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1.
Yale J Biol Med ; 94(3): 459-464, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34602883

RESUMO

Unmet dermatologic needs of the uninsured patient population are important to identify and address, especially as the COVID-19 pandemic has introduced additional barriers of access to care. We describe the successful collaboration between a student-run free clinic and dermatology practice since 2012, highlighting excellent time to appointment intervals and resolution rates as well as the associated modest financial cost. We believe that the information provided in our report may serve as a proof of concept and facilitate the implementation of such collaborations throughout the United States.


Assuntos
COVID-19 , Clínica Dirigida por Estudantes , Humanos , Pessoas sem Cobertura de Seguro de Saúde , Pandemias , Encaminhamento e Consulta , SARS-CoV-2 , Estados Unidos
2.
J Prim Care Community Health ; 12: 21501327211037532, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34369185

RESUMO

The objective of this study was to describe the frequency that healthcare and social support services offered by JeffHOPE, a student run clinic for people experiencing homelessness in Philadelphia, PA, were utilized by patients. This study also aimed to investigate where patients would seek medical care on a given day had they not been able to access JeffHOPE. This study was conducted via mixed methods consisting of retrospective chart review of patient encounter records and a patient survey conducted weekly throughout 2019, both at a single clinic site, and retrospective chart review of January through March 2020 records at 5 clinic sites. This study found that the frequency of services utilized varied between clinic sites, and that Pharmacy and Procedure committees were the most utilized when examining the combined clinic data. Additionally, the survey found that JeffHOPE provided medical care to those that otherwise would not have sought it. Clinics also served as an alternative to accessing care for non-emergent issues in an Emergency Department (ED) for some patients, but for others it replaced seeing their primary care provider (PCP). This study confirmed that the services offered by JeffHOPE are well-utilized by patients experiencing homelessness in Philadelphia. It also revealed that while the organization's medical services filled care gaps and potentially decreased unnecessary ED visits, they were also sometimes accessed in lieu of a PCP visit. A focused effort on linkage to formal primary care services for all JeffHOPE patients and expanding collection of more granular data to all clinics represent important future endeavors for this student run organization.


Assuntos
Pessoas em Situação de Rua , Clínica Dirigida por Estudantes , Instituições de Assistência Ambulatorial , Humanos , Estudos Retrospectivos , Serviço Social
3.
J Health Care Poor Underserved ; 32(3): 1155-1159, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421019

RESUMO

We highlight the operations of The Free Clinic at Lubbock Impact, describing its services and the patient population it serves. Dermatology Nights have been an integral part to the clinic, addressing skin conditions that the uninsured and homeless population experience.


Assuntos
Pessoas sem Cobertura de Seguro de Saúde , Clínica Dirigida por Estudantes , Instituições de Assistência Ambulatorial , Humanos , Estudantes , Texas
4.
BMC Med Educ ; 21(1): 356, 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174871

RESUMO

BACKGROUND: Initiatives employing medical students' volunteerism and idealism, such as the Student-Run Free Clinics (SRFC) program, are prevalent in US medical schools. Many studies evaluated various aspects of volunteering, sometimes resulting in conflicting evidence. This study simultaneously sought to identify the characteristics of volunteers vs. non-volunteers, and to characterize the volunteers' perception of the SRFC. METHODS: We administered a survey to the Long School of Medicine (LSOM) Class of 2018 before their third year of medical school. The authors compared and contrasted the findings of the SRFC volunteers with their non-volunteering counterparts by analyzing their demographics, volunteering history, academic performance, and clinical skills. The volunteers were also asked about their SRFC experiences. RESULTS: While most volunteers were female (62 %) and non-traditional students (67 %), the difference was not statistically significant (p = 0.15 and p = 0.38, respectively). Additionally, there were no statistically significant differences between the two groups in measures of academic performance (p = 0.25). Most of the volunteers learned about the SRFC program prior to starting medical school. Further, while SRFC volunteers were more likely to engage in additional local volunteering initiatives, the difference was not statistically significant (p = 0.03, prespecified  α= 0.006). Importantly, volunteers agreed/strongly agreed that SRFC volunteering emphasized aspects that were missing or underemphasized in the formal medical school curriculum. CONCLUSIONS: Medical students' age, gender, undergraduate major, and non-traditional status were not statistically different between volunteers vs. non-volunteers. However, there may be tendencies for volunteers to be female, non-traditional, and locally engaged. Further, the timing of knowledge of the SRFC program may not affect student involvement in the SRFC, either. Most importantly, however, while volunteering does not affect the students' academic performance, it may provide improvements in clinical competencies.


