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INTRODUCTION: Student-run free clinics (SRFCs) offer medical students a unique opportunity to develop their clinical, diagnostic, and social skills while providing care to medically underserved communities. This study aims to evaluate the value of SRFC involvement on students self-reported confidence in various clinical domains and satisfaction with their medical education. METHODS: We conducted a single-center retrospective pre-post assessment at an urban academic institution among second- to fourth-year medical students. We administered a 25-item questionnaire capturing the scope of clinic involvement and assessing self-reported confidence in multiple clinical domains following a one-year-long participation in student-run free clinics. RESULTS: Fifty-six students completed the survey. Participation in SRFCs significantly increased self-reported confidence in patient history-taking (p

AbstractPhenomenon: Student-run free clinics (SRFCs) serve an integral role in most United States (US) medical schools and contribute substantially to literature on the quality of care to uninsured persons. There has been substantial growth over the past decade of scholarly work produced by SRFCs as they have increased in size and number. Research on patient care outcomes informs better care structures for patients, however there is no current synthesis of patient care outcomes research among SRFCs. This article provides an overview of SRFC research on patient outcomes to understand current research domains and to identify gaps in the literature. Approach: We completed a scoping review by searching Scopus, PubMed, and Journal of Student Run Clinics in June 2021. All peer-reviewed, English-language articles focused on patient-centered outcomes at SRFCs in the US were included. Two independent reviewers performed title, abstract, and full-text screening of relevant works, and eight reviewers conducted data extraction. Descriptive data analysis was performed along with relevant content analysis of patient-centered outcomes. Findings: The search strategy identified 784 studies, of which 87 met inclusion criteria. Most studies were published within the last six years (81.6%), located in California, New York, or Florida (43.7%), and intervention based (33.3%). Many studies (46.0%) had a specific disease of focus of which diabetes was the most researched(19.5%). Patient-centered studies were the leading focus of the study aims (40.2%), where key findings demonstrated primarily improved outcomes in clinic metrics post-intervention (36.8%) or equivalent/better clinical performance than national metrics (20.7%). Insights: This review brings to light gaps in the literature reporting research in SRFCs and can be applied to other low-resource settings. Future efforts to expand SRFC outcomes research should focus on community relationship building, understanding institutional support, and ensuring education on best practices for research within SRFCs. Doing so informs patient care improvement as SRFCs continue to operate as safety net clinics for marginalized populations. [ABSTRACT FROM AUTHOR]

Patient outcomes are highly dependent on the accurate and timely receipt of medications. Patient assistance programs (PAPs) provide key medications to uninsured patients at little to no cost. In Texas and our county, nearly 1 in 5 people are uninsured. Approximately 3,500 uninsured patients over the past year have received care from our clinic. PAP applications require various administrative steps to obtain approval for medication assistance, resulting in delays for patients to receive their medications. To combat these delays, we implemented a new electronic system, which has significantly decreased all administrative steps in completing applications.

Background: Point of Care Ultrasound (PoCUS) emerged in the early 1990’s as a promising clinical and educational tool that allows for quicker diagnosis at the bedside. Our PoCUS program at Indiana University School of Medicine uniquely exposes students to training during their first weeks of medical school, with training continuing through all 4 years. Our paper demonstrates the portability and efficiency of PoCUS devices to benefit student run clinics, where vulnerable patients come to seek free medical care. Case: We report the case of a 48-year-old man presenting to our student run clinic with shortness of breath and cough. He recently immigrated from Nigeria, had no prior interaction with United States healthcare, and faced a significant language barrier. Physical examination conducted by the medical students revealed mild bibasilar crackles and 1+ pitting edema in the lower extremities. This prompted the students to suspect heart failure, and the first-year medical student used bedside ultrasound to reveal a reduced ejection fraction of approximately 15%, which resulted in expedited and escalated medical care. Conclusion: This case report demonstrates how incorporating PoCUS early into the undergraduate medical curriculum might improve patient care by expediting the diagnosis, while also enhancing student education. The use of bedside ultrasound rapidly updated the team to the severity and type of heart failure present. Therefore, the care team quickly escalated the appropriate treatment, and impressed the importance of follow up care to the patient.

