Experience and Attitudes Toward Telehealth in Student-Run Free Clinics (SRFC).

INTRODUCTION/OBJECTIVES: Telehealth services expanded during the coronavirus disease 2019 (COVID-19) pandemic. Student-run free clinics (SRFC) deliver important health care services to underserved populations, who may face barriers to telehealth use. This study characterizes telehealth usage, experiences, and attitudes among individuals working in SRFCs. METHODS: In November 2021, a survey adapted from the COVID-19 Healthcare Coalition Telehealth Impact Physician Survey was sent to all registrants who identified themselves as students at the 2020 Society of Student-Run Free Clinics Annual Conference. RESULTS: Thirty-eight individuals of 576 registrants (7%) representing 21 of 88 (24%) SRFCs completed the survey. Twenty-one (58%) individuals reported using telehealth in their clinic. Those that did not cited lack of infrastructure as a barrier (eg, broadband, Internet challenges, technology investments), were more likely to serve homeless (P = .01), and less likely to serve non-English speaking populations (P = .02). There were increases in telehealth and decreases in in-person visits after March 11, 2020 though changes did not reach statistical significance. At least 15 (68%) wanted to continue chronic disease management, preventative care, and mental/behavioral health via telehealth after COVID-19. Most felt that telehealth was easy to use and improved the health, safety, and timeliness of care of patients, but not work satisfaction or access to care. Difficulty accessing physical devices, Internet, and data was the most-cited barrier to maintaining and accessing telehealth. CONCLUSIONS: Nearly all participants cited significant benefits and barriers to telehealth that impacted perceived access to care and sustainability. SRFCs' experiences may be modulated by their underserved populations and role in student education. Addressing barriers, particularly patient- and clinic-level technology challenges, could work to improve inequities in telehealth uptake.

A performance analysis of diabetic retinopathy screening at a student-run free clinic before and during the COVID-19 pandemic period

Purpose : To evaluate the impact of the COVID-19 pandemic on diabetic retinopathy screening (DRS) to uninsured, predominantly Latino patients at the UC San Diego Student-Run Free Clinic Project (SRFCP). Methods : A retrospective analysis of the electronic medical records of all diabetic patients seen in the years 2019, 2020, and 2021 (N = 196, 183, and 178 respectively) at the SRFCP was performed. Ophthalmology specialty clinic metrics from before, during, and after the COVID-19 pandemic-related lockdowns were compared to assess the impact of the COVID-19 pandemic lockdowns on DRS rates. All statistical analyses were performed in Microsoft Excel. Results : In patients with available demographic data (N=164), 92.1% were Latino, 69.5% female, with a mean age of 58.7 years (SD=10.6). A chi-squared test for goodness of fit showed that the distribution of patients seen (p<0.001), referred (p=0.012), or scheduled (p<0.001) in 2020 and 2021 differed significantly when compared to 2019. In 2019, 99 (50.5%) of 196 patients requiring DRS were referred, of which 97 (49.5%) were scheduled, and 89 (45.4%) were seen by the ophthalmology clinic (Figure 1). In 2020, a similar percentage of patients were referred (76/183 patients, or 41.5%), but the number of patients scheduled and seen dropped to 37 (20.2%) and 21 (11.4%), respectively. In 2021, clinic performance recovered with 113 (63.5%) of 178 patients eligible for DRS referred, 100 (56.2%) scheduled, and 82 (46.1%) seen. No-shows and cancellations constituted 12 (12.4%) and 6 (6.2%) of the 97 encounters in 2019. Conversely, of the 37 encounters scheduled in 2020, the no-show (10.8%) and cancellation (40.5%) rates were notably higher. Conclusions : The COVID-19 pandemic significantly diminished the delivery of eye care to patients at the SRFCP. 2020 saw a meaningful decline from 2019 in all clinic performance metrics which was reversed in 2021. These results show the current need for annual DRS surpassed the ability of the ophthalmology specialty clinic to schedule and deliver care to these patients in all years evaluated, especially in 2020 due to COVID-19 restrictions. SRFCP patients may benefit from telemedicine-based DRS programs such as remote imaging during primary care visits to further improve screening capacity. (Figure Presented).

