Vida Sana: a lifestyle intervention for uninsured, predominantly Spanish-speaking immigrants improves metabolic syndrome indicators.

Metabolic syndrome is an increasingly common condition that can contribute to the development of type 2 diabetes and cardiovascular disease. 35 % of adults living in the United States meet the criteria for having metabolic syndrome, with that number being even higher in populations with health disparities. We describe a 'healthy lifestyles' program implemented at a free clinic serving a predominantly Hispanic cohort of low-income, uninsured individuals living in Providence, Rhode Island. The "Vida Sana/Healthy Life" (Vida Sana) program uses low literacy, language-appropriate materials and trained peers to educate participants about healthy lifestyles in a setting that also provided opportunities for social engagement. 192 of 126 (65.6 %) participants in Vida Sana completed 6 out of 8 sessions of the Vida Sana program over a 12-month period. At the completion of the program, nearly 90 % of Vida Sana participants showed an increase in their health literacy, and at least 60 % of participants decreased each of the risk factors (blood sugar, cholesterol, body mass index or waist circumference) associated with metabolic syndrome.

A nurse-run walk-in clinic: cost-effective alternative to non-urgent emergency department use by the uninsured.

Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients' lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic's first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic's operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs.

Barriers to Health Insurance Pre- and Post-Affordable Care Act Implementation in Providence, RI.

The impact of healthcare reform under the Affordable Care Act (ACA) on individuals living in cities has not yet been quantified by local Departments of Health. This makes it difficult for safety net sources of healthcare, such as free clinics, to plan for the future. Therefore, members of Clinica Esperanza/Hope Clinic conducted a survey in predominantly Latino communities of South and West Providence, RI, using a convenience sample method (N = 206). Survey results were compared to a prior survey conducted in the same communities prior to ACA implementation. Despite gains due to Obamacare, a much higher level of uninsurance was reported in this survey than has been reported statewide. In 2014, as compared to 2010, 48% vs. 95% of respondents reported being uninsured, and more held private (20% vs. 5%) or government-subsidized health insurance (32% vs. 1%). Undocumented immigration status and cost were the two most commonly reported reasons for remaining uninsured under the ACA. First-generation immigrants living in urban centers are still reporting significantly higher rates of uninsurance (48%) than the general population in RI (7.4%).

Assessment of hypertension guidelines adherence at a free clinic serving a predominantly Latino population in Providence, RI.

Hypertension affects more than 50 million people in the United States. A recent national health study (NHANES) found that the proportion of certain Hispanic ethnic groups with stage 1 and stage 2 hypertension was greater than for whites. In order to identify areas of improvement, as well as to examine trends in patient outcomes, Clínica Esperanza/Hope Clinic (CEHC), a free clinic for the uninsured, recently conducted a study to evaluate how well the clinic's hypertensive patients are treated, according to current guidelines for hypertension, as compared to other clinics in the U.S. that serve the uninsured. For five out of the six health measures documented, at least 50% of CEHC hypertensive patients met or exceeded the goal values; these numbers are on par with if not better than other national comparators. This study has provided encouraging baseline data, upon which CEHC plans to make further improvements.