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Free Clinics

Local Responses to Health Care Needs

edited by Virginia M. Brennan

Publication Year: 2013

In community after community, pro bono and student-run health clinics have sprung up over the past 30 years, providing critically needed care to medically underserved populations. Free Clinics is a mosaic formed by accounts of such clinics around the United States. These wide-ranging narratives—from urban to rural, from primary care to behavioral health care—provide examples that will assist other communities seeking to find the model that best fits their needs. The Patient Protection and Affordable Care Act has improved access to health care for many Americans, but millions remain and will remain uninsured or underinsured. Free clinics provide non-emergency care to those in need. Nationwide, professionals can be found offering volunteer services at these clinics. Contributors to this volume—typically people with personal familiarity (as clinicians or area residents) with the clinics they write about—cover a variety of topics, including a review of the literature, data-driven accounts of clinic usage, and ethical guidelines for student-run clinics. They describe the motivations of clinic staff, the day-to-day work of a family nurse practitioner working in clinics and teaching at a university, the challenges and rewards of providing health care for homeless people, and more. Student-run clinics are the topic of the second section: in addition to providing care to a small subset of those in need, student-run clinics are an important venue for training future clinicians and helping the seeds of altruism with which many enter their professions to germinate. Free Clinics will be useful to policymakers, students and faculty in public health and health policy programs, and clinicians and students who are embarking on launching new clinics.

Published by: The Johns Hopkins University Press


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p. C-C

Title Page, Copyright Page

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pp. i-iv


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pp. v-viii

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pp. ix-x

With ever- rising health care costs, access to health services has become a national priority. The increasing expense has a dampening effect on the growth of the U.S. economy, and inadequate health care access hinders the productivity and efficiency 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 charity...

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pp. xi-xviii

This book opens with a comprehensive review— by Emily Rose Schiller, Michelle Ann Thurston, Zubair Khan, and Michael D. Fetters— of the literature on free clinics, nongovernmental organizations that strive to respond to a community’s health care needs through health education, free preventive and diagnostic services, basic primary care, and a support network of peers and practitioners. Noting...

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Chapter 1. Free Clinics Stand as a Pillar of the Health Care Safety Net: Findings from a Narrative Literature Review

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pp. 1-22

The 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.1,2 This legislation is projected to guarantee coverage and expand access to health care for 32 million more Americans.3 Unfortunately, about 46 million people were uninsured or underinsured at the time of...

Part I: Free Clinics

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Chapter 2. Psychiatric Street Outreach to Homeless People: Fostering Relationship, Reconnection, and Recovery

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pp. 25-29

Individuals suffering the devastating effects of serious and persistent mental illnesses 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 recent...

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Chapter 3. Nurse Practitioners in Community Health Settings Today

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pp. 30-35

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 University’s ...

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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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pp. 36-49

The recruitment and retention of well- trained, motivated health care providers in underserved communities is a well described, longstanding, and refractory problem.1–5 In 1998, Singer and colleagues reported that the median tenure of primary care practitioners in federally funded community health centers (CHCs) is three years, regardless of National Health Service Corps obligations.1 Provider ...

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Chapter 5. The Jane Dent Home: The Rise and Fall of Homes for the Aged in Low-Income Communities

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pp. 50-63

When the Jane Dent Home opened its doors in 1893 as a home for the aged in Chicago’s 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...

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Chapter 6. Early Collaboration for Adaptation: Addressing Depression in Low-Income New Mothers

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pp. 64-69

Numerous studies demonstrate that, in settings for the care of the medically underserved, evidence- based depression treatments are underused.1–4 Locating mental health services in nonspecialty settings has the potential to increase access to ser vices for underserved populations.5,6...

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Chapter 7. Neighborhood Clinics: An Academic Medical Center–Community Health Center Partnership

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pp. 70-76

The number of uninsured and underinsured in the United States is growing,1 and the challenges of their care are complex. The providers and ser vices available to the un/underinsured are limited, and financial barriers are compounded by such obstacles as lack of transportation and language nonconcordance between providers and patients.2–4 The result for consumers is insuffi cient, delayed, or fragmented...

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Chapter 8. Free Clinics Helping to Patch the Safety Net

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pp. 77-85

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 financial support and operate largely through the eff orts of volunteer 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...

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Chapter 9. Impact of Providing a Medical Home to the Uninsured: Evaluation of a Statewide Program

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pp. 86-105

Previous studies have shown that having a regular source of care (RSOC) is associated with higher quality of care, increased preventive care, and decreased emergency department (ED) visits.1–4 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 uninsured...

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Chapter 10. Characteristics of Patients at Three Free Clinics

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pp. 106-119

First seen in the 1960s,1,2 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 patchwork safety net system that attempts to care for financially disenfranchised people. According to the Free Clinic Foundation of America, a ...

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Chapter 11. Donated Care Programs: A Stopgap Measure or a Long-Run Alternative to Health Insurance?

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pp. 120-131

In the wake of the failure to enact broad federal health care reform in 1994, interest in local solutions to the problem of providing health care to the uninsured has grown.1–3 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.4 Other community-based approaches have emerged as outgrowths of the free clinic...

