A Report From The Field Student-Run Free Clinics: An Equitable Local Solution to National Healthcare Disparities Kavelin Rumalla 1, Adithi Reddy 1, Antonio.

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A Report From The Field Student-Run Free Clinics: An Equitable Local Solution to National Healthcare Disparities Kavelin Rumalla 1, Adithi Reddy 1, Antonio Petralia 1, Valerie J Rader 2 1 UMKC School of Medicine, 2 St. Luke’s Health System BACKGROUND ● Low socioeconomic status (SES) is associated with a lack of access to healthcare which contributes to higher morbidity and mortality rates 1-3 ○ Low SES is as significant a risk factor for mortality as smoking 4. ● Student-run clinics (SRCs) mitigate healthcare disparity by facilitating greater access to healthcare for the underserved 5-7. KANSAS CITY AREA HEALTH DISPARITIES We compared socioeconomic status, healthcare access, and healthcare outcomes of two historically disparate counties in the Greater Kansas City area, specifically Wyandotte County and Johnson County, using data from the KC HealthMatters 2014 database. OUR MEASURES OF HEALTHCARE OUTCOMES CONCLUSION ● Along with enriching medical student education, the care provided by student-run medical organizations reduce the morbidity and mortality rates of the underinsured population 6,20,21. ● Student-run free clinics restore one major branch of medicine: preventative medical care 6,20,21. ● Kansas City has a group of organizations that provide healthcare to those in need called the Safety Net. ● Sojourner Health Clinic is an example of a Safety Net SRC in Kansas City that provides valuable preventative medicine services and treatment to the underserved. ●As this study is based on descriptive statistics, it is limited to examining an apparent association rather than establishing a statistically significant correlation between low SES and healthcare disparities. ● In future studies, goals will include assessing the effectiveness of student-run clinics in reducing healthcare access disparities in communities and in improving healthcare outcomes of socioeconomically-underprivileged individuals. SUMMARY ● We found an association between low SES and limited access to healthcare, as outlined by the aforementioned parameters. ● This is likely a contributing factor to the low SES demographic’s highly-increased risk of morbidity and mortality as compared to those with greater healthcare access 1-4. REFERENCES 1 Health, United States 2011: With Special Feature on Socioeconomic Status and Health. Pamphlet published by the CDC Fiscella, K., et al. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA 2000; 283: 2579–84. 3 Phelan, J. C., et al. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav 2010; 51 Suppl; S28–40. 4 Adler, N. E. et al. Socioeconomic status and health. The challenge of the gradient. Am Psychol 1994; 49: 15–24. 5 Safety Net Health Care: Delivering Care to Vulnerable Patients. Pamphlet published by the Health Care Foundation of Greater Kansas City Niescierenko, M. L., et al.. Insuring the uninsured: A student-run initiative to improve access to care in an urban community. J Natl Med Assoc 2006; 98: 906–11. 7 Buchanan, D., et al. Balancing service and education: ethical management of student-run clinics. J Health Care Poor Underserved 2006; 17: 477–85. 8 Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic. J Health Care Poor Underserved 2013; 24: 344–58. 9 Woolhandler, S., et al. Reverse targeting of preventive care due to lack of health insurance. JAMA 1988; 259: 2872–4. 10 Yarnall, K. S., et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93: 635– Starfield, B., et al. Contribution of primary care to health systems and health. Milbank Q 2005; 83: 457– Fries, J. F. et al. Reducing health care costs by reducing the need and demand for medical services. The Health Project Consortium. N Engl J Med 1993: 329; 321–5. 13 Watanabe, J. H., et al. Association of increased emergency rooms costs for patients without access to necessary medications. Res Soc Adm Pharm Isaacson, J. H., et al. Patient perceptions of having 1st- and 2nd-year medical students involved in their care. Teach Learn Med 2014; 26: 164–7. 15 Ellett, J. D., et al. Patient satisfaction in a student-run free medical clinic. Fam Med 2010; 42: 16–8. 16 Sojourner Health Clinic. Website published by UMKC School of Medicine. 2014; Home page. 17 Simmons, B. B., et al. Students who participate in a student-run free health clinic need education about access to care issues. J Health Care Poor Underserved 2009; 20: 964–8. 