Local Responses to Health Care Needs
Publication Year: 2013
Published by: The Johns Hopkins University Press
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Title Page, Copyright Page
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With ever- rising health care costs, access to health ser vices has become a national priority. The increasing expense has a dampening eff ect on the growth of the U.S. economy, and inadequate health care access hinders the productivity and effi -ciency of the labor pool. With the growing burden of the uninsured, U.S. health care is facing another crisis. Like a strong ballast against the storm, free and char-...
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This book opens with a comprehensive reviewâ by Emily Rose Schiller, Michelle Ann Thurston, Zubair Khan, and Michael D. Fettersâ of the literature on free clinics, nongovernmental organizations that strive to respond to a communityâs health care needs through health education, free preventive and diagnostic ser-vices, basic primary care, and a support network of peers and practitioners. Not-...
Chapter 1. Free Clinics Stand as a Pillar of the Health Care Safety Net: Findings from a Narrative Literature Review
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Once youâve seen one free clinic, youâve only seen one free clinic.âSlogan of the National Association of Free Clinics National Summit 2007The Patient Protection and Aff ordable Care Act, signed into law by President Barack Obama on March 23, 2010, has been hailed as a great step forward for improving the U.S. health care system.ï,ïº This legislation is projected to guarantee coverage and expand access to health care for 32 million more Americans.ï» Unfor-...
Part I: Free Clinics
Chapter 2. Psychiatric Street Outreach to Homeless People: Fostering Relationship, Reconnection, and Recovery
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Individuals suff ering the devastating eff ects of serious and per sis tent mental ill-nesses constitute a profoundly vulnerable segment of the homeless population in this country. Although methodological limitations may constrain attempts to count precisely the number of people who are chronically homeless and also contending with mental illness, several investigations provide reliable estimates. The most re-cent study conducted by the U.S. Conference of Mayors, for instance, estimated that ...
Chapter 3. Nurse Practitioners in Community Health Settings Today
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During a typical week as a family nurse practitioner, I provide primary care to uninsured immigrant patients on a mobile van, teach an undergraduate nursing course entitled Community and Environmental Health Nursing at the Catholic University of America, screen Hispanic women for breast and cervical cancer through Celebremos La Vida (Celebrate Life) at Georgetown Universityâs Lombardi Cancer Center, and lead continuing professional education programs ...
Chapter 4. Following the Call: How Providers Make Sense of Their Decisions to Work in Faith-Based and Secular Urban Community Health Centers
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The recruitment and retention of well- trained, motivated health care providers in underserved communities is a well described, longstanding, and refractory problem.ïâ ï½ In 1998, Singer and colleagues reported that the median tenure of pri-mary care practitioners in federally funded community health centers (CHCs) is three years, regardless of National Health Ser vice Corps obligations.ï Provider turnover exacts substantial tolls on the health care safety net. Patient care suff ers ...
Chapter 5. The Jane Dent Home: The Rise and Fall of Homes for the Aged in Low-Income Communities
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When the Jane Dent Home opened its doors in 1893 as a home for the aged in Chicagoâs African American community, other ethnic communities in the city were establishing similar institutions to protect their elders from neglect, loneliness, and, ultimately, the poor house. When the doors of the Jane Dent Home were closed for good in 1975, many other ethnically based homes for the aged had also closed their doors, but there were some that had moved into new neighbor-...
Chapter 6. Early Collaboration for Adaptation: Addressing Depression in Low-Income New Mothers
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Numerous studies demonstrate that, in settings for the care of the medically underserved, evidence- based depression treatments are underused.ïâ ï¼ Locat-ing mental health ser vices in nonspecialty settings has the potential to increase This chapter describes collaboration by a university- based researcher and a nurse home visitation agency aimed at fi tting depression treatment into a setting where new mothers who reside in eco nom ical ly disadvantaged neighborhoods ...
Chapter 7. Neighborhood Clinics: An Academic Medical Center–Community Health Center Partnership
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The number of uninsured and underinsured in the United States is growing,ï and the challenges of their care are complex. The providers and ser vices avail-able to the un/underinsured are limited, and fi nancial barriers are compounded by such obstacles as lack of transportation and language nonconcordance between providers and patients.ïºâ ï¼ The result for consumers is insuffi cient, delayed, or frag-mented care, with adverse health consequences. The result for the health care system ...