Game-based simulation education is becoming an integral component in healthcare programs. It is defined as any educational activity implying simulation procedures to recreate clinical scenarios. Previous studies have shown that simulation can improve patient safety by enhancing healthcare providers' competencies. However, few studies have investigated students' perceptions of simulation within osteopathic programs. This study aimed to measure and compare Year three osteopathy students' perceptions of a game-based simulation versus traditional clinical training. Year three students at the end of their 12 weeks clinical training were invited to participate in this research project. This included filling out a Likert-based survey and semi-structured interviews. Three clinical training modalities were implemented and evaluated: a demonstration clinic , a video-streamed demonstration clinic , and a game-based simulation, the clinical battle. Sixty-seven Year three osteopathy students completed the surveys, and eight students were interviewed. The clinical battle was significantly felt as the most engaging, most useful to gain feedback, and least stressful of the three training modalities proposed (p < 0.05). The clinical battle was also perceived as similar to a demonstration clinic in formulating a diagnosis and for reflective practice (p > 0.05). The semi-structured interviews offered deep structured explanatory narratives drawn from thematic analyses. Five themes were identified: engagement, clinical reasoning improvement, stress, ideas for improving clinical training, and reflective practice and self-assessment. The simulation-based training implemented in this study was positively perceived by students for their clinical education. Future research could focus on the effectiveness of game-based simulation versus traditional training on clinical competencies acquisition. [ABSTRACT FROM AUTHOR]

Background: Student-run free clinics are present at many medical schools throughout the United States. While many work with adult homeless or uninsured populations, few work with pediatric populations. We investigated the impact of volunteering at a free preparticipation sports physical clinic on medical students' educational motivation, school engagement, confidence in their clinical skills, connectedness to community, and self-efficacy., Methods: First and second year undergraduate medical students who volunteered at a preparticipation sports physical clinic were eligible for the study. 30 students participated in the study, some volunteering multiple times, for a total of 55 post-volunteering surveys. Pre- and post-volunteering surveys were administered via REDCap. The surveys were designed using Likert scales and the General Self-Efficacy scale. Paired two tailed t-tests were used to analyze pre- and post-volunteering data., Results: Students had statistically significant increases in their confidence in working with pediatric populations, performing a standard physical exam, working in an interdisciplinary setting, and communicating with patients. They also demonstrated statistically significant increases in their feelings of connectedness to their reason for practicing medicine and to the greater local community., Conclusions: This research demonstrated measurable increases in motivation and confidence in clinical skills for medical students that participated. This is a valuable experience for medical students and is a model that other medical schools can adopt to help diversify and strengthen their curriculum. In the future, we would like to collect more data to further evaluate the impact of this volunteering on medical students, patients, families, and other community stakeholders., (© 2024. The Author(s).)

Objective: This report explores the experiences of preclinical medical students who led group dialectical behavior therapy (DBT) for a student-run LGBTQ + mental health clinic., Methods: In the clinic, experienced clinicians trained and supervised preclinical medical students to facilitate DBT groups. The authors conducted a qualitative study to understand the impact of the DBT groups on the student facilitators via semi-structured interviews, which were evaluated using thematic analysis., Results: The clinic hosted nine iterations of group DBT facilitated by preclinical medical students, involving 18 student leaders and 30 patients. Twelve student facilitators were interviewed. Participants had a diverse array of specialty interests and were primarily motivated by the opportunity for early clinical experience. They reported improved clinical skills, increased appreciation of psychotherapy as a treatment modality, and increased interest in incorporating psychotherapy in their future practice. Furthermore, participants reported using DBT skills to cultivate wellbeing during clerkship year and in their personal lives., Conclusions: Offering preclinical medical students the opportunity to lead group DBT therapy is a novel educational model providing early training in psychotherapy techniques. This opportunity for early direct patient experience in a supervised group setting attracted medical students with a diverse range of specialty interests. This model provided medical students specific DBT skills to implement in future patient care interactions and to maintain their personal wellbeing throughout medical training. The broad appeal and lasting effects of this program may prove beneficial at other institutions., (© 2024. The Author(s), under exclusive licence to Academic Psychiatry, LLC.)