18 Simpson, S. A. et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education. J Gen Intern Med 2007; 22: 352– KC HealthMatters: Community Dashboard. Searchable Health Database published by the Health Care Foundation of Greater Kansas City Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic. J Health Care Poor Underserved 2013; 24: 344– Simpson, S. A., et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education. J Gen Intern Med 2007; 22: 352–356. Navigating Healthcare Without Insurance ● In uninsured populations, controllable conditions such as diabetes and hypertension frequently present as medical emergencies. Preventative Care Precedes Emergency Care ● The uninsured are more likely to seek emergency attention for acute exacerbations of chronic problems because they have limited access to primary care 8,9. Primary Care Saves Lives ● People with access to routine checkups and screenings can prevent many more severe health issues associated with hospital stays and emergency situations 10,11. ● Compared to other institutions receiving safety net funds like emergency departments, free clinics are cost effective options and provide quality preventative medicine services 12,13. ● Patients report equal trust in and equal care by students and physicians in free clinics ● Student-run clinics report having a surplus of volunteers so there is room to expand the reach of this form of healthcare 17,18. Wyandotte CountyJohnson County Adults with Health Insurance %88.4 % Preventable Hospital Stays (Per 1000 Stays) Primary Care Providers (Per 100,000 Individuals) Socioeconomic status was examined using the following criteria: ● “Median Household Income (2014)” ● “People ages 25+ with a High School Degree or Higher (2014)” ● “Unemployed Workers in Civilian Labor Force (2014)” Healthcare access was examined using the following criteria: ● “Percent of Adult Population with Health Insurance” ● “Number of Preventable Hospital Stays per 1,000 Medicaid Enrollees” ● “Number of Primary Care Providers per 100,000 People in the Population”

1 Health, United States 2011: With Special Feature on Socioeconomic Status and Health. Pamphlet published by the CDC Fiscella, K., et al. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA 2000; 283: 2579–84. 3 Phelan, J. C., et al. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav 2010; 51 Suppl; S28–40. 4 Adler, N. E. et al. Socioeconomic status and health. The challenge of the gradient. Am Psychol 1994; 49: 15–24. 5 Safety Net Health Care: Delivering Care to Vulnerable Patients. Pamphlet published by the Health Care Foundation of Greater Kansas City Niescierenko, M. L., et al.. Insuring the uninsured: A student-run initiative to improve access to care in an urban community. J Natl Med Assoc 2006; 98: 906–11. 7 Buchanan, D., et al. Balancing service and education: ethical management of student-run clinics. J Health Care Poor Underserved 2006; 17: 477–85. 8 Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic. J Health Care Poor Underserved 2013; 24: 344–58. 9 Woolhandler, S., et al. Reverse targeting of preventive care due to lack of health insurance. JAMA 1988; 259: 2872–4. 10 Yarnall, K. S., et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93: 635– Starfield, B., et al. Contribution of primary care to health systems and health. Milbank Q 2005; 83: 457– Fries, J. F. et al. Reducing health care costs by reducing the need and demand for medical services. The Health Project Consortium. N Engl J Med 1993: 329; 321–5. 13 Watanabe, J. H., et al. Association of increased emergency rooms costs for patients without access to necessary medications. Res Soc Adm Pharm Isaacson, J. H., et al. Patient perceptions of having 1st- and 2nd-year medical students involved in their care. Teach Learn Med 2014; 26: 164–7. 15 Ellett, J. D., et al. Patient satisfaction in a student-run free medical clinic. Fam Med 2010; 42: 16–8. 16 Sojourner Health Clinic. Website published by UMKC School of Medicine. 2014; Home page. 17 Simmons, B. B., et al. Students who participate in a student-run free health clinic need education about access to care issues. J Health Care Poor Underserved 2009; 20: 964–8. 18 Simpson, S. A. et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education. J Gen Intern Med 2007; 22: 352– KC HealthMatters: Community Dashboard. Searchable Health Database published by the Health Care Foundation of Greater Kansas City Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic. J Health Care Poor Underserved 2013; 24: 344– Simpson, S. A., et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education. J Gen Intern Med 2007; 22: 352–356.