Chapter 8. Free Clinics Helping to Patch the Safety Net
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Volunteer- based clinics, sometimes called free clinics, have existed in the United States for de cades. These clinics, which provide free or low- cost care to uninsured and underinsured patients, depend largely on the philanthropic community for fi nancial support and operate largely through the eff orts of volun-teer physicians and other health care providers. Care at many volunteer- based clinics is completely free of charge, while other clinics request a nominal fee or ...
Chapter 9. Impact of Providing a Medical Home to the Uninsured: Evaluation of a Statewide Program
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Previous studies have shown that having a regular source of care (RSOC) is as-sociated with higher quality of care, increased preventive care, and decreased emergency department (ED) visits.ïâ ï¼ While the majority of people in the United States have as RSOC, many do not. Barriers to having an RSOC include lack of insurance, low income, and unreliable transportation. Since low- income unin-sured people represent a vulnerable population who are likely to be without an ...
Chapter 10. Characteristics of Patients at Three Free Clinics
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First seen in the 1960s,ï,ïº free clinics were established to provide medical care for individuals, particularly those who were underinsured or uninsured, and were unable to obtain needed care elsewhere. Free clinics are part of an extensive patch-work safety net system that attempts to care for fi nancially disenfranchised people. According to the Free Clinic Foundation of America, a free clinic, which by defi ni-tion does not charge for its ser vices, is a private, community- based health care ...
Chapter 11. Donated Care Programs: A Stopgap Measure or a Long-Run Alternative to Health Insurance?
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In the wake of the failure to enact broad federal health care reform in 1994, inter-est in local solutions to the problem of providing health care to the uninsured has grown.ïâ ï» Volunteer- based clinics, sometimes referred to as free clinics, have long been an important source of free or highly subsidized health care for the uninsured, and their numbers have grown substantially in recent years.ï¼ Other community- based approaches have emerged as outgrowths of the free clinic ...
Chapter 12. Missed Appointment Rates in Primary Care: The Importance of Site of Care
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When patients miss primary care appointments, practices function less effi -ciently and patient access to care decreases. Valuable provider and clerical staff time may be wasted, and compensatory double- booking may disrupt patient fl ow. These problems are of par tic u lar concern to fi nancially strained publicly funded neighborhood health centers, whose role is to provide continuity and ac-cess for disadvantaged patients. Prior studies have found that patients of lower ...
Chapter 13. Free Clinics and the Uninsured: The Increasing Demands of Chronic Illness
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Despite the economic prosperity of the 1990s, the number of uninsured indi-viduals and families in the United States has continued to increase. In 1998, approximately 44 million Americans younger than 65 lacked health insurance.ï The traditional safety net providers for the uninsured have been community health centers, public hospitals, academic health centers, and private practitioners willing to treat patients for reduced or no fees. Volunteer free clinics emerged in ...
Chapter 14. Missed Opportunities for Patient Education and Social Worker Consultation at the Arbor Free Clinic
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A staggering 43.6 million Americans were uninsured in 2002, according to the United States Census Bureau.ï Uninsured patients frequently rely on free clinics for health care because they are oft en unable to use other clinics in their communities. Physician contact, patient education materials, and social worker consultation are among the important health care opportunities that free clinics off er. The limited availability of volunteer staff and donated medical supplies oft en ...
Chapter 15. Adapting the Chronic Care Model to Treat Chronic Illness at a Free Medical Clinic
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In 2000, an estimated 38 million nonel der ly adults in the United States were without health insurance.ï The literature suggests a high chronic disease burden among uninsured and minority populations and a greater degree of morbidity and mortality compared with their insured counterparts.ïºâ ï¼ Increasingly, in re-sponse, free clinics have developed across the United States to provide health care to the uninsured.ï½,ï¾ Eff ective models of care delivery must be explored to ensure ...
Chapter 16. Medical Respite Care for Homeless People: A Growing National Phenomenon
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Homeless people experience health problems, especially chronic medical ill-ness, with much greater prevalence than those who are housed, and they suf-fer mortality rates three to four times higher than those of the general popula-tion.ï,ïº Lack of housing also creates major obstacles to obtaining necessary medical ser vices and adhering to treatment. Studies have consistently shown that homeless people rely heavily upon hospitals and emergency departments to address their ...