Assuntos
Clínica Dirigida por Estudantes , Estudantes de Medicina , Instituições de Assistência Ambulatorial , Competência Clínica , Feminino , Humanos , Voluntários
5.
J Health Care Poor Underserved ; 32(2): 1069-1082, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120994

RESUMO

BACKGROUND: Student-run free clinics (SRFCs) provide care to medically underserved individuals who may otherwise utilize the emergency department (ED) for primary care. OBJECTIVE: Evaluate the effect of enrollment at the DAWN SRFC in Aurora, Colorado on University of Colorado ED utilization. METHODS: Th is was a retrospective longitudinal analysis of 164 patients who established care at the DAWN clinic and were also seen at the nearby ED over an eight-year period. A paired t-test was used on the full cohort and a linear mixed effects model was used on a guaranteed at-risk subset with ED visits before and aft er care initiation at the DAWN clinic. RESULTS: Average ED visits decreased from 1.48 to 0.95 for the full cohort (p=.0002). In the guaranteed at-risk subset, a 0.98 visit decrease per person (p=.0217) was observed. CONCLUSIONS: Patient enrollment at the DAWN clinic was associated with a statistically significant reduction in all-cause ED visits.


Assuntos
Clínica Dirigida por Estudantes , Colorado , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos , Estudantes
6.
Plast Reconstr Surg ; 148(2): 190e-194e, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34133411

RESUMO

BACKGROUND: Recent changes to the plastic surgery residency training requirements along with a general call for expanded education in cosmetic surgery have encouraged many institutions to incorporate resident aesthetic clinics into their curricula. Although the safety and satisfaction rates of resident aesthetic clinics have been well-studied, their financial viability has not. This study reviews the financial viability of the resident aesthetic clinic at the authors' institution through a cost analysis. METHODS: Billing data were analyzed for all patient visits to the resident aesthetic clinic of the authors' institution during calendar year 2018. Data were extracted, including type and anatomical location of each procedure, charges collected, and supplies used. A financial analysis was performed based on fixed and variable costs and gross revenue. RESULTS: A total of 100 unique patients were seen in the clinic over a 1-year period, resulting in 53 operations. This included 15 face, four breast, and 34 body contouring procedures. In addition, 160 cosmetic injections were performed. The gross revenue was $69,955 and the net revenue was $36,600. CONCLUSIONS: The resident aesthetic clinic at the authors' institution proved to be financially viable. The authors encourage other institutions to more closely examine the financial state of their resident aesthetic clinics as well. Furthermore, the authors hope that this analysis demonstrates to other programs that, with certain practice models, cost should not be a barrier to initiating and maintaining this valuable training tool.


Assuntos
Técnicas Cosméticas/economia , Internato e Residência/economia , Procedimentos Cirúrgicos Reconstrutivos/economia , Clínica Dirigida por Estudantes/economia , Cirurgia Plástica/educação , Técnicas Cosméticas/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Humanos , Internato e Residência/organização & administração , Internato e Residência/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/educação , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Clínica Dirigida por Estudantes/organização & administração , Clínica Dirigida por Estudantes/estatística & dados numéricos , Cirurgia Plástica/organização & administração
7.
J Ambul Care Manage ; 44(3): 197-206, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34016847

RESUMO

In response to the coronavirus disease-2019 (COVID-19) pandemic, we developed and launched a student-led telemedicine program in Chelsea. From April to November 2020, over 200 student volunteers contacted over 1000 patients to assess COVID-19 symptoms, provide counseling, and triage patients. Through a retrospective cohort study, we determined that student triage decision was associated with patient outcomes, including hospitalization status, COVID-19 test administration, and COVID-19 test result. These results quantify the outcomes of a student-led telemedicine clinic to combat the ongoing pandemic and may serve as a model for implementation of similar clinics to alleviate mounting health care system burden.