Ema Tokolahi,1,2 Patrick Broman,1 Glynis Longhurst,1 Amy Pearce,1 Cassandra Cook,1 Patrea Andersen,1,3,4 Sharon Brownie1,5 1Centre for Health and Social Practice/Centre for Sports Science and Human Performance, Wintec, Hamilton, New Zealand; 2School of Occupational Therapy, Otago Polytechnic, Dunedin, New Zealand; 3School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia; 4School of Nursing, Midwifery and Social Science, CQUniversity, Rockhamptom, Queensland, Australia; 5School of Medicine, Griffith University, Gold Coast, Queensland, AustraliaCorrespondence: Ema TokolahiWintec, Centre for Health and Social Practice, Private Bag 3036, Hamilton, 3240, New ZealandTel +64 7 834 8800Email ema.tokolahi@wintec.ac.nzBackground: Student-led clinics have gained increasing attention as a mechanism for students across various health professions to gain authentic interprofessional clinical placement experience during their educational programme.Purpose: This scoping review is designed to identify and describe experiences relating to student-led clinics in Aotearoa New Zealand.Methods: The review involved five key steps: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results.Discussion: Student-led health clinics present invaluable educational opportunities for authentic collaborative practice and capacity to improve population health and well-being, especially in marginalised and disadvantaged communities. Clinic establishment and operation require consideration of a complex set of factors.Conclusion: Community consultation (including with Indigenous populations) should precede establishment of clinics. There is scope for more reporting and objective evaluation to ensure best practice is being determined, developed, and achieved.Keywords: student run clinic, student-led clinic, interprofessional education, clinical practicum

The Crimson Care Collaborative (CCC) is a network of seven student-faculty clinics in the Greater Boston area that provides primary care services to underserved patient populations and social services to address social determinants of health. Promoting healthy behaviors and health-seeking habits are among the most important focuses in the field of public health and medicine. The main objective of this study is to understand the influence that the student-faculty collaborative clinic in Chelsea has on where patients seek out medical information and if that influence changes with time. To study this phenomenon, a retrospective analysis was conducted for six years of data (2013–2019). The CCC Chelsea patient survey database included 349 surveys for 229 patients. McNemar's test for paired patient survey data showed no significant difference between health information seeking preferences before and after a CCC visit ([2.783], p = 0.093). Chi-square comparing these three visit types is associated with a significant p-value of 0.025 ( χ 2 = 7.374). Patients who are at their second visit at CCC are more likely to report favoring reliable sources of medical information, and patients at their third visit are increasingly more likely to report first consulting reliable sources of medical information, including doctors and other healthcare providers. Fisher's test showed no significant difference between health information seeking preferences for patients who last saw a health professional less than 6 months prior to survey administration and greater than 6 months prior to survey administration at a significance level of 0.05 (p = 0.06). Our results suggest that clinic attendance may have an impact on patients' use of reputable sources of medical information in CCC Chelsea, and the positive impact that clinic attendance has on health information seeking habits may be long-standing. [ABSTRACT FROM AUTHOR]

Background and objectivesStudent-Run Free Clinics (SRFCs) play a significant role in medical education yet there is minimal information about patient outcomes over time in this setting. The purpose of this study was to assess longitudinal outcomes of hypertension management during routine care at four SRFC sites, while comparing control rates with national standards, and examining for characteristics independently associated with uncontrolled hypertension.MethodsThe authors conducted a retrospective medical record review of visits from January 2004 through April 2016 with an initial visit for hypertension and a follow-up visit 9 to 15 months later. Hypertension control was analyzed using descriptive statistics, paired t tests, logistic regression, and a longitudinal linear mixed-effects model.ResultsThis study included 496 patients and 4,798 visits. The mean age was 50.9 (SD 10.8) years old, 71.2% (346) were Latinos, 63.3% (314) were Spanish speaking, and 15.5% (72) were homeless. Mean blood pressure was reduced from 141.6 (SD 21.8)/85.1 (SD 13.2) to 132.1 (SD 17.3)/79.4 (SD10.8), a decrease of 9.5 (CI 7.4, 11.5)/5.7 (CI 4.4, 7.0) mmHg. Blood pressure was significantly reduced within the first month of treatment, and this reduction was sustained throughout the follow-up period. Using the National Health and Nutrition Examination Survey (NHANES) definition (

