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A Survey of Patients and Providers at Free Clinics Across the United States

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Abstract

This study set out to demonstrate the need for free clinics on a national level, to identify difference among types of free clinics in the US, to identify which services were commonly used, and to determine where else patients would seek care if not at the free clinics. Two separate, distinct surveys were sent out, one to free clinic directors and another to free clinic patients. Chi-squared tests, two tailed t-tests, and percentages were used to describe results and significant differences. 1,114 free clinics were identified in the US. 172 free clinics and 362 patients responded. Most clinics (44%) were independent. A mean of 4,310 annual visits was reported. Most patients used primary care (86%) and pharmacy (80%) services. If the free clinic did not exist, 24% would not seek care, 21% due to cost. Most would seek care at another free clinic (47%), or the emergency room (23%). Most patients were satisfied with their care at the free clinic (97%). Patient satisfaction correlated with use of primary care (P = 0.0143). Most patients (77%) reported greater satisfaction with the care they received at the free clinic than with their prior care. Free clinics provide primary care to a substantial number of uninsured and working poor. They provide an alternative to patients who might otherwise seek primary care in the emergency room. Even with reform of the national health care system, free clinics will provide primary care to millions of uninsured. How they will adapt to provide this care is yet to be seen.

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References

  1. Zon, C. (1979). Free clinic movement is alive and well. Voluntary Action Leadership, 11.

  2. Smith, D. E. (1974). The free clinic movement in the U.S. Medical Journal of Australia, 2(4 Suppl), 34–36.

    CAS  PubMed  Google Scholar 

  3. Seizer, F. (1984). The role of a free clinic in the mid eighties. Urban Health, 13(8), 32–33.

    CAS  PubMed  Google Scholar 

  4. Smiley, C. W. (1975). The flower children of sudbury. The story of a street clinic for hippies. Scandinavian Journal of Social Medicine, 3(3), 139–142.

    CAS  PubMed  Google Scholar 

  5. A milwaukee clinic fills a need but faces failure—NYTimes.com. Available at: http://www.nytimes.com/2009/09/02/health/policy/02clinic.html?_r=2&hp. Accessed 4 Sep 2009.

  6. Andrulis, D., Christina, A., & Carol, P. (2001). Getting health care when you are uninsured: A survey of uninsured patients at three community clinics in berkeley, California.

  7. DeNavas-Walt, C, Proctor, B. D., & Lee. C. H. (2005). Income, poverty, and health insurance coverage in the U.S.: 2004. US Census Bureau, 2005.

  8. Census bureau: number of US uninsured rises to 47 million americans. Available at: http://www.medscape.com/viewarticle/567737. Accessed 28 Aug 2009, 2009.

  9. Health insurance—main. Available at: http://www.census.gov/hhes/www/hlthins/hlthins.html. Accessed 28 Aug 2009, 2009.

  10. Pell, T., & Feller, E. R. (2005). A collaborative management model for mental health care at the rhode island free clinic. Medicine and Health, Rhode Island, 88(8), 265–267.

    PubMed  Google Scholar 

  11. Finke, M. (1997). Free clinics. Iowa Medicine, 87(8), 314–316.

    CAS  PubMed  Google Scholar 

  12. Nadkarni, M. M. M., & Philbrick, J. T. M. (2005). Free clinics: A nation-wide survey. American Journal of the Medical Sciences, 330(1), 25–31.

    Article  PubMed  Google Scholar 

  13. Grimes, W. R. (2004). Starting a free clinic in a rural area. People in a small kentucky town pool their talents to solve the access problem. Health progress, 85(2), 23–25, 51.

    Google Scholar 

  14. Wynne, S. W. (1930). Free clinics for the preschool child. American Journal of Public Health and the Nation’s Health, 20(3), 263–268.

    Article  CAS  PubMed  Google Scholar 

  15. Alexander, R. J. (1972). People’s free clinic. Texas Medicine, 68(2), 94–100.

    CAS  PubMed  Google Scholar 

  16. Amenta, M. M. (1974). Free clinics change the scene. American Journal of Nursing, 74(2), 284–288.

    Article  CAS  PubMed  Google Scholar 

  17. Asbell, M. B. (1967). Free dental clinic of salem county memorial hospital 1921–1926. Outlook and Bulletin. Southern Dental Society of New Jersey, 36(4), 46–47.

    CAS  PubMed  Google Scholar 

  18. Bardack, M. A., Thompson,S.H. (1993). Model prenatal program of rush medical college at st. basil’s free peoples clinic, Chicago. Public Health Rep, 108(2), 161–165.

    Google Scholar 

  19. Barlow, R. (1982). Empirical findings on the association between education and child health status: Discussion. Health Policy and Education, 2(3–4), 375–378.