Assuntos
COVID-19/diagnóstico , Pneumonia Viral/diagnóstico , Clínica Dirigida por Estudantes , Telemedicina/organização & administração , COVID-19/epidemiologia , Aconselhamento , Inglaterra/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Triagem
8.
Alerta (San Salvador) ; 4(2): 20-27, may. 26, 2021. ilus, tab
Artigo em Espanhol | LILACS, BISSAL | ID: biblio-1224709

RESUMO

Durante la pandemia por la COVID-19, la salud mental de los salvadoreños se vio afectada por diversas razones. Algunas personas que manifiestan malestar de índole psicológico, buscan atención en una clínica especializada en salud mental, por ello, es importante verificar la satisfacción del paciente al recibir el servicio y valorar la percepción en relación al terapeuta que ejerce su labor en dicha clínica


During the COVID-19 pandemic, the mental health of Salvadorans was affected for various reasons. Some people who manifest discomfort of a psychological nature seek care in a clinic specialized in mental health, therefore, it is important to verify the satisfaction of the patient when receiving the service and assess the perception in relation to the therapist who works in said clinic


Assuntos
Satisfação do Paciente , Assistência ao Paciente , Serviços de Saúde Mental , Clínica Dirigida por Estudantes
9.
J Natl Med Assoc ; 113(4): 431-435, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33863490

RESUMO

IMPORTANCE: Student-run free clinics (SRFCs) primarily service the uninsured and are a unique way for medical students to gain hands-on exposure to ophthalmology. The free clinic model takes many different forms- some with episodic and longitudinal models-- and this is mirrored in corresponding eye services. OBJECTIVE: To describe SRFC ophthalmology services nationwide. DESIGN: This was a telephone survey study administered from June through July of 2018. SETTING: This study surveyed medical school SRFC clinics across the United States. PARTICIPANTS: Survey request was sent to 19 SRFCs previously identified as having ophthalmology services via internet search. Fourteen SRFCs (73%) participated; participants were either student clinic leaders or medical directors. One respondent no longer had a distinct eye clinic so was excluded from relevant results. MAIN OUTCOME AND MEASURE: Characteristics of ophthalmology SRFCs including participants, frequency of sessions, common diagnoses treated, and challenges encountered were assessed through this survey. RESULTS: On average, each SRFC provided 5.15 hours per month of ophthalmology services. The mean number of medical students involved per session was 8.7. Lack of infrastructure to ensure adequate patient follow-up and faculty recruiting were cited as the main challenges in providing ophthalmology services. Most SRFC leaders indicated exposure to ophthalmology and practice with the exam as the main experiences that students sought and achieved. The most common conditions treated were refractive error (92.3%) and diabetic retinopathy (69.2%). CONCLUSION: There are a small number of SRFCs that have ophthalmology services, and they share common features in terms of participants, staffing, and, barriers to sustainability. Ophthalmology services at SRFCs offer a unique venue for medical students to gain exposure to an under-represented field in medical school curricula. The growth of this critical venue for medical student training could be enhanced by recruitment strategies aimed at ophthalmology faculty with a strong interest in service and teaching.


Assuntos
Oftalmologia , Clínica Dirigida por Estudantes , Estudantes de Medicina , Instituições de Assistência Ambulatorial , Currículo , Humanos , Estados Unidos
10.
J Surg Res ; 264: 474-480, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33857791

RESUMO

BACKGROUND: The chief resident service provides surgical trainees in their final year of training the opportunity to maximize responsibility, continuity, and decision-making. Although supervised, chief residents operate according to personal preferences instead of adapting to their attendings' preferences. We hypothesized that outcomes following cholecystectomy are equivalent between the chief resident service and standard academic services. METHODS: We matched adults undergoing cholecystectomy from 07/2016-06/2019 on the chief resident service to two standard academic service patients based on operative indication and age. We compared demographics, operative details, and 30-d complications. RESULTS: This study included 186 patients undergoing cholecystectomy. Body mass index (32.4 versus 32.0, P = 0.49) and Charlson comorbidity index (0.9 versus 1.4, P = 0.16) were similar between chief resident and standard academic services, respectively. Operative approach was similar (95.2% laparoscopic on chief resident service versus 94.4% on standard service), but residents on the chief resident service performed cholangiograms more often (48.4% versus 22.6%, P < 0.01) and averaged longer operative times during laparoscopic cholecystectomy with cholangiogram (146±28 versus 85±22 min, P < 0.01) and without (94±31 versus 76±35 min, P < 0.01) compared with standard academic services, respectively. 30-d complication rates were similar (5.2% chief resident versus 5.0% standard, P = 0.95). No patients suffered bile leak, bile duct injury, or reoperation. Emergency Department visits were similar (12.1% chief resident versus 7.4% standard, P = 0.32); readmissions were less frequent on the chief resident service (0.0% versus 5.0% standard, P = 0.03). CONCLUSIONS: With appropriate supervision, chief residents provide safe care for patients undergoing cholecystectomy while directing medical decisions and practicing according to their preferences.