Introduction: Changes in society, new public demands for dental care and contemporary educational insights have influenced dental education worldwide and demand a renewed perspective. Following this perspective, an innovative interprofessional dental Master curriculum was developed at Radboud University Nijmegen in the Netherlands. Educational principles: The curriculum is based on five contemporary educational principles and the core of the curriculum consists of a Student Run Dental Clinic that is fully run by students under professional supervision. The new curriculum: In the Student Run Dental Clinic, Master dental students and Bachelor oral hygiene students are responsible for the care of approximately 750 patients. The students work within the same clinic for 3 years and patients receive oral health care from the same students over a long period. The clinic is a longitudinal cross-disciplinary clinic with different dental subdisciplines. Entrustable professional activities (also known as EPAs), to our knowledge not yet widely used in dental education, were introduced to facilitate learning and assessment. Fourteen EPAs have been developed to stimulate interprofessional education and learning. Of these, five EPAs are identical for the dental and oral hygiene curriculum, leading to extended interprofessional education and learning in the Student Run Dental Clinic. Discussion: Preliminary results show that EPAs are generally well received by supervisors and students. Conclusion: To monitor and investigate the exact effect of the interventions and underlying mechanisms, a research programme on interprofessional learning, practice-based learning and EPAs and entrustment in dental education was recently set up. [ABSTRACT FROM AUTHOR]

Background: Giving students more responsibility for real patients during medical school may help prepare them for their transition to clinical practice. Student-led clinics (SLCs) may facilitate this. Within SLCs, students take the lead role in delivering patient care while being supported and supervised by qualified clinicians. A general practice SLC was established in Dundee, with four final-year medical students and one GP involved in each clinic., Aim: This study aimed to explore students' and educators' experiences and perceptions of this SLC., Method: This was an exploratory case study. Semi-structured interviews were conducted with 11 students and three educators, and 18 hours of observation were conducted over six clinics. Interview transcripts and fieldnotes were integrated and thematically analysed., Results: Overall, students' and educators' experiences and perceptions were positive. Students thrived in their lead role in patient care, gaining a sense of empowerment and developing confidence in their abilities. Both students and educators felt comfortable with students having this level of responsibility due to the students' stage of training and the supervision provided by educators. Teaching within the SLC involved individual discussions and group debriefs. Students felt a sense of belonging as a result of their relationships with their peers and educators. Challenges arose when the clinic ran behind schedule due to unexpected complex patients or lengthy individual discussions., Conclusion: The findings suggest that giving students responsibility for real patients is beneficial and feasible when adequate support is provided, and that it is possible for one GP to supervise multiple students successfully., (© British Journal of General Practice 2024.)

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. [ABSTRACT FROM AUTHOR]

Background: Most United States medical schools have affiliated student-run free clinics, but the quality of services provided in such contexts compared to national metrics is unknown. This study determines whether a student-run, attending-supervised free clinic servicing a low-income and minority race patient population in New York City can meet national metrics of care., Methods: Through chart review from January 1, 2020 to December 31, 2020, patient outcomes and service utilization in the Healthcare Effectiveness Data and Information Set were examined and compared to national rates of patients using Medicaid HMO or Medicare. Patients are ≥ 21 years of age, residents of East Harlem, and ineligible for health insurance because of legal residency requirements. The majority identify as Hispanic and speak Spanish as their primary language. All patients who were seen in the clinic during the 2020 calendar year were included. The primary study outcome is the number of Healthcare Effectiveness Data and Information Set measures in which patients, seen in a student-run free clinic, meet or exceed national comparisons., Results: The healthcare outcomes of 238 patients, mean age 47.8 years and 54.6% female, were examined in 18 Healthcare Effectiveness Data and Information Set measures. The student-run free clinic met or exceeded national metrics in 16 out of 18 categories., Conclusions: The student-run free clinic met or exceeded the national standard of care according to national metrics. Evidence-based priorities have been clarified for future improvement. Other student-run free clinics should similarly evaluate the quality of their services., (© 2024. The Author(s).)

