Prevent and Protect: A Vaccination Initiative for Uninsured Patients at a Student-Run Free Clinic.

Lower vaccination rates in uninsured adults may be related to prohibitive costs of and limited access to vaccines. To compare Tdap and pneumococcal vaccination rates of a student-run free clinic to national averages. A retrospective chart review of 236 adult patients from 05/2017 to 06/2019 was conducted. Vaccine eligibility was determined according to CDC guidelines at the time of the patient visit and according vaccination history by review of medical records. Percent up-to-date was determined by dividing the number of up-to-date individuals by the total number of patients eligible for the vaccine. BRIDGE Healthcare Clinic vaccination rates were near or surpassed national averages. The percent of up-to-date individuals was 63.1% for Tdap, 90% for pneumococcal vaccines in adults 65 or older, and 86.5% for pneumococcal vaccines in high-risk adults 18-64 years. This compares with 2017 national averages of 63.4%, 69%, and 24.5%, respectively (Center for Disease Control and Prevention (CDC) Vaccination coverage among adults in the United States, National Health Interview Survey. Retrieved February 8, 2018 from https://www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/pubs-resources/NHIS-2017.html#pneumo , 2017). Of the 197 vaccines provided during the course of this study, 184 were provided by the BRIDGE Healthcare Clinic. In conclusion, with the appropriate funding and stewardship, student-run free clinics play a resourceful role in increasing access to preventative health care for uninsured patients.

Enhancing Adherence to Cervical Cancer Screening Guidelines at a Student-Run Free Clinic.

Women who lack health insurance have much lower rates of cervical cancer screening and higher rates of cervical cancer than insured women. The current screening rate for insured patients is 86.9%, while the rate for uninsured women is 68.2%. Student-run free clinics may help increase the rates of cervical cancer screening in uninsured women. As screening rates in this setting are uncertain, this study was performed to determine rates of cervical cancer screening at a student-run free clinic, and therefore determine its effectiveness in increasing screening rates in uninsured women. A retrospective chart review was conducted among female patients ages 21-64 at a student-run free clinic to determine how many patients were up-to-date with cervical cancer screening per American Cancer Society (ACS) guidelines. A total of 239 women were included in the retrospective chart review. At their most recent visit, 87.9% of clinic patients were up-to-date on cervical cancer screening. This screening rate is higher than both the reported uninsured (68.2%) and insured (86.9%) national screening rates in the United States. Although there are multiple barriers that prevent uninsured patients from undergoing cervical cancer screenings, screening rates at our student-run free clinic are higher than national screening rates. This higher screening rate can be attributed to a standardized screening system, access to resources including Pap tests provided by community partners, and the clinic's ability to longitudinally follow patients. However, there remain areas for improvement, such as reducing no-show rates and ensuring that staff screen for cervical cancer at each visit.

Addressing Breast Cancer Screening Disparities Among Uninsured and Insured Patients: A Student-Run Free Clinic Initiative.

Mammography rates among the uninsured are less than half of those among insured patients as reported by American Cancer Society (Breast cancer facts & figures 2017-2018, American Cancer Society, Inc., Atlanta, 2017). This may stem from high costs of and limited access to a usual place for health care, which may portend delayed breast cancer diagnoses and poorer outcomes among uninsured women. Student-run free clinics provide opportunities for uninsured patients to establish a medical home, thereby increasing access to preventative health care. The purpose of this study is to determine the rates of breast cancer screening at a student-run free clinic and compare them to national averages. A retrospective chart review was conducted using patients of BRIDGE Healthcare Clinic who were women ages 40-75 years between January 2012 and March 2018. Medical records were reviewed for demographics, date of mammogram, and screening results. A total of 194 women 40 years or older were included in the review. Overall, of the 157 women who were 45 years or older at their most recent visit, 75.5% were up-to-date according to guidelines set forth by the American Cancer Society. These values are well above the reported national rates in insured and uninsured women (21%, 53%, respectively) as reported by American Cancer Society (Breast cancer facts & figures 2017-2018, American Cancer Society, Inc., Atlanta, 2017). Of the patients who obtained screening mammograms, 84.5% utilized BRIDGE Healthcare Clinic's program. Volunteer providers are often the sole source of health care for a substantial portion of uninsured patients, who may have unmet preventative health needs. As such, the findings of this study suggest that student-run free clinics play an important role in increasing uninsured patients' access to mammograms. The breast cancer screening program described herein may serve as an example for implementation by other student-run free clinics.

Acute HIV Infection in a Patient with Repeat HIV Antibody/Antigen Negative Results Presenting at an Urban Emergency Department: A Case Report.

BACKGROUND: It is not uncommon for patients with human immunodeficiency virus (HIV) infections to visit the emergency department (ED) during seroconversion. However, patients with newly acquired HIV may not have a reactive screening result. We report a case of a patient who initially screened reactive on a fourth generation HIV test and subsequently nonreactive twice, but ultimately had positive viral load tests. CASE REPORT: A 41-year-old woman experiencing symptoms of a sore throat, odynophagia, and back and flank pain for 5 days presented to the ED. The patient had a reactive HIV screen but negative confirmatory antibody test. The ED provider ordered a HIV viral load, informed the patient, and discharged with oral antibacterial agent. The patient returned the next day and after review of Visit 1 results, the ED provider ordered a second HIV screen, which had a nonreactive result. Another HIV viral load order was placed. The patient was discharged and returned a third time, 4 days after initial presentation. On this visit she was admitted, and the initial HIV viral load result returned positive. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We report a case of a patient who initially screened reactive on a fourth generation HIV screening and then twice nonreactive on the same screening test, ultimately having positive viral loads. The most probable explanation for her series of atypical HIV results is that the patient presented during the p24 seroconversion window, which is graphically conveyed in Figure 1. If her first screening had been performed during the window, no further test would have been performed to rule out HIV, contributing to misdiagnosis. ED providers need to be aware that, at some time points during seroconversion from "negative" to "positive", patients recently infected with HIV and manifesting prodromal symptoms may nonetheless have a negative screening result.