Free Clinics: Local Responses to Health Care Needs

Preface

Preface 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 that free clinics form an important component of a health care safety net, the authors identify research areas to advance these clinics’ effectiveness. Although free clinics vary greatly in their structures, missions, and services provided, all share seven major areas interventions might address: populations served; geography ; epidemiology; funding, administration, and operations; approaches to care; health information technology; and volunteers. Improving free clinics could include adapting new models of care, creating or expanding electronic health records , improving screening for and assistance to clients who might qualify for government aid, eliminating barriers to care, and providing additional preventive and diagnostic screenings. After this overview, the book is divided into two parts: “Free Clinics” and “Student-Run Clinics.” The array of descriptions and reflections in these chapters illustrate the wide variety of measures that providers and community leaders have devised to respond locally to the problems of people who are uninsured. Part I: Free Clinics Providers Part I begins with a short chapter by Richard C. Christensen, psychiatrist and long-time physician to people who are homeless. Christensen describes the core objectives of a street psychiatric outreach initiative to help people who are homeless in Jacksonville, Florida, by fostering relationship, reconnection, and recovery. Next, in chapter 3, Lois A. Wessel describes a typical week’s work of one family nurse practitioner living in the Washington, DC, metropolitan area: • providing primary care to uninsured immigrant patients on a mobile van, • teaching an undergraduate nursing course entitled Community and Environmental Health Nursing at the Catholic University of America, • screening Hispanic women for breast and cervical cancer through Celebremos La Vida (Celebrate Life) at Georgetown University’s Lombardi Cancer Center, and • leading continuing professional education programs for health care providers who work with the poor and underserved through the Pediatric Asthma Prevention Project and the Early Childhood Caries Prevention Project of the Association of Clinicians for the Underserved (ACU). xii Preface Chapter 4 maintains the focus on providers by reporting on a qualitative study of faith-based and secular urban community health centers. Farr A. Curlin and colleagues surveyed providers in Chicago about their motivations (religious and other) for working in clinics for the medically underserved. Historical and descriptive accounts The next three chapters describe individual clinics. Chapter 5 takes a historical perspective on nursing homes through description and analysis of the 100-year history of the Jane Dent Home, a home for the elderly in an African American neighborhood in Chicago. Susan C. Reed and Nancy Davis trace the rise and fall of community-created homes for the aged in the United States before and after the advent of Medicaid. Next are two chapters describing academic–community partnerships in free clinics. First, Susan G. Pfefferle and colleagues describe the Nurses for Newborns Foundation in St. Louis, where a university-based researcher collaborated with the community-based organization to address depression in low-income new mothers who would not ordinarily have access to mental health services. Second, Mina Silberberg and her colleagues describe a clinic run by a federally qualified health center and Duke University in Durham, North Carolina. The clinic expands the community’s primary care capacity, combining the advantages of big and small settings and of its dual affiliation. Survey data suggest the clinic prevents health care delays and lowers emergency department use. Data-driven accounts With the background established by the literature review and the individual descriptive accounts in place, this book continues with nine chapters that analyze data on one or more free clinics. Stephanie Geller and colleagues at Brown University surveyed free clinics in seven midwestern states. Findings from this survey show that, in a single year, these 106 clinics provided medical, dental, and pharmaceutical services to over 200,000 patients, suggesting that free clinics nationwide are caring for a substantial number of our nation’s uninsured. The next chapter concerns an attempt by one state, Delaware, to deal with the need for health care among the uninsured. James M. Gill and colleagues analyze the effectiveness of this statelevel initiative. What do patients at free clinics have in common? Rachel Mott-Keis and colleagues report on the characteristics of patients at...