Background and Objectives: Student-run free clinics (SRFCs) are settings in which students in health professions gain clinical experience, often while providing free or reduced-cost health care to the surrounding community. The current literature quantifies the many benefits these clinics provide to their patients and the impact they have on students' future careers; but few previous studies have assessed the financial impact of the education provided at an SRFC. We report on a net educational benefit, an educational benefit to educational cost ratio, and a net educational benefit to educational cost ratio of one SRFC from the perspective of the university., Methods: We calculated the value of education by multiplying all student hours worked in the clinic by the associated value of 1 hour in the typical tuition-based curriculum. Clinic educational costs and student hours were obtained from clinic records from August 1, 2021 through July 31, 2022., Results: We found the total educational value students received to be $73,571 over one academic year. The educational operating expenses of the clinic totaled $9,053, resulting in a benefit-cost ratio of 8.13., Conclusions: This analysis demonstrated a potential financial advantage of operating an SRFC when assessing clinic education expenses in relation to the value of university-generated education. Our research may serve as a starting point to showcase the economic benefit of SRFCs to their parent institutions and encourage further analysis of other benefits SRFCs may provide to institutions of higher education.

Background Student-Run Free Clinics (SRFCs) have been an integral part of US medical schools since the 1960s and provide health care to underserved populations. In 2018, we established an SRFC in Hamburg, Germany, a major city in Northern Europe. The aim of this study was to describe the central problems and to investigate the usefulness of an SRFC in a country with free access to medical care, such as Germany. Methods All consecutive patients treated at the SRFC Hamburg between February 2018 and March 2019 that consented to this study were analyzed regarding clinical characteristics, diagnosis, readmission rate and country of origin. Results Between February 2018 and March 2019, 229 patients were treated at the SRFC in Hamburg. The patients came from 33 different countries with a majority (n  = 206, 90%) from countries inside the European Union. The most common reasons for visiting the SRFC were infections (23.2%), acute or chronic wounds (13.5%) and fractures (6.3%). Conclusion Our multicultural patients suffer mainly from infections and traumatological and dermatological diseases. We find similarities to published Canadian SRFC patient cohorts but differences in diseases and treatment modalities compared to US SRFCs. Importantly, we demonstrate the relevance and necessity of the SRFC in a major city in Northern Europe. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The Student-Run Clinic Association (SRCA) is a pan-Canadian effort to develop new student-run clinics and scale the operation of existing clinics. Student-run clinics utilize a multidisciplinary team of health professional students to provide accessible primary care services to vulnerable and marginalized populations under the supervision of qualified and licensed healthcare providers. The SRCA plays an integral role in building the infrastructure necessary for student-run clinics to be sustainable and scalable across the country. The outcome of our initiative is to enhance equitable, high-quality care to underserved populations in Canada, while simultaneously providing future healthcare providers with experience serving this population.