    Article  CAS  PubMed  Google Scholar 

  20. Bauer, S. (1993). Community clinic offers access to care. A system and a city collaborate to care for an immigrant population. Health Progress, 74(8), 42–44, 65.

    Google Scholar 

  21. Beck, E. (2005). The UCSD student-run free clinic project: Transdisciplinary health professional education. Journal of Health Care for the Poor and Underserved, 16(2), 207–219.

    Article  PubMed  Google Scholar 

  22. Bell, R. A., Camacho, F., Goonan, K., et al. (2001). Quality of diabetes care among low-income patients in north carolina. American Journal of Preventive Medicine, 21(2), 124–131.

    Article  CAS  PubMed  Google Scholar 

  23. Berry, J. S. (1975). A model free clinic. IMJ. Illinois Medical Journal, 147(6), 562–563, 581.

  24. Bibeau, D. L., Taylor, M. L., Rife, J. C., & Howell, K. A. (1997). Reaching the poor with health promotion through community free clinics. American Journal of Health Promotion, 12(2), 87–89.

    CAS  PubMed  Google Scholar 

  25. Black, P. M. (1977). Chief complaints in a free walk-in clinic: A study of 3, 009 consecutive patient visits. Public Health Reports, 92(2), 150–153.

    CAS  PubMed  Google Scholar 

  26. Blewett, L. A., Casey, M., & Call, K. T. (2004). Improving access to primary care for a growing latino population: The role of safety net providers in the rural midwest. The Journal of Rural Health, 20(3), 237–245.

    Article  PubMed  Google Scholar 

  27. Buchanan, D., & Witlen, R. (2006). Balancing service and education: Ethical management of student-run clinics. Journal of Health Care for the Poor and Underserved, 17(3), 477–485.

    Article  PubMed  Google Scholar 

  28. Campos-Outcalt, D. E. (1985). Specialties chosen by medical students who participated in a student-run, community-based free clinic. American Journal of Preventive Medicine, 1(4), 50–51.

    CAS  PubMed  Google Scholar 

  29. Carter, K. F., Green, R. D., Green, L., & Dufour, L. T. (1994). Health needs of homeless clients accessing nursing care at a free clinic. Journal of Community Health Nursing, 11(3), 139–147.

    Article  CAS  PubMed  Google Scholar 

  30. Clark, D. L., Melillo, A., Wallace, D., Pierrel, S., & Buck, D. S. (2003). A multidisciplinary, learner-centered, student-run clinic for the homeless. Family Medicine, 35(6), 394–397.

    PubMed  Google Scholar 

  31. Creighton, H. (1973). Law for the nurse-supervisor. Free clinics. Supervisor Nurse, 4(4), 64–68.

    CAS  PubMed  Google Scholar 

  32. Davis, A. (2005). Physician assistant volunteers belong in free clinics. JAAPA, 18(4), 16–17.

    PubMed  Google Scholar 

  33. Deniaud, F., Collignon, A., Guesnon, M. S., et al. (2006). Schistosoma haematobium among immigrants consulting in municipal free clinics in paris in 2003. Bulletin de la Société de Pathologie Exotique, 99(2), 110–112.

    CAS  PubMed  Google Scholar 

  34. Doll, W. (1985). Whatever happened to the ‘60s free clinics? New Physician, 34(3), 8–11.

    CAS  PubMed  Google Scholar 

  35. Easton, J. D. (1971). The berkeley free clinic. Journal California Dental Association, 47(2), 16–17.

    CAS  PubMed  Google Scholar 

  36. Fleming, O., & Mills, J. (2005). Free clinics in north carolina: A network of compassion, volunteerism, and quality care for those without healthcare options. North Carolina Medical Journal, 66(2), 127–129.

    PubMed  Google Scholar 

  37. Garvin, J. M. (1978). Free clinics: The forgotten alternative. Virginia Medical, 105(9), 662–664.

    CAS  PubMed  Google Scholar 

  38. Geller, S., Taylor, B. M., & Denman Scott, H. (2004). Free clinics helping to patch the safety net. Journal of Health Care for the Poor and Underserved, 15, 42–51.

    Article  PubMed  Google Scholar 

  39. Geller, S., Taylor, B. M., & Scott, H. D. (2004). Free clinics helping to patch the safety net. Journal of Health Care for the Poor and Underserved, 15(1), 42–51.

    Article  PubMed  Google Scholar 

  40. Gordon, J. B. (1976). Quality of care in free clinics. American Journal of Public Health, 66(10), 955–956.

    Article  CAS  PubMed  Google Scholar 

  41. Isaacs, S. L., & Jellinek, P. (2007). Is there a (volunteer) doctor in the house? free clinics and volunteer physician referral networks in the united states. Health Affairs(Millwood), 26(3), 871–876.

