 32.2% reported alcohol use, and 17.5% reported illicit drug use. CCI was positively associated with age. Females reported higher rates of anemia, anxiety, chronic obstructive pulmonary disease, and psychiatric disorders. Hypertension, diabetes, certain respiratory diseases, and mental health disorders were more prevalent in the homeless population than in the general population in Tampa, Florida. Homeless women appeared to have higher morbidity than homeless men. Rates of tobacco and illicit drug use were significantly higher whereas alcohol use was lower in the study population than the general population. This study underscores the critical need for mental health initiatives, substance abuse treatment programs, and women's health programs that are accessible to the homeless in Tampa.

Sports: An underutilized tool for patients with disabilities.

Sport activities promote health and well-being in this population, which is disproportionately affected by obesity, sedentary lifestyle, and social isolation.

Chronic disease and socioeconomic factors among uninsured patients: A retrospective study.

OBJECTIVES: Uninsured patients represent an understudied population. The current study aimed to estimate the burden of 10 common chronic conditions and to investigate the associated factors among patients who use free clinics for their health care needs. METHODS: Patient charts from four free clinics were reviewed from January to December of 2015. Proportion of prevalence, adjusted odds ratios (AOR), and 95% confidence intervals (CI) for associations between participant characteristics and chronic conditions are reported. RESULTS: Prevalence of hypertension and hyperlipidemia significantly differed by clinic, age, gender, race, and marital status. Compared to age 15-44 years, older patients (45-64 years, and ≥65) were 5-10 times more likely to suffer from hypertension. Compared to women, men; compared to White, African-Americans; and compared to single, married patients had higher prevalences of hypertension. Older patients were 5-8 times more likely to suffer from hyperlipidemia. Asians, and married patients were also more likely to experience hyperlipidemia. Prevalence of diabetes, depression and arthritis significantly differed by age and race. Prevalence of coronary artery disease and chronic obstructive pulmonary disease increased 6-13 folds among older patients. DISCUSSION: Patients of free clinics suffer from high burden of chronic conditions. Patients who frequent free clinics are primarily older, unemployed, women, minorities, and are of low income.

Perceived Barriers to Gynecologic Care by Women Who Use Wheelchairs.

Objective The aim of this study was to evaluate the current barriers associated with gynecologic care as perceived by women who use wheelchairs. Methods This qualitative study evaluated the barriers to gynecologic healthcare as described by female wheelchair users. We recruited English-speaking female participants aged 18 years and older who primarily used a wheelchair for mobility through flyer and email distribution. Interviews were conducted by three investigators using a semi-structured interview guide and recorded for transcription. Two investigators reviewed all transcriptions for accuracy which were then coded to identify emergent themes. Results The thematic saturation was achieved with 16 interviews. The most common barrier cited was transferring to the exam table (n=16). Women reported that their providers lacked knowledge and experience with women who use wheelchairs (n= 11). Conclusion There are many barriers to gynecologic care for women who use wheelchairs. Interventions are needed to improve accessibility to care for women who use wheelchairs.

Prevalence and management of diabetes among the uninsured: A multicenter study in Tampa Bay, FL.

AIMS: This study describes the prevalence and management of uninsured patients with diabetes in free clinics around the Tampa Bay area. METHODS: A retrospective chart review collected data from uninsured patients who visited nine free clinics from January 2016 to December 2017. The data included sociodemographics, chronic disease diagnoses and treatments, and social history. Statistical analysis including chi-square tests and logistic regression were used to describe patients with diabetes. RESULTS: With a prevalence of 19.41% among 6815 uninsured patients and a mean HbA1c of 7.9% (63 mmol/mol), patients with diabetes were more likely to be White, women, obese, unemployed, and have hypertension and depression compared to patients without diabetes. There were no significant differences in sociodemographic variables between those with controlled and uncontrolled diabetes. Among the variables studied by logistic regression, unemployment was found to be a significant predictor of poor glycemic control among men. CONCLUSIONS: Diabetes is a challenging chronic disease among the uninsured of Tampa Bay due to its prevalence and suboptimal glycemic control. Obesity and unemployment represent significant challenges that increase the burden of diabetes among the uninsured. Free clinics may benefit from additional resources and intervention programs, with future research assessing their effects on care outcomes.

Burden of Chronic Conditions among Patients from Free Clinics: A Retrospective Chart Review of 2015.

INTRODUCTION: There is limited research about the poor and uninsured patients who visit free clinics. METHODS: We conducted a retrospective chart review of uninsured adult patients in four free clinics seen between January and December 2015. Prevalence of chronic conditions and their association with socioeconomic factors were investigated. RESULTS: In 2015, 3,196 adult patients with chronic conditions were managed in four free clinics. Many of these patients were women (60.8%) and Hispanic (44.7%); the group had a mean age of 47.9 years (SD=14.1) and a median income of $14,400. The top five prevalent conditions were hypertension (33.6%), hyperlipidemia (20.7%), diabetes (14%), major depression (11.7%), and arthritis (8.7%). In the multivariable analysis, clinic site, age, marital status, employment status, and household size were significantly associated with the Disease Burden Index. DISCUSSION: Public health prevention programs should focus on uninsured patients of free clinics who are mainly low-income, sicker, and unemployed, and often women and Hispanics.

A Survey of Family Medicine Department Chairs About Faculty With Disabilities: A CERA Study.