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. [ABSTRACT FROM AUTHOR]

The purpose of this study is to report the utility of a universal depression screening in a student-run free clinic (SRFC) to improve bridging to psychiatric care. Patients (n = 224) seen by an SRFC between April 2017 and November 2022 were screened for depression in the patient's primary language using the standardized Patient Health Questionnaire (PHQ-9). A PHQ-9 score greater or equal to 5 prompted psychiatry referral. Retrospective chart review was conducted to determine clinical characteristics and length of psychiatry follow-up. Out of 224 patients screened, 77 patients had positive depression screens and were referred to the SRFC's adjacent psychiatry clinic. Of these 77 patients, 56 patients (73%) were female, the average age was 43.7 (SD = 14.5), and the mean PHQ score was 10 (SD = 5.13). Thirty-seven patients (48%) accepted referral, while 40 (52%) declined or were lost to follow-up. There were no statistical differences in age or number of medical comorbidities between the two groups. Patients who accepted referrals were more likely to be female, as well as to have psychiatric histories, higher PHQ-9 scores, and a history of trauma. Reasons for declining and being lost to follow-up included transition to insurance, geographic relocation and deferral due to hesitancy in seeking psychiatric care. Implementation of a standardized depression screening reveals a significant rate of depressive symptoms among an urban uninsured primary care population. Universal screening may serve as a tool to improve the delivery of psychiatric care to underserved patients., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Free clinics provide care for those who may otherwise not have access. While this care is often free for patients, it is not free to operate such clinics. This review will provide a budget and breakdown of all expenditures at a student-run free clinic along with average costs of services provided to patients., Methods: Accounting data was used to categorize all expenses and generate an annual budget. An inventory tracking system was developed to measure the costs of all medical supplies and services accurately, providing information on costs per clinic and costs per patient for each provided service., Results: The average cost per clinic was $53.55 (per patient: $2.14) for general clinic supplies, $43.74 (per patient: $7.29) for telehealth, $278.47 (per patient: $12.66) for laboratory services, $247.25 (per patient: $10.75) for pharmacy services, and $8.30 (per patient: $1.19) for social work. These costs contributed to a relative minority (< 33%) of the total costs to run a free clinic, where the highest costs were for volunteer appreciation and administrative overhead. Twelve categories of expenditures (administrative overhead, volunteer appreciation, medical and lab supplies, conferences and special projects, advertising and marketing, telehealth, pharmacy, specialty clinics, chronic care, patient transportation, social work, and accounting services) were ranked in order of necessity, and methods for cost reduction were discussed for each category., Conclusions: Categorizing costs can show where cost savings and cost-effective additions may be implemented. This study may serve as a financial and budgeting reference for other clinics., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

High costs make many medications inaccessible to patients in the United States. Uninsured and underinsured patients are disproportionately affected. Pharmaceutical companies offer patient assistance programs (PAPs) to lower the cost-sharing burden of expensive prescription medications for uninsured patients. PAPs are used by various clinics, particularly oncology clinics and those caring for underserved communities, to expand patients' access to medications. Prior studies describing the implementation of PAPs in student-run free clinics have demonstrated cost-savings during the first few years of using PAPs. However, there is a lack of data regarding the efficacy and cost savings of longitudinal use of PAPs across several years. This study describes the growth of PAP use at a student-run free clinic in Nashville, Tennessee over ten years, demonstrating that PAPs can be used reliably and sustainably to expand patients' access to expensive medications. From 2012 to 2021, we increased the number of medications available through PAPs from 8 to 59 and the number of patient enrollments from 20 to 232. In 2021, our PAP enrollments demonstrated potential cost savings of over $1.2 million. Strategies, limitations, and future directions of PAP use are also discussed, highlighting that PAPs can be a powerful tool for free clinics in serving underserved communities., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Our institution's student-run free clinic has been able to offer medication at no out-of-pocket cost to all patients since it opened in 2004. We have employed two strategies to manage prescription drug costs while simultaneously increasing medication coverage: (1) using Patient Drug Assistance Programs (PDAPs) and (2) developing an institutional-level partnership with pharmaceutical charities for medication subsidization. In this study, we aimed to analyze the financial impact of these measures on the clinic.A query of clinic data over the past 5 years identified 299 active PDAPs, corresponding to 299 fully-subsidized prescriptions. In 2017, there were 35 active PDAPs, increasing to 52 (2018), 62 (2019), and 82 (2020) before a decline to 68 PDAPs in 2021. The company affiliated with the most PDAPs varied annually: GlaxoSmithKline (2017), Lilly (2018, 2019, 2020), and both GlaxoSmithKline and Lilly (2021). The most frequent medications were sitagliptin (2017), insulin (2018, 2019), albuterol (2017, 2018), and dulaglutide (2020, 2021).In addition, data extracted from the private company subsidization program was analyzed for the year 2021. Program membership was $10,000 for institution-wide medication subsidization for all uninsured patients in the hospital system. In total, the clinic was able to acquire 220 medications with a 96% subsidy, corresponding to a direct clinic cost of $2,101.28. Comparatively, the market value of these medications was $52,401.51.Utilization of free drug acquisition programs and partnerships with pharmaceutical charities allowed for an increase in cost-savings and medications provided. Although the process for applying for medication assistance programs is complex, these programs serve as powerful tools for providing medications that may otherwise be unavailable due to cost. Other clinics and healthcare settings with uninsured patients should consider these programs as a means to ease medication cost burden., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Narrative medicine is an approach to healthcare that acknowledges the stories of patients' lives both within and beyond the clinical setting. Narrative medicine has been increasingly recognized as a promising tool to support modern educational needs in health professions training, such as interprofessional practice, while enhancing quality of care. Here, we describe the development, implementation, and application of a narrative medicine program at the University of Minnesota Phillips Neighborhood Clinic. First, in a qualitative analysis of patient stories ( n  = 12) we identified themes regarding the value of the storytelling experience; patients' personal journeys; and patients' experiences in healthcare and other systems. Second, an interprofessional educational activity for student volunteers ( n  = 57) leveraging a patient narrative was observed to be satisfactory, significantly improve attitudes toward the underserved, and enhance quality of care from the perspectives of trainees. Together, findings from the two studies imply the potential benefits of broader incorporation of narrative medicine into interprofessional service settings, for both learners and patients.