    Article  Google Scholar 

  42. Keis, R. M., DeGeus, L. G., Cashman, S., & Savageau, J. (2004). Characteristics of patients at three free clinics. Journal of Health Care for the Poor and Underserved, 15(4), 603–617.

    Article  PubMed  Google Scholar 

  43. Kelleher, K. C. (1991). Free clinics. A solution that can work. now!. JAMA, 266(6), 838–840.

    Article  CAS  PubMed  Google Scholar 

  44. Kent, C. (1991). Perspectives. free clinics: Hippie holdover or wave of the future?. Faulkner & Gray’s Medicine & Health. 45(43), Suppl 4 p.

  45. Lenehan, G. P. (1998). Free clinics and parish nursing offer unique rewards. Journal of Emergency Nursing, 24(1), 3–4.

    Article  CAS  PubMed  Google Scholar 

  46. Nadkarni, M. M., & Philbrick, J. T. (2003). Free clinics and the uninsured: The increasing demands of chronic illness. Journal of Health Care for the Poor and Underserved, 14(2), 165–174.

    PubMed  Google Scholar 

  47. Reed, K. (2007). Free clinics and iowa’s uninsured: The last safety net. Iowa Medicine, 97(2), 23.

    Google Scholar 

  48. TF, S., Jr, & Day, C. M. (1974). Survival potential and quality of care among free clinics. Public Health Reports, 89(6), 558–562.

    Google Scholar 

  49. Andersen, R. M., McCutcheon, A., Aday, L. A., Chiu, G. Y., & Bell, R. (1983). Exploring dimensions of access to medical care. Health Services Research, 18(1), 49–74.

    CAS  PubMed  Google Scholar 

  50. Phillips, K. A., Morrison, K. R., Andersen, R., & Aday, L. A. (1998). Understanding the context of health care utilization: Assessing environmental and provider-related variables in the behavioral model of utilization. Health Services Research, 33(3 Pt 1), 571–596.

    CAS  PubMed  Google Scholar 

  51. Arora, N. K. P., Ayanian, J. Z., & Guadagnoli, E. (2005). Examining the relationship of patients’ attitudes and beliefs with their self-reported level of participation in medical decision-making. Medical Care, 43(9), 865–872.

    Article  PubMed  Google Scholar 

  52. Williams, G. O., & Dueker, D. L. (1985). The nonuse of free health-screening by rural elderly. American Journal of Preventive Medicine, 1(4), 52–57.

    CAS  PubMed  Google Scholar 

  53. Tjepkema, M. (2008). Health care use among gay, lesbian and bisexual canadians. Health Reports, 19(1), 53–64 Accessed 4 Sep 2009.

    Google Scholar 

  54. de Bocanegra, H. T., & Gany, F. (2004). Good provider, good patient: Changing behaviors to eliminate disparities in health care. The American Journal of Managed Care, 10, 20–28.

    Google Scholar 

  55. Sofaer, S., & Firminger, K. (2005). Patient perceptions of the quality of health services. Annual Review of Public Health, 26(1), 513–559.

    Article  PubMed  Google Scholar 

  56. Centers for Disease Ccontrol (2004). Health care in america: Trends in utilization. US Deptartment of Health and Human Services.

  57. JMP software—data analysis—statistics—six sigma—DOE. (2009). Available at: http://www.jmp.com/. Accessed 8/31/2009, 2009.

  58. Simpson, S. A., & Long, J. A. (2007). Medical student-run health clinics: Important contributors to patient care and medical education. Journal of General Internal Medicine, 22(3), 352–356.

    Article  PubMed  Google Scholar 

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Acknowledgments

Thanks to Hemant Ishwaran PhD and Neal Dawson MD who both provided suggestions and guidance. Also thanks to Marija Rogonjic and Amy Rivera for their indispensable administrative support. Last but not least, thanks to all of the free clinic providers and patients who participated.

Conflict of Interest Statement

All authors state that they have no conflicts of interest.

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Authors and Affiliations

  1. CDC/HSHPS University of Puerto Rico, 13500 Shaker Blvd #302, Cleveland, OH, 44120, USA

    Alida Maria Gertz

  2. School of Medicine, Master of Public Health Program, Department of Epidemiology & Biostatistics, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44195, USA

    Scott Frank

  3. Center for Health Care Research & Policy, Case Western Reserve University at Metro Health Medical Center, 2500 Metrohealth Drive, Cleveland, OH, 44109, USA

    Carol E. Blixen

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  1. Alida Maria Gertz
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  2. Scott Frank
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Correspondence to Alida Maria Gertz.

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Gertz, A.M., Frank, S. & Blixen, C.E. A Survey of Patients and Providers at Free Clinics Across the United States. J Community Health 36, 83–93 (2011). https://doi.org/10.1007/s10900-010-9286-x

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  • DOI: https://doi.org/10.1007/s10900-010-9286-x

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