BACKGROUND AND OBJECTIVES: Despite 21 million US adults having a disability, little is known about the types of disabilities among faculty in family medicine departments, accommodations used, or work limitations. METHODS: We surveyed family medicine department chairs electronically about the number, types of disabilities encountered, accommodations and associated costs, and attitudes toward family medicine faculty with disabilities. This 10-item survey was part of the Council of Academic Family Medicine Educational Research Alliance omnibus survey. Data were summarized using descriptive statistics. RESULTS: The survey response rate was 59% (88/148). Types of disabilities were reported for approximately 50 faculty members by 31 department chairs; only seven knew about the disability at hiring. The most common impairments were mobility, hearing, and mental health problems. Accommodations included adjusting schedules, additional time to meet tasks, and assistive technology. No additional costs were reported for accommodations by about one-third of respondents while costs were over $5,000 for approximately one-quarter. Most chairs reported that faculty performance was similar to peers without disabilities (42.2%) or adequate but not at the level of peers (40%); only one reported inadequate job performance. Faculty members with disabilities appeared to be accepted by peers, patients, learners, and staff, and only two faculty left their program because of the disability. CONCLUSIONS: Most chairs did not report experience with faculty members with disabilities. The disabilities encountered and accommodations were not unusual, but costs were sometimes high. While about half of chairs reported adequate or superior job performance for their faculty with disabilities, a sizeable minority judged such faculty to have poorer performance than peers despite reporting wide acceptance of faculty with disabilities by patients and colleagues. This study raises concerns about potential underreporting by faculty with disabilities and poorer perceived job performance despite wide acceptance and provision of accommodations, sometimes at high cost.

An innovative clerkship module focused on patients with disabilities.

Lack of medical training results in physicians being unprepared to provide care to people with disabilities, which, in turn, contributes to the substantial health disparities that are evident in this population. Few medical schools or primary care residencies address the care of adults with disabilities. Competencies and guidelines to assist American physicians in caring for patients with physical or intellectual disabilities have yet to be established, thus making educational goals unclear. This article describes one novel training module regarding people with disabilities that was developed at the University of South Florida Health, Morsani College of Medicine (USF) and inserted into the primary care clerkship during a major curriculum redesign in 2005. Since then, all USF third-year medical students have been required to participate in this disability-related course component. The authors describe the module's development and integration into the primary care clerkship, as well as the specific elements of their curriculum. By using a variety of teaching modalities in the classroom and community, and especially by involving people with disabilities themselves, the medical students have a very comprehensive learning experience regarding people who have physical, sensory, or intellectual disabilities. The authors have been able to show that USF medical students, on completion of this module, demonstrate improved knowledge, attitudes, and comfort in caring for people with disabilities, which the authors believe will lead to improved health and health care access for this underserved population. Suggestions for program replication, including common challenges, are also discussed.

Desired educational outcomes of disability-related training for the generalist physician: knowledge, attitudes, and skills.

The problems adults with disabilities face obtaining quality primary care services are persistent and undermine national efforts to improve the health status of this group. Efforts to address this issue by providing disability-related training to physicians are hampered by limited information about what generalist physicians need to know to care for patients with disabilities. The authors consider the desired outcomes of disability-related training for generalists by exploring the contributions of the domains of knowledge, attitudes, and skills to patient-directed behavior and summarizing the empirical data.Because disability reflects a complex interplay among individual, interpersonal, institutional, community, and societal factors, generalist physicians can promote and protect the health of adults with disabilities by interventions at multiple levels. Thus, the authors use the social-ecological framework, an approach to health promotion that recognizes the complex relationships between individuals and their environments, to delineate the recommended knowledge, attitudes, and skills in the context of primary care. The importance of role models who demonstrate the three domains, the interactions among them, and issues in evaluation are also discussed. This clear delineation of the recommended educational outcomes of disability-related training in terms of knowledge, attitudes, and skills will support efforts to better prepare generalist physicians-in training and in practice-to care for adults with disabilities and to evaluate these training strategies.

Empiric treatment of minimally abnormal papanicolaou smears with 0.75% metronidazole vaginal gel.

BACKGROUND: The purpose of this study was to compare the efficacy of 0.75% metronidazole vaginal gel with no treatment in patients who have had a minimally abnormal Papanicolaou smear. METHODS: One hundred forty-five patients whose initial Papanicolaou smears were limited by inflammation or benign cellular changes, reactive cellular changes, or atypical squamous cells of undetermined significance that did not favor a neoplastic process were randomized to 5 days of treatment with 0.75% metronidazole vaginal gel or to a control group receiving no treatment. Papanicolaou smears were repeated after 3 to 4 months. RESULTS: Cytologic findings of the follow-up Papanicolaou smears were normal in 61 of 114 (54%) of patients. Sixty-two percent (n = 37) of the Papanicolaou smears in the control group converted to normal on follow-up, whereas 44% (n = 24) of the Papanicolaou smears in the treatment group converted to normal (P = .07). Only one follow-up Papanicolaou smear worsened to low-grade squamous intraepithelial lesion. In no subgroup was treatment effective. CONCLUSIONS: Empiric treatment for an asymptomatic, minimally abnormal Papanicolaou smear with 0.75% metronidazole vaginal gel before a repeated cytologic examination did not improve the rate of reversion to normal cytologic findings.