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Chapter 12. Missed Appointment Rates in Primary Care: The Importance of Site of Care

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pp. 132-143

When patients miss primary care appointments, practices function less efficiently and patient access to care decreases. Valuable provider and clerical staff time may be wasted, and compensatory double- booking may disrupt patient flow. These problems are of particular concern to financially strained publicly funded neighborhood health centers, whose role is to provide continuity and access...

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Chapter 13. Free Clinics and the Uninsured: The Increasing Demands of Chronic Illness

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pp. 144-153

Despite the economic prosperity of the 1990s, the number of uninsured individuals and families in the United States has continued to increase. In 1998, approximately 44 million Americans younger than 65 lacked health insurance.1 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 ...

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Chapter 14. Missed Opportunities for Patient Education and Social Worker Consultation at the Arbor Free Clinic

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pp. 154-161

A staggering 43.6 million Americans were uninsured in 2002, according to the United States Census Bureau.1 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...

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Chapter 15. Adapting the Chronic Care Model to Treat Chronic Illness at a Free Medical Clinic

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pp. 162-172

In 2000, an estimated 38 million nonel der ly adults in the United States were without health insurance.1 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.2-4 Increasingly, in response, free clinics have developed across the United States to provide health care ...

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Chapter 16. Medical Respite Care for Homeless People: A Growing National Phenomenon

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pp. 173-178

Homeless people experience health problems, especially chronic medical illness, with much greater prevalence than those who are housed, and they suffer mortality rates three to four times higher than those of the general population. 1,2 Lack of housing also creates major obstacles to obtaining necessary medical ser vices and adhering to treatment. Studies have consistently shown that homeless ...

Part II: Student-Run Clinics

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Chapter 17. Balancing Service and Education: Ethical Management of Student-Run Clinics

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pp. 181-188

Student-run free medical clinics have been established in homeless shelters and other locations by students of many United States medical schools.2 Often, these clinics begin as small student- initiated grassroots efforts.3 Some have grown into extensive enterprises that provide clinical ser vices for low- income patients and educational opportunities for students.4 As these clinics grow in size and number, ...

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Chapter 18. Quality of Diabetes Care at a Student-Run Free Clinic

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pp. 189-201

Approximately 17% of the 8.5 million Americans with diabetes lack health insurance, and many suff er the consequences of poor access to health care.1 A signifi cant proportion of these uninsured patients receive care at free clinics supported by various community organizations; these include a growing number of student-run free clinics emerging from medical schools across the nation over the...

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Chapter 19. Students Who Participate in a Student-Run Free Health Clinic Need Education about Access to Care Issues

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pp. 202-207

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.1,2 However, student- run clinics often have important limitations, such as diffi culty with continuity, labwork, radiological studies, and free medications. Patients at student-run clinics appear to be sicker than the general ...

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Chapter 20. The UCSD Student-Run Free Clinic Project: Transdisciplinary Health Professional Education

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pp. 208-221

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 program’s eff ort by offering ...

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Chapter 21. Charlottesville Health Access: A Locality-Based Model of Health Care Navigation for the Homeless

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pp. 222-227

Homelessness in Charlottesville, Virginia, presents a significant 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 line— twice the national average.1 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 state’s capital. In ...

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Chapter 22. UCLA Mobile Clinic Project

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pp. 228-232

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 schizophrenia. Physical examination was remarkable only for hypertension. He was referred to a local permanent free clinic for further care but did not follow up.
Two years later, the patient presented with hemoptysis, nosebleeds, gingival bleeding, and difficulty swallowing. Physical examination was remarkable for elevated...

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Chapter 23. The Promise Clinic: A Service-Learning Approach to Increasing Access to Health Care

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pp. 233-241

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 Jersey– Robert Wood Johnson Medical School (UMDNJ- RWJMS) to add a community-based service-learning component to their curriculum. The project offered medical students the opportunity to interact with the community through health education workshops, shadowing opportunities at local community...

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Chapter 24. Engaging Student Health Organizations in Reducing Health Disparities in Underserved Communities through Volunteerism: Developing a Student Health Corps

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pp. 242-256

The 2000 U.S. Census indicates that underrepresented minorities (URMs) (African Americans, Hispanics, and Native Americans/Alaskan Indians) and Asian/ Pacific 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 2050.1 Despite improvement in overall life expectancy in the...

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Chapter 25. HealthSTAT: A Student Approach to Building Skills Needed to Serve Poor Communities

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pp. 257-266

A growing number of health professionals argue that community service, advocacy, and leadership constitute core professional responsibilities with important implications for responsibly serving poor communities.1-4 Yet, few schools’ curricula address the skills required to fulfill those responsibilities. Such skills include community partnership, public speaking, fundraising, consensus building, organization al management, community or ga niz ing, team building, and interprofessional...


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pp. 267-271

E-ISBN-13: 9781421408859
E-ISBN-10: 1421408856
Print-ISBN-13: 9781421408842
Print-ISBN-10: 1421408848

Page Count: 296
Illustrations: 11 b&w illus.
Publication Year: 2013