Longitudinal Hypertension Outcomes at Four Student-Run Free Clinic Sites.

BACKGROUND AND OBJECTIVES: Student-Run Free Clinics (SRFCs) play a significant role in medical education yet there is minimal information about patient outcomes over time in this setting. The purpose of this study was to assess longitudinal outcomes of hypertension management during routine care at four SRFC sites, while comparing control rates with national standards, and examining for characteristics independently associated with uncontrolled hypertension. METHODS: The authors conducted a retrospective medical record review of visits from January 2004 through April 2016 with an initial visit for hypertension and a follow-up visit 9 to 15 months later. Hypertension control was analyzed using descriptive statistics, paired t tests, logistic regression, and a longitudinal linear mixed-effects model. RESULTS: This study included 496 patients and 4,798 visits. The mean age was 50.9 (SD 10.8) years old, 71.2% (346) were Latinos, 63.3% (314) were Spanish speaking, and 15.5% (72) were homeless. Mean blood pressure was reduced from 141.6 (SD 21.8)/85.1 (SD 13.2) to 132.1 (SD 17.3)/79.4 (SD10.8), a decrease of 9.5 (CI 7.4, 11.5)/5.7 (CI 4.4, 7.0) mmHg. Blood pressure was significantly reduced within the first month of treatment, and this reduction was sustained throughout the follow-up period. Using the National Health and Nutrition Examination Survey (NHANES) definition (<140/<90), blood pressure was controlled in 59.7% (296/496) of patients. No significant differences in control were noted based on gender, ethnicity, language, housing status, or clinic site. CONCLUSIONS: SRFCs can provide effective long-term hypertension management and achieve rates of control that exceed national averages despite serving those least likely to be controlled.

Medical Student Perceptions of the Learning Environment: Learning Communities Are Associated With a More Positive Learning Environment in a Multi-Institutional Medical School Study.

PURPOSE: Many medical schools have implemented learning communities (LCs) to improve the learning environment (LE) for students. The authors conducted this study to determine whether a relationship exists between medical student perceptions of the LE and presence of LCs during the preclerkship years. METHOD: Students from 24 schools participating in the American Medical Association Learning Environment Study completed the 17-item Medical Student Learning Environment Survey (MSLES) at the end of their first and second years of medical school between 2011 and 2013. Mean total MSLES scores and individual item scores at the end of the first and second years in schools with and without LCs were compared with t tests, and effect sizes were calculated. Mixed-effects longitudinal models were used to control for student demographics and random school and student effects on the relationship between LC status and MSLES score. RESULTS: A total of 4,980 students (81% of 6,148 matriculants) from 18 schools with LCs and 6 without LCs participated. Mean [SD] MSLES scores were significantly higher in LC schools compared with non-LC schools at the end of year one (3.72 [0.44] versus 3.57 [0.43], P < .001) and year two (3.69 [0.49] versus 3.42 [0.54], P < .001). The effect size increased from 0.35 (small) at the end of year one to 0.53 (medium) at the end of year two. CONCLUSIONS: This large multi-institutional cohort study found that LCs at medical schools were associated with more positive perceptions of the LE by preclerkship students.

Longitudinal hyperlipidemia outcomes at three student-run free clinic sites.

BACKGROUND AND OBJECTIVES: Student-run free clinics (SRFC) aim to improve health outcomes of vulnerable populations by providing care to those who have difficulty accessing the traditional health care safety net. Reducing low density lipoprotein (LDL) is known to improve health outcomes, yet uninsured patients remain especially susceptible to poor control. This study describes hyperlipidemia control over time among patients who received care at three University of California San Diego Student-Run Free Clinic Project (SRFCP) sites. METHODS: The authors performed a retrospective review of clinic visits from August 2006--November 2010 from three sites of the SRFCP. Patients with a new diagnosis of hyperlipidemia, a baseline LDL level, and at least one follow-up LDL drawn between 6 weeks and 18 months were included in this study (n=96). Hyperlipidemia control was analyzed using descriptive statistics, Fisher's exact tests, paired t tests, and binary logistic regression. RESULTS: At the last visit, 58.3% (56/96) of patients had achieved LDL goal. LDL decreased from a baseline mean of 135.8 mg/dL to 101.3mg/dL among the cohort (P<.001). Statins were used in 86.5% (83/96) of patients. No significant differences were noted when stratified by language, gender, diabetes comorbidity, homelessness, or clinic site. When comparing Hispanics and Caucasians only, Hispanic patients had better LDL control than Caucasians. CONCLUSIONS: This study demonstrates that a SRFC can effectively manage hyperlipidemia over time, and rates of control can exceed national standards.

