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A Report From The FieldStudent-Run Free Clinics: An Equitable Local Solution to National Healthcare DisparitiesKavelin Rumalla1, Adithi Reddy1, Antonio Petralia1, Valerie J Rader21UMKC School of Medicine,2St. Luke’s Health System
BACKGROUNDLow socioeconomic status (SES) is associated with a lack of access to healthcare which contributes to higher morbidity and mortality rates1-3Low SES is as significant a risk factor for mortality as smoking4.Student-run clinics (SRCs) mitigate healthcare disparity by facilitating greater access to healthcare for the underserved5-7.
KANSAS CITY AREAHEALTH DISPARITIESWe 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.
CONCLUSIONAlong with enriching medical student education, the care provided by student-run medical organizations reduce the morbidity and mortality rates of the underinsured population6,20,21.Student-run free clinics restore one major branch of medicine: preventative medical care6,20,21.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, goalswill include assessing the effectiveness of student-run clinics in reducing healthcare access disparities in communitiesand in improving healthcare outcomes of socioeconomically-underprivileged individuals.
SUMMARYWe found an associationbetween low SES andlimitedaccess to healthcare, as outlined by the aforementioned parameters.This is likely a contributing factor to the low SESdemographic’shighly-increased risk of morbidity and mortality as compared to those with greater healthcare access1-4.
REFERENCES1Health, United States 2011: With Special Feature on Socioeconomic Status and Health. Pamphlet published by the CDC. 2011.2Fiscella, K., et al. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care.JAMA2000; 283:2579–84.3Phelan, J. C., et al. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications.J Health Soc Behav2010; 51 Suppl;S28–40.4Adler, N. E. et al.Socioeconomic status and health. The challenge of the gradient.Am Psychol1994; 49:15–24.5Safety Net Health Care: Delivering Care to Vulnerable Patients. Pamphlet published by the Health Care Foundation of Greater Kansas City. 2011.6Niescierenko, M. L., et al.. Insuring the uninsured: A student-run initiative to improve access to care in an urban community.J Natl Med Assoc2006; 98: 906–11.7Buchanan, D., et al. Balancing service and education: ethical management of student-run clinics.J Health Care Poor Underserved2006; 17:477–85.8Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic.J Health Care Poor Underserved2013; 24:344–58.9Woolhandler, S., et al. Reverse targeting of preventive care due to lack of health insurance.JAMA1988; 259: 2872–4.10Yarnall, K. S., et al. Primary care: isthere enough time for prevention?Am J Public Health2003; 93: 635–41.11Starfield, B., et al. Contribution of primary care to health systems and health.Milbank Q2005; 83: 457–502.12Fries, J. F. et al. Reducing health care costs by reducing the need and demand for medical services. The Health Project Consortium.N Engl J Med1993: 329; 321–5.13Watanabe, J. H., et al. Association of increased emergency rooms costs for patients without access to necessary medications.Res Soc Adm Pharm2014.14Isaacson, J. H., et al. Patient perceptions of having 1st- and 2nd-year medical students involved in their care.Teach Learn Med2014; 26: 164–7.15Ellett, J. D., et al. Patient satisfaction in a student-run free medical clinic.Fam Med2010; 42: 16–8.16Sojourner Health Clinic. Website published by UMKC School of Medicine. 2014; Home page. <http://www.sojournerclinic.org>17Simmons, B. B., et al. Students who participate in astudent-run free health clinic need education about access to care issues.J Health Care Poor Underserved2009; 20: 964–8.18Simpson, S. A. et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education.J Gen Intern Med2007; 22: 352–356.19KC HealthMatters: Community Dashboard. Searchable Health Database published by the Health Care Foundation of Greater Kansas City. 2014. <http://kchealthmatters.org/community-dashboard>20Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic.J Health Care Poor Underserved2013; 24: 344–58.21Simpson, S. A., et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education.J Gen Intern Med2007; 22: 352–356.

Navigating Healthcare Without InsuranceIn uninsured populations, controllable conditions such as diabetes and hypertension frequently present as medical emergencies.Preventative Care Precedes Emergency CareThe uninsured are more likely to seek emergency attention for acuteexacerbationsof chronic problems because they have limited access to primary care8,9.Primary Care Saves LivesPeople with access to routine checkups and screenings can prevent many more severe health issues associated with hospital stays and emergency situations10,11.Compared to other institutions receiving safety net funds like emergency departments, free clinics are cost effective options and provide quality preventative medicine services12,13.Patients report equal trust in and equal care by students and physicians in free clinics14-16.Student-run clinics report having a surplus of volunteers so there is room to expand the reach of this form of healthcare17,18.
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”
1Health, United States 2011: With Special Feature on Socioeconomic Status and Health. Pamphlet published by the CDC. 2011.2Fiscella, K., et al. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care.JAMA2000; 283:2579–84.3Phelan, J. C., et al. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications.J Health Soc Behav2010; 51 Suppl;S28–40.4Adler, N. E. et al.Socioeconomic status and health. The challenge of the gradient.Am Psychol1994; 49:15–24.5Safety Net Health Care: Delivering Care to Vulnerable Patients. Pamphlet published by the Health Care Foundation of Greater Kansas City. 2011.6Niescierenko, M. L., et al.. Insuring the uninsured: A student-run initiative to improve access to care in an urban community.J Natl Med Assoc2006; 98: 906–11.7Buchanan, D., et al. Balancing service and education: ethical management of student-run clinics.J Health Care Poor Underserved2006; 17:477–85.8Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic.J Health Care Poor Underserved2013; 24:344–58.9Woolhandler, S., et al. Reverse targeting of preventive care due to lack of health insurance.JAMA1988; 259: 2872–4.10Yarnall, K. S., et al. Primary care: isthere enough time for prevention?Am J Public Health2003; 93: 635–41.11Starfield, B., et al. Contribution of primary care to health systems and health.Milbank Q2005; 83: 457–502.12Fries, J. F. et al. Reducing health care costs by reducing the need and demand for medical services. The Health Project Consortium.N Engl J Med1993: 329; 321–5.13Watanabe, J. H., et al. Association of increased emergency rooms costs for patients without access to necessary medications.Res Soc Adm Pharm2014.14Isaacson, J. H., et al. Patient perceptions of having 1st- and 2nd-year medical students involved in their care.Teach Learn Med2014; 26: 164–7.15Ellett, J. D., et al. Patient satisfaction in a student-run free medical clinic.Fam Med2010; 42: 16–8.16Sojourner Health Clinic. Website published by UMKC School of Medicine. 2014; Home page. <http://www.sojournerclinic.org>17Simmons, B. B., et al. Students who participate in astudent-run free health clinic need education about access to care issues.J Health Care Poor Underserved2009; 20: 964–8.18Simpson, S. A. et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education.J Gen Intern Med2007; 22: 352–356.19KC HealthMatters: Community Dashboard. Searchable Health Database published by the Health Care Foundation of Greater Kansas City. 2014. <http://kchealthmatters.org/community-dashboard>20Zucker, J., et al. Measuring and assessing preventive medicine services in a student-run free clinic.J Health Care Poor Underserved2013; 24: 344–58.21Simpson, S. A., et al. Medical Student-Run Health Clinics: Important Contributors to Patient Care and Medical Education.J Gen Intern Med2007; 22: 352–356.

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Kavelin_Rumalia,Antonio_Petralia,Adithi_Reddy