Objectives: Many tobacco users are motivated to quit but lack the resources to do so. To date, studies characterizing tobacco users at student-run free clinics have used small sample sizes, which may not be large enough to detect differences across key variables. As such, we assessed sociodemographic differences between tobacco users and nonusers at a student-run free clinic using a pooled cross-sectional design., Methods: We used patient-level data from the electronic health records for all of the patients who were seen during January 2012 to February 2020 inclusive. Our dependent variable was whether patients self-reported tobacco use. We assessed for differences across age, sex, race/ethnicity, and education level using a multivariable logistic regression model., Results: Across 4264 patients, 28.7% reported tobacco use. When controlling for other factors, greater odds of tobacco use were observed in this cohort for patients who were male (odds ratio [OR] 1.690, 95% confidence interval [CI] 1.468-1.944), those with educational attainment of 9th to 11th grade (OR 2.291, 95% CI 1.558-3.369), and those who were high school graduates/completed the General Education Development test (OR 1.849, 95% CI 1.295-2.638) compared with those with less than a high school education. Similarly, patients of older age had greater odds of tobacco use., Conclusions: Our study found patient-level differences that may need to be integrated into improving the reach of intervention methods. Future research should look at a broader set of metrics (eg, geographic location, socioeconomic status) and ascertain reasons for sociodemographic differences observed.