The effect of involvement in a student-run free clinic project on attitudes toward the underserved and interest in primary care.

METHODS: The authors designed a survey instrument to examine the effect of involvement in a student-run free clinic project (SRFCP) on medical student self-reported attitudes toward the underserved and interest in primary care. From 2001-2010, first-and second-year medical students in an introductory service-learning elective course rated each of 15 statements on a seven-point Likert scale pre/post survey. Wilcoxon's signed rank test was performed on all matched pairs and an intent-to-treat analysis included unmatched pairs. RESULTS: The response rate was 97.9%, with 914 of 934 students enrolled participating. Significant increases were seen in each of the 15 items in matched pre/post survey pairs, N = 433 (47.4%), or with an intent-to-treat analysis, N = 914 (p ≤ .002 for all). CONCLUSIONS: This study found that medical student involvement in a SRFCP improved student knowledge, skills, attitudes and self-efficacy with the underserved, interest in work with the underserved after graduation, and interest in primary care.

Clinical outcomes of diabetic patients at a student-run free clinic project.

OBJECTIVES: Our objective was to determine if the quality of care of diabetic patients at a Student-Run Free Clinic Project (SRFCP) meets the standard of care, is comparable with other published outcomes, and whether pertinent diabetic clinical indicators improve over time. METHODS: The authors conducted a retrospective chart review of diabetic patients at three University of California-San Diego (UCSD) SRFCP sites from December 1, 2008 to December 1, 2009 (n=182), calculated the percentage who received recommended screening tests, percent at goal, and compared these to published outcomes using Fisher's exact tests. Baseline measures were compared to most recent values using paired t tests. RESULTS: The percentage of patients who received recommended screening tests (process measures) was blood pressure (BP) 100%, HbA1c 99.5%, creatinine 99.5%, LDL 93%, HDL and triglycerides 88%, microalbumin/creatinine ratio 80%, and ophthalmology exam 32%. Intermediate outcomes included: 70% of patients were at LDL goal <100, 70% had microalbumin/creatinine ratio <30, 61% of males were at HDL goal %gt;40, 47% of females at HDL goal>50, 52% with triglycerides <150, 45% had BP <130/80, and 30% of patients had HbA1c <7. Mean HbA1c, LDL, HDL, triglycerides and blood pressure improved significantly over time. CONCLUSIONS: Diabetic patients at UCSD SRFCP reached goals for both process measures and intermediate outcomes at rates that meet or exceed published outcomes of insured and uninsured diabetics on nearly all measures, with the exception of ophthalmology screening. Glycemic control, cholesterol levels, and blood pressure improved significantly during care at the UCSD SRFCP.

Medical student perceptions of the educational value of a student-run free clinic.

BACKGROUND AND OBJECTIVES: Many medical schools have student-run free clinics (SRFCs), yet their educational value has not been well studied. We performed a one-time cross-sectional survey to assess medical student perceptions of the educational value of an SRFC at their institution. METHODS: The authors designed and validated a survey instrument including six statements on a 5-point Likert-scale. The questionnaire was distributed from February through May 2010 to all students enrolled at the University of California San Diego (UCSD) School of Medicine as part of a larger yearly, anonymous, internet-based survey regarding their experiences at the institution. RESULTS: The response rate was 66.5% with 347 of 522 eligible students participating. Ninety percent agreed or strongly agreed that the SRFC was a valuable educational experience, mean score: 4.51 on a scale of 5. Eighty-two percent agreed or strongly agreed that the teaching was excellent, mean score: 4.23. Students agreed or strongly agreed that the SRFC improved attitudes toward working with underserved patients (72%, mean score 3.99), helped students stay connected to sense of purpose, (71%, mean score 3.98), improved overall sense of well-being (67%, mean score 3.88), and influenced their decision to come to UCSD (52%, mean score 3.37). Eighty-four percent of qualitative responses in a free text comment box were positive (46 of 55). CONCLUSIONS: To the authors' knowledge, this is the first study to report the perceptions of an entire medical student body of a SRFC at their institution. The majority felt that this was a valuable educational experience.