Assuntos
Colecistectomia Laparoscópica/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Clínica Dirigida por Estudantes/estatística & dados numéricos , Adulto , Colecistectomia Laparoscópica/efeitos adversos , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Confiança
11.
Optom Vis Sci ; 98(3): 243-249, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33771953

RESUMO

SIGNIFICANCE: Uncorrected refractive error is the main cause of visual impairment globally. Understanding barriers and facilitators underserved individuals face in obtaining eyeglasses will help address high rates of uncorrected refractive error. PURPOSE: The purpose of this study was to understand the barriers and facilitators to obtaining eyeglasses among low-income patients in Michigan. METHODS: Participants older than 18 years with hyperopia, myopia, or presbyopia and without active eye disease, severe mental illness, or cognitive impairment at Hope Clinic, Ypsilanti, Michigan, were included in this study. The participants answered a sociodemographic survey and underwent autorefraction and an interview. Interviews were audiorecorded, transcribed, and analyzed by two investigators. RESULTS: Interviews were completed by 43 participants, and 30 participants' interviews were analyzed. The mean ± standard deviation age of 30 participants was 55 ± 12 years, 70% were female, 57% were African American, 40% had high school diploma or less, 57% earned less than U.S. $25,000 per year, 93% had worn glasses previously, and 87% had some medical insurance. Uncorrected visual acuity was logMAR 0.73 ± 0.61; best-corrected visual acuity was logMAR 0.16 ± 0.21. Thematic saturation was reached after 25 transcripts. Top barriers to using eyeglasses were cost (312 mentions, 29 participants), negative experiences with eyeglasses (263, 29), and limited access to eye care (175, 27). Top facilitators were positive experiences with glasses (230, 29), easy access to eyeglasses (143, 27), and availability of transportation (65, 27). Most participants (97%, 29) reported being negatively impacted by uncorrected refractive error. Most (97%, 29) were skeptical about obtaining eyeglasses online because of possible prescription problems. CONCLUSIONS: Key barriers to correcting uncorrected refractive error in our community span across multiple health domains but are predominately rooted in external factors such as cost and access to vision care. Online eyeglasses may address access issues, but many participants were uncomfortable or unable to obtain glasses online.


Assuntos
Óculos/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Erros de Refração/terapia , Clínica Dirigida por Estudantes/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto , Idoso , Instituições de Assistência Ambulatorial , Feminino , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Michigan , Pessoa de Meia-Idade , Pobreza , Prevalência , Inquéritos e Questionários , Acuidade Visual
12.
J Prim Care Community Health ; 12: 2150132721993631, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33615883

RESUMO

The onset of the COVID-19 pandemic and subsequent county shelter-in-place order forced the Cardinal Free Clinics (CFCs), Stanford University's 2 student-run free clinics, to close in March 2020. As student-run free clinics adhering to university-guided COVID policies, we have not been able to see patients in person since March of 2020. However, the closure of our in-person operations provided our student management team with an opportunity to innovate. In consultation with Stanford's Telehealth team and educators, we rapidly developed a telehealth clinic model for our patients. We adapted available telehealth guidelines to meet our patient care needs and educational objectives, which manifested in 3 key innovations: reconfigured clinic operations, an evidence-based social needs screen to more effectively assess and address social needs alongside medical needs, and a new telehealth training module for student volunteers. After 6 months of piloting our telehealth services, we believe that these changes have made our services and operations more robust and provided benefit to both our patients and volunteers. Despite an uncertain and evolving public health landscape, we are confident that these developments will strengthen the future operations of the CFCs.


Assuntos
COVID-19/epidemiologia , Inovação Organizacional , Pandemias , Clínica Dirigida por Estudantes/organização & administração , California/epidemiologia , Humanos
13.
Fam Med ; 53(2): 129-132, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33566348

