Transcript Document
BACKGROUND
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Low socioeconomic status (SES) is associated with a lack of access to healthcare which contributes to higher morbidity and mortality rates 1-3
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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 .
OUR MEASURES OF HEALTHCARE OUTCOMES Navigating Healthcare Without Insurance
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In uninsured populations, controllable conditions such as diabetes and hypertension frequently present as medical emergencies.
Preventative Care Precedes Emergency Care
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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
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People with access to routine checkups and screenings can
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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 14-16 .
Student-run clinics report having a surplus of volunteers so there is room to expand the reach of this form of healthcare 17,18 .
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
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.
Wyandotte County Johnson County
Adults with Health Insurance 19 Preventable Hospital Stays (Per 1000 Stays) 19 69.2% 66 88.4 % 55 Primary Care Providers (Per 100,000 Individuals) 19 61 104 Socioeconomic status was examined using the following criteria:
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“Median Household Income (2014)”
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“People ages 25+ with a High School Degree or Higher (2014)”
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“Unemployed Workers in Civilian Labor Force (2014)” Healthcare access was examined using the following criteria:
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“Percent of Adult Population with Health Insurance”
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“Number of Preventable Hospital Stays per 1,000 Medicaid
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Enrollees” “Number of Primary Care Providers per 100,000 People in the Population”
SUMMARY
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We found an association between low SES and limited access to healthcare, as outlined by the aforementioned parameters.
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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 .
CONCLUSION
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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 .
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Student-run free clinics restore one major branch of medicine: preventative medical care 6,20,21 .
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Kansas City has a group of organizations that provide healthcare to those in need called the Safety Net.
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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.
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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.
REFERENCES
1 Health, United States 2011: With Special Feature on Socioeconomic Status and Health. Pamphlet published by the CDC. 2011.
2 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
;
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. 2011.
6 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.
S28–40.
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: 635–41. 11 Starfield, B., et al. Contribution of primary care to health systems and health.
Milbank Q
2005; 83: 457–502. 12 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
2014.
14 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.
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: 352–356.
19 KC HealthMatters: Community Dashboard. Searchable Health Database published by the Health Care Foundation of Greater Kansas City. 2014.
J Health Care Poor Underserved
2013; 24: 344–58.
21 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.
1 Health, United States 2011: With Special Feature on Socioeconomic Status and Health. Pamphlet published by the CDC. 2011.
2 Fiscella, K., et al. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care.
JAMA
2000; 283
:
3 Phelan, J. C., et al. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications.
4 Adler, N. E. et al
.
Socioeconomic status and health. The challenge of the gradient.
Am Psychol
1994; 49
:
15–24.
2579–84.
J Health Soc Behav
2010; 51 Suppl
;
S28–40.
5 Safety Net Health Care: Delivering Care to Vulnerable Patients. Pamphlet published by the Health Care Foundation of Greater Kansas City. 2011.
6 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: 635–41. 11 Starfield, B., et al. Contribution of primary care to health systems and health.
Milbank Q
2005; 83: 457–502. 12 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
2014.
14 Isaacson, J. H., et al. Patient perceptions of having 1st- and 2nd-year medical students involved in their care.
Teach Learn Med
15 Ellett, J. D., et al. Patient satisfaction in a student-run free medical clinic.
Fam Med
2010; 42: 16–8.
2014; 26: 164–7.
16 Sojourner Health Clinic. Website published by UMKC School of Medicine. 2014; Home page.
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: 352–356.
19 KC HealthMatters: Community Dashboard. Searchable Health Database published by the Health Care Foundation of Greater Kansas City. 2014.
J Health Care Poor Underserved
2013; 24: 344–58.
21 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.