Treatment of Pharyngitis in Uninsured Patients: A Multicenter Study of Free Clinics

61 Background: Uninsured patients with low socioeconomic status are at higher risk for developing colorectal cancer. There is limited quantifiable data regarding risk factors and prevalence of colorectal cancer in this vulnerable population. The purpose of this study is to assess the risk factors for colorectal cancer in the low income and uninsured patient population across nine free clinics around Tampa Bay, Florida. Methods: An IRB-approved manually extracted retrospective query of several medical record systems from nine free clinics in the Tampa Bay area in 2017 revealed 1,836 (36.1%) of 5,076 total patients who are over 50 years old. Patient demographics, weight, smoking status, alcohol use, type 2 diabetes status, inflammatory bowel disease and colorectal cancer prevalence were also extracted and analyzed. Results: Among patients over 50, the majority of patients were female (n = 1073, 58.4%) and of Hispanic ethnicity (n = 752, 41.0%). Of the 1,349 patients who reported their smoking status, 213 (15.8%) were active smokers and 218 (16.2%) were past smokers, with a mean 16.3 (SD = 15.5) pack year history. Of the 1,124 patients who reported their history of alcohol consumption, 217 (19.3%) were current consumers and 40 (3.6%) were past consumers. The average BMI of patients over 50 years was 30.2 (SD = 6.9), with 558 (30.4%) cases of diabetes. Eleven patients (0.6%) had a history of inflammatory bowel disease. The prevalence of documented colorectal cancer in this sample was 0.6% (n = 11) in our sample population. Conclusions: There is a high prevalence of risk factors for colorectal cancer in this sample of uninsured patients but a lower reported prevalence of colorectal cancer compared to the general population. Additionally, many known risk factors for colorectal cancer, such as diet, physical activity, or family history, are not routinely documented by free clinics. As these clinics provide opportune points of primary care, this baseline data should prompt more attention to colorectal screening and risk factor modification in this vulnerable population.

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Secondary prevention among uninsured stroke patients: A free clinic study

SAGE Open Medicine ◽

10.1177/2050312120965325 ◽

2020 ◽

Vol 8 ◽

pp. 205031212096532

Author(s):

Madeline R MacDonald ◽

Sydney Zarriello ◽

Justin Swanson ◽

Noura Ayoubi ◽

Rahul Mhaskar ◽

...

Keyword(s):

Secondary Prevention ◽

Medical Records ◽

Chart Review ◽

Retrospective Chart Review ◽

Free Clinics ◽

Stroke Patients ◽

Uninsured Patients ◽

Patients With Diabetes ◽

History Of ◽

Clinic Study

Objectives: Free clinics manage a diversity of diseases among the uninsured. We sought to assess the medical management of stroke in a population of uninsured patients. Methods: A retrospective chart review was conducted to collect chronic disease statistics from 6558 electronic medical records and paper charts at nine free clinics in Tampa, Florida, from January 2016 to December 2017. Demographics and risk factors were compared between stroke patients and non-stroke patients. Medication rates for several comorbidities were also assessed. Results: Two percent (107) of patients had been diagnosed with a stroke. Stroke patients were older (mean (M) = 56.0, standard deviation (SD) = 11.2) than the rest of the sample (M = 43.3, SD = 15.4), p < 0.001 and a majority were men (n = 62, 58%). Of the stroke patients with hypertension (n = 79), 81% (n = 64) were receiving anti-hypertensive medications. Of the stroke patients with diabetes (n = 43), 72% (n = 31) were receiving diabetes medications. Among all stroke patients, 44% were receiving aspirin therapy (n = 47). Similarly, 39% of all stroke patients (n = 42) were taking statins. Conclusions: Uninsured patients with a history of stroke may not be receiving adequate secondary prevention highlighting the risk and vulnerability of uninsured patients. This finding identifies an area for improvement in secondary stroke prevention in free clinics.

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The complex comorbidities of uninsured cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19054 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19054-e19054

Author(s):

Shreni Shah ◽

Madeline MacDonald ◽

Yuanyuan Lu ◽

Smitha Pabbathi ◽

Abu-Sayeef Mirza

Keyword(s):