Part II: Student-Run Clinics
Chapter 17. Balancing Service and Education: Ethical Management of Student-Run Clinics
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In a cramped hallway of a cash- strapped student- run clinic at a homeless shelter, six medical students interview patients with minimal provisions for privacy. Se-nior students tutor fi rst- year students on how to present to the faculty preceptor and write a progress note. The volunteer faculty member supervises the care of 20 pa-tients during the three- hour session. The patients feel comforted by the studentsâ This eve ning, there are 5 patients with severe per sis tent asthma, all treated with ...
Chapter 18. Quality of Diabetes Care at a Student-Run Free Clinic
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Approximately 17% of the 8.5 million Americans with diabetes lack health in-surance, and many suff er the consequences of poor access to health care.ï A signifi cant proportion of these uninsured patients receive care at free clinics sup-ported by various community organizations; these include a growing number of student- run free clinics emerging from medical schools across the nation over the past de cade.ïº While improved glycemic control, reduced blood pressure and cho-...
Chapter 19. Students Who Participate in a Student-Run Free Health Clinic Need Education about Access to Care Issues
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Student- run clinics contribute to the health care safety net and provide care for a signifi cant, although small, portion of the uninsured, seeing more than 36,000 visits annually.ï,ïº However, student- run clinics oft en have important limi-tations, such as diffi culty with continuity, labwork, radiological studies, and free medications. Patients at student- run clinics appear to be sicker than the general population, with higher rates of diabetes, asthma, hypertension, and psychiatric ...
Chapter 20. The UCSD Student-Run Free Clinic Project: Transdisciplinary Health Professional Education
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The UCSD Student- Run Free Clinic Project resulted from the dreams of a group of medical students at UCSD School of Medicine. In 1996, a small group of medical students and faculty approached a community partner doing excellent work with street homeless, in a part of the city with few resources for homeless people, and off ered to strengthen the community programâs eff ort by of-fering some clinical ser vices on a weekly basis. The street homeless program, based ...
Chapter 21. Charlottesville Health Access: A Locality-Based Model of Health Care Navigation for the Homeless
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Homelessness in Charlottesville, Virginia, presents a signifi cant public health crisis. This homeless population faces uncommon challenges in both the urban Charlottesville area and the rural surrounding counties. In the city of 41,000, 27.3% of residents live below the poverty lineâ twice the national average.ï The population density of Charlottesville proper is 4,048 people per square mile, making it more densely populated than Richmond (3,377 people/sq. mi.), the stateâs capital. In com-...
Chapter 22. UCLA Mobile Clinic Project
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H. E. was a 51- year- old homeless male who presented to the UCLA Mobile Clinic. He complained of chronic nosebleeds and had a history of schizo phre nia. Physical examination was remarkable only for hypertension. He was referred to a local per-Two years later, the patient presented with hemoptysis, nosebleeds, gingival bleeding, and diffi culty swallowing. Physical examination was remarkable for el-...
Chapter 23. The Promise Clinic: A Service-Learning Approach to Increasing Access to Health Care
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The Homeless and Indigent Population Health Outreach Project (HIPHOP) was founded in 1995 by medical students at the University of Medicine and Dentistry of New Jerseyâ Robert Wood Johnson Medical School (UMDNJ- RWJMS) to add a community- based service- learning component to their curriculum. The project off ered medical students the opportunity to interact with the community through health education workshops, shadowing opportunities at local commu-...
Chapter 24. Engaging Student Health Organizations in Reducing Health Disparities in Underserved Communities through Volunteerism: Developing a Student Health Corps
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The 2000 U.S. Census indicates that underrepresented minorities (URMs) (Af-rican Americans, Hispanics, and Native Americans/Alaskan Indians) and Asian/ Pacifi c Islanders account for nearly a third of the U.S. population, with the projection that these racial/ethnic populations will constitute the majority in the United States by 2050.ï Despite improvement in overall life expectancy in the United States, racial/ethnic minorities have not shown the same progress and con-...
Chapter 25. HealthSTAT: A Student Approach to Building Skills Needed to Serve Poor Communities
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A growing number of health professionals argue that community ser vice, advo-cacy, and leadership constitute core professional responsibilities with impor-tant implications for responsibly serving poor communities.ïâ ï¼ Yet, few schoolsâ curricula address the skills required to fulfi ll those responsibilities. Such skills include community partnership, public speaking, fundraising, consensus build-ing, or gan i za tion al management, community or ga niz ing, team building, and in-...
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Page Count: 296
Illustrations: 11 b&w illus.
Publication Year: 2013