Student-run free clinics (SRFCs) serve as an important public safety-net for un- and under-insured patients. Few studies have investigated their financial impact or return of investment to the community. The aim of this study was to estimate the financial impact of the Indiana University Student Outreach Clinic (IUSOC) using national market values of medical visits and lab services in 2021.From internal triage classification records maintained from March to December 2021, Current Procedural Terminology (CPT) codes were assigned corresponding to "New Patient," "Returning Quick or Long" and "Fast Track" visits. Total Work Relative Value Units (wRVUs) were calculated to then estimate the total monetary value for medical services. Similarly, the collection of laboratory services rendered from March to December 2021 were assigned costs using the 2021 Center for Medicare and Medicaid Services (CMS) fee schedule.There were a total of 1475 medical visits identified in this study under the triage categories of interest, with 440 New Patient visits, 1032 Returning Quick and Long visits, and 3 Fast Track visits. From the calculated total wRVUs, the estimated monetary value for medical services was $95,413.79. Additionally, there were 3633 eligible lab tests ordered; almost half of these (1523, 41.9%) were categorized as routine lab tests (CMP, BMP, CBC, lipid panel). The estimated value of lab services was $56,296.81.Our estimates reveal that the IUSOC provided nearly $150,000 worth of free healthcare to the community in 2021. Further, most patients were seen for return visits, revealing the opportunity to streamline logistics., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To determine imaging utilization and expenditures among an underserved population at a student-run free clinic., Methods: This was a retrospective review of billing records for all radiology studies performed over a 4-year period at a student-run free clinic supervised by physician faculty. All imaging services were outsourced through either direct payment by the clinic to a local imaging group or through in-kind donations. Radiology studies were grouped by modality and diagnostic category. Data were analyzed to determine overall and average imaging utilization and expenditures., Results: Across the 4-year study period, 413 radiology studies were performed with a yearly average of 103 (SD = 16). During this time, 192 (46%) ultrasounds, 123 (30%) radiographic studies, 40 (10%) MRIs, 37 (9%) CTs, 8 (2%) interventional procedures, and 5 (1%) nuclear imaging studies were obtained. Overall, expenditures were $157,888 with a yearly average of $39,472 (SD = $1982). In-kind donations accounted for $138,508 (88%) of expenditures. Across the 4-year study period, utilization increased by 15% with less than 1% increase in expenditures., Discussion: Ultrasound was the most common imaging modality used. Overall imaging utilization was considerably less than that of published data in an ambulatory setting., (Copyright © 2023 Elsevier Inc. All rights reserved.)

While the incidence of cervical cancer continues to decrease, there is a significant discrepancy in incidence rates and screening behaviors among Hispanic and non-Hispanic white patients in the USA. This project examines the relationship between Spanish health literacy and cervical cancer screening knowledge, attitudes, and practices among native Spanish-speaking patients at risk for cervical cancer at the USF BRIDGE Healthcare Clinic, a student-run free clinic in Tampa, FL. Spanish-speaking patients ≥21 years (n = 34) participated in a quality improvement project that included an assessment of Spanish health literacy and a written survey on cervical cancer knowledge. Chi-squared tests were performed to assess potential relationships between health literacy and cervical cancer knowledge, attitudes, health behaviors, and demographics. Seven participants (20.6%) scored between 0 and 14 on the SAHL-S, indicating inadequate health literacy. A significant difference in cervical cancer health knowledge was found between patients with adequate health literacy compared to patients with inadequate health literacy (p = 0.002). There is a potential association between low Spanish health literacy and subsequent poorer understanding of cervical cancer in BRIDGE patients. This implies that patients of low health literacy may have poorer comprehension of other aspects of their care beyond cervical cancer screening. Strategies are discussed to improve communication with BRIDGE patients of low Spanish health literacy that may be applicable to other patient populations., (© 2023. The Author(s) under exclusive licence to American Association for Cancer Education.)

Objective: To assess rates of breast and cervical cancer screening at student-run free clinics to understand challenges and strategies for advancing quality and accessibility of women's health screening., Methods: The authors performed a systematic search of publications in Ovid MEDLINE, PubMed, Web of Science, and Google Scholar databases from database inception to 2020. English-language publications assessing rates of breast and cervical cancer screening in student-run free clinics were included. Structured data extraction was completed for each publication by two reviewers independently. Risk of bias was assessed using a modified Agency for Healthcare Research and Quality checklist. Results were synthesized qualitatively because of study heterogeneity., Results: Of 3634 references identified, 12 references met study inclusion criteria. The proportion of patients up-to-date on breast cancer screening per guidelines ranged from 45% to 94%. The proportion of patients up-to-date on cervical cancer screening per guidelines ranged from 40% to 88%., Conclusion: Student-run free clinics can match breast and cervical cancer screening rates among uninsured populations nationally, although more work is required to bridge the gap in care that exists for the underinsured and uninsured., (© 2023 International Federation of Gynecology and Obstetrics.)