Chronic Disease ◽

Cancer Patients ◽

Chronic Conditions ◽

Retrospective Chart Review ◽

Free Clinics ◽

Uninsured Patients ◽

Cancer History ◽

Patients With Cancer ◽

History Of ◽

History Of Cancer

e19054 Background: Uninsured patients diagnosed with cancer receive fewer screenings, frequently present with later-stage cancer, and are often unable to access standard-of-care treatment when compared to insured patients. We previously performed a study demonstrating that uninsured patients with cancer histories have higher levels of comorbidity. However, there is limited data on long-term studies describing comorbid chronic conditions among uninsured cancer patients. Here we examine socioeconomic factors and comorbid chronic conditions in uninsured patients with a cancer history over a period of three years. Methods: A retrospective chart review was conducted from 10 free clinics around the Tampa Bay region. Patients with any documented history of cancer who utilized a free clinic between 2016 and 2018 were included. Patients with no documentation of cancer history were excluded. Demographics, chronic disease parameters, and Charlson Comorbidity Index (CCI) scores were extracted and analyzed. Results: Between 2016 – 2018, a total of 17,003 uninsured patients were treated at 10 free clinics. Of these patients, 455 (2.7%) had a documented history of cancer, 9021 (53.1%) had no history of cancer, and 7527 (44.3%) had no documentation of cancer in their charts. Cancer patients were mostly women (305, 67.0%) and the average age was 55.2 years. Patients with cancer had significantly higher CCI scores compared to patients without cancer in 2016 (3.0 [2.0 SD] versus 0.94 [1.2 SD]), 2017 (2.71 [2.38 SD] versus 0.93 [1.26 SD]), and 2018 (3.27 [2.22 SD] versus 1.08 [1.26 SD]), p < 0.001. Patients with a cancer history were also more likely to be current drinkers (16.9% versus 13.0%) or smokers (17.8% versus 11.0%) compared to patients without a history of cancer. Conclusions: The results demonstrate that uninsured cancer patients consistently have higher levels of chronic disease and comorbidity compared to uninsured patients without a cancer diagnosis. This study increases awareness of the disease burden and mortality risk specific to uninsured cancer survivors which could inform free clinics and volunteer providers to better address the needs of this vulnerable population.

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A pilot study to implement and sustain the US PHS clinical practice guidelines for treating tobacco use and dependence in free clinics, a safety net care setting for the uninsured

The Journal of Smoking Cessation ◽

10.1017/jsc.2019.21 ◽

2019 ◽

Vol 15 (1) ◽

pp. 14-22

Author(s):

Kristie L. Foley ◽

Eunyoung Y Song ◽

Jessica Pockey ◽

Cindy Jones ◽

John G. Spangler ◽

...

Keyword(s):

Tobacco Use ◽

Care Setting ◽

Safety Net ◽

Free Clinics ◽

Community Partner ◽

Cross Sectional Survey ◽

Uninsured Patients ◽

Cross Sectional ◽

Community Partners ◽

The Us

AbstractIntroductionUninsured patients are more likely than the general population to use tobacco and less likely to quit.AimsTo determine if the mode of delivering the PHS Guidelines influenced the effectiveness of smoking cessation among patients in a safety net setting.MethodsSix free clinics were randomly assigned to a training program delivered by an academic physician or community partner plus video support. A repeated cross-sectional survey of patients was conducted at three waves to assess effectiveness to promote quitting.ResultsTobacco use was triple the rate of the US population: 57.7% (Wave 1), 44.7% (Wave 2), and 48.9% (Wave 3). Patients were more likely to report receipt of at least one evidence-based strategy to promote quitting at Wave 2 (AOR = 2.33, 95% CI (1.18–4.58)). Patients treated in clinics trained by the community partner were significantly more likely to report receiving cessation assistance at Wave 2 (AOR 2.54, 95%CI 1.29–5.00) and the trend was similar, but not significant at Wave 3. Patients in the community partner-led arm were significantly less likely to report tobacco use at Wave 3 (AOR 0.59, 95% CI 0.35–0.99).ConclusionsImplementation of the PHS Guidelines in free clinics demonstrates preliminary efficacy, with delivery by community partners offering greater scalability.

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Dermatologic care of uninsured patients managed at free clinics

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2019.03.010 ◽

2019 ◽

Vol 81 (2) ◽

pp. 433-437 ◽

Cited By ~ 1

Author(s):

Noura Ayoubi ◽

Abu-Sayeef Mirza ◽

Justin Swanson ◽

Rema Hamoui ◽

Rahul Mhaskar

Keyword(s):

Free Clinics ◽

Uninsured Patients

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Chronic disease and socioeconomic factors among uninsured patients: A retrospective study

Chronic Illness ◽

10.1177/1742395319828430 ◽

2019 ◽

pp. 174239531982843 ◽

Cited By ~ 1

Author(s):

Shams Rahman ◽

Abu-Sayeef Mirza ◽

Deanna Wathington ◽

Shikerria Green ◽

Yeshuwa Mayers ◽

...

Keyword(s):

Low Income ◽

Chronic Conditions ◽

Older Patients ◽

Chronic Obstructive ◽

Free Clinics ◽

Health Care Needs ◽

Care Needs ◽

Uninsured Patients ◽

Obstructive Pulmonary Disease ◽

Artery Disease

Objectives Uninsured patients represent an understudied population. The current study aimed to estimate the burden of 10 common chronic conditions and to investigate the associated factors among patients who use free clinics for their health care needs. Methods Patient charts from four free clinics were reviewed from January to December of 2015. Proportion of prevalence, adjusted odds ratios (AOR), and 95% confidence intervals (CI) for associations between participant characteristics and chronic conditions are reported. Results Prevalence of hypertension and hyperlipidemia significantly differed by clinic, age, gender, race, and marital status. Compared to age 15–44 years, older patients (45–64 years, and ≥65) were 5–10 times more likely to suffer from hypertension. Compared to women, men; compared to White, African-Americans; and compared to single, married patients had higher prevalences of hypertension. Older patients were 5–8 times more likely to suffer from hyperlipidemia. Asians, and married patients were also more likely to experience hyperlipidemia. Prevalence of diabetes, depression and arthritis significantly differed by age and race. Prevalence of coronary artery disease and chronic obstructive pulmonary disease increased 6–13 folds among older patients. Discussion Patients of free clinics suffer from high burden of chronic conditions. Patients who frequent free clinics are primarily older, unemployed, women, minorities, and are of low income.

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