RESUMO

BACKGROUND AND OBJECTIVES: Medical student-run free clinics (SRFC) provide underserved patients access to health care. Few studies have examined the effects of specific care models implemented by these clinics. We looked at the impact of a continuity of care delivery model on chronic care outcomes at an SRFC sponsored by Ohio State University College of Medicine. METHODS: Using the SRFC electronic medical records, we abstracted health records of patients at risk for atherosclerotic cardiovascular disease (ASCVD). We formed three study groups matched on age and gender. Group 1 were the patients enrolled in a continuity of care program, Group 2 were patients who visit the SRFC at 3-month intervals, and Group 3 were sporadic visitors. Authors compared groups' ASCVD risk score change over 12 months using a Group x Time Analysis of Variance. RESULTS: We identified 81 subjects that met the qualifications for this study and assigned them to one of the three study groups. A Group x Time interaction showed that mean ASCVD risk scores improved significantly for continuity of care patients and regular visitor controls, but not for sporadic controls (F=3.82; df=2/1.72; P=.035; es=1.28). CONCLUSIONS: This SRFCs continuity of care delivery had no appreciable impact on lowering ASCVD Risk scores over and above frequent regular visits to the clinic. This finding suggests that SRFCs should focus on getting their chronic patient population to maintain a schedule of frequent check-ups, without investing in continuity of care. Longer-term studies are needed to detect a continuity of care delivery model effect.


Assuntos
Doenças Cardiovasculares , Clínica Dirigida por Estudantes , Estudantes de Medicina , Instituições de Assistência Ambulatorial , Continuidade da Assistência ao Paciente , Humanos
16.
Acad Med ; 96(7): 1021-1025, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33464736

RESUMO

PURPOSE: Student-run clinics (SRCs) are increasingly recognized as an educational experience in many health professions' curricula. Several benefits have been documented, including students with SRC experience using patient-centered approaches to care, showing interest in working with marginalized populations, and more fully appreciating the care provided by interprofessional teams. Yet, few studies have explored student experiences within SRCs or examined how these experiences affect and shape these documented attitudes. This study explored the experiences of students at an SRC and the effect of these experiences on their learnings. METHOD: From November 2016 to July 2017, 23 students in the Community Health Initiative by University Students SRC at the University of British Columbia participated in 2 focus group interviews: the first after their first clinic day and the second on their final clinic day. Open- and closed-ended questions were used to explore participants' learnings from the SRC. Using a grounded theory approach, the authors iteratively analyzed the transcribed interviews, adjusting questions for subsequent focus groups as new themes evolved. Three investigators each separately coded the data; the full team then collectively consolidated the themes and developed explanatory models for each theme. RESULTS: Two themes were identified from the focus group input: (1) through managing real, complex patients-in situations unlike those offered in classroom and case-based learning environments-students gained insights into the intricacies of incorporating the patient's perspective into their definition and management of the patient's problem, and (2) by working as a team instead of focusing on delineating scopes of practice, students gained a meaningful understanding of the roles of practitioners from other health professions. CONCLUSIONS: This study provides insights into the unique opportunities SRCs offer health care students early in their training, enabling them to develop a richer understanding and appreciation of holistic and interprofessional approaches to patient care.


Assuntos
Atenção à Saúde/organização & administração , Aprendizagem Baseada em Problemas/estatística & dados numéricos , Clínica Dirigida por Estudantes/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Centros Médicos Acadêmicos/organização & administração , Colúmbia Britânica , Currículo , Escolaridade , Grupos Focais/estatística & dados numéricos , Pessoal de Saúde/educação , Humanos , Relações Interprofissionais/ética , Entrevistas como Assunto/métodos , Aprendizagem/fisiologia , Assistência ao Paciente/ética , Assistência ao Paciente/métodos , Clínica Dirigida por Estudantes/organização & administração , Estudantes de Medicina/psicologia
19.
Community Ment Health J ; 57(1): 196-202, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32440798

RESUMO

Student-run free clinics are uniquely positioned to understand the barriers to accessing mental health resources. We abstracted patient demographics and clinical characteristics from 355 patient charts and examined referral patterns for a subset of patients. Seventy-three (21%) of patients were found to have a psychiatric diagnosis and were more likely to have more medical comorbidities (10 versus 6, p < 0.001), total medications (8 versus 6, p < 0.001, and to be English-speaking (odds ratio: 1.97, p < 0.05). Of patients who received a referral, 37 (60%) were referred to specialty treatment, the majority to a single outside agency provider. 15 (25%) of patients were interviewed. Barriers to successful referral included transportation and medical symptoms. A facilitator of successful referral was concern for individual's health. Language, social stigma, and cost were not cited as barriers. This study describes mental health needs at a SRFC and suggests opportunities for improvement.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Saúde Mental , Clínica Dirigida por Estudantes , Instituições de Assistência Ambulatorial , Humanos , Encaminhamento e Consulta , Estudantes
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