RELATIONSHIPS BETWEEN VACCINE CONFIDENCE AND VACCINE UPTAKE AT A STUDENT-RUN CLINIC FOR THE UNINSURED IN EAST HARLEM

BACKGROUND: The East Harlem Health Outreach Partnership (EHHOP) is a student-run clinic that serves a particularly vulnerable patient population lacking access to basic health insurance, largely because many do not meet USA residency requirements. COVID-19 has exacerbated the existing health disparities faced by our patients, who are predominantly Black and/or Hispanic/Latino living in East Harlem, one of the hardest hit neighborhoods in NYC. We hypothesized that high engagement in longitudinal care through the student-run clinic is associated with especially high rates of vaccine confidence and vaccine uptake. METHODS: This study included phone interviews with 63 EHHOP patients between 12/13/20 and 3/3/21. We asked 14 questions in order to measure vaccine confidence, COVID-19 sentiment, and patient trust. Patients were ages 21-78 with an even distribution of male and female patients. Most interviews were conducted in Spanish with professional translators, and the survey was created both in English and Spanish. All questions were scored on a 1-5 scale of agreement with a given. Patients were then followed through December of 2021 in order to ascertain vaccine uptake over time. RESULTS: 95.2% of those interviewed are now confirmed to be vaccinated (60/63), 3.2% have refused (2/63), and only 1.6% have unknown status (1/63). Both patients who chose not to be vaccinated had responded they were unlikely to get the COVID-19 vaccine. When comparing those likely to get the vaccine versus those who were not, the most highly significant differences in scores came when asking whether patients are more likely to take the vaccine due to their physician recommending it, and when asked whether they generally trusted those recommending they get the vaccine (p = 4.8E-5 and 4.3E-6 respectively). The next most significant differences were in perceptions of whether the vaccine would be effective and whether they felt the vaccine was created too quickly (p = 3.3E-2 and 5.3E-3 respectively). We also have precise day of first dose information for 51/60 vaccinated respondents. While there may be confounders, we found that choosing to be vaccinated earlier correlated most significantly with whether individuals were likely to take the vaccine, whether the trusted those recommending the vaccine, and whether they felt the vaccine was created too quickly (p = 3.6E-2, 1.5E-2, and 1.4E-2 respectively). CONCLUSIONS: These data indicate that the strongest predictors of vaccine uptake rate and timing are not just vaccine confidence in general, but specifically trust in those recommending the vaccine. This indicates that even in the context of marginalized populations often underserved by the healthcare system, longitudinal trust-building relationships may be a significant part of successful vaccine uptake. Those with the highest burden of disease should be given preferential treatment with high-quality, longitudinal care, and such care is shown to make a great difference in the context of vaccine uptake.

Assessment of a Student-Run Free Gender-Affirming Care Clinic's Transition to Telehealth.

Background: Transgender and Gender-Nonconforming (TGNC) people continue to experience severe health discrimination and limited access to care. Methods: Using survey data collected during August-September, 2020, we report on our findings regarding volunteer provider and patient satisfaction with a student-run free gender-affirming care telehealth clinic at the University of North Carolina at Chapel Hill School of Medicine. Results: We find that patients report overall excellent experiences with telehealth care, primarily due to decreased transportation burden, more efficient use of time, and more frequent communication with student volunteer providers. Conclusion: Our findings show that telehealth is a viable option for student-run clinics in the TGNC community.

Diabetes Control in a Student-Run Free Clinic During the COVID-19 Pandemic.

Student run free health clinics (SRFCs) provide medical care to vulnerable populations in communities throughout the United States. The COVID-19 pandemic had a significant impact on the delivery of healthcare services and demanded a rapid adjustment in care delivery methods in both resource-rich and resource-poor settings. The aim of this study is to evaluate the impact of the pandemic on the management of chronic disease, specifically diabetes. Patients with diabetes who received care continuously throughout the pre-pandemic (face-to-face) and pandemic (telehealth) study periods at MedZou Community Health Center, a SRFC located in central Missouri, were evaluated. This sample of patients (n = 29) was evaluated on six quality measures including annual eye exams, blood pressure, hemoglobin A1c, chronic kidney disease monitoring, flu vaccination, and statin therapy. Overall diabetes care, as measured by the number of quality measures met per patient, decreased by 0.37 after the onset of the pandemic. The median COVID-era ranks were not statistically significantly different than the pre-pandemic ranks (z = 1.65, P = 0.099). Fewer patients received an influenza vaccination the year following the onset of the pandemic (10.3%) compared to the year before the pandemic (37.9%; difference in proportions 0.276, 95% CI 0.079, 0.473; p = 0.005). No other individual measures of diabetes care statistically differed significantly in the year after the pandemic began. Twenty-six (90%) patients received diabetes care using telehealth after the onset of the pandemic. Diabetes care using telehealth in a SRFC may be an acceptable alternative model when face-to-face visits are not feasible. Observed decreases in diabetes-related clinical quality measure performance warrant further study.

Responding to COVID-19: Implementing a Telemedicine Program at a Student-Run Free Clinic.

Introduction: Telemedicine has enabled access to care during the COVID-19 pandemic. This article describes the creation and implementation of a telemedicine clinic in a student-run free clinic (SRFC) serving uninsured patients in Tampa, FL. Methods: A new workflow was developed for a telemedicine clinic, including a screening algorithm to determine appropriateness for telemedicine appointments. Volunteer students and providers conducted patient remote visits that allowed students to have service-learning experiences. Analysis of patient visits between March 31, 2020, and July 23, 2020, was conducted. Study protocol was reviewed by the Institutional Review Board and an exemption was obtained. Results: Eighty-four visits were conducted for 58 unique patients. Seventy-two percent were female and 88% were of Hispanic or Latino origin. Forty-four students and 33 physicians volunteered. The majority of visits were general follow-ups (83%) followed by psychiatry (11%) and cardiology (6%). Conclusion: Telemedicine is a viable method of providing care for an at-risk uninsured population at an SRFC. It can also enhance service learning for medical student volunteers.

Impact of the COVID-19 Pandemic & Telehealth Implementation in a Student Run Free Clinic.

Student run free clinics (SRFCs) fill a void in healthcare access for many communities and have been subject to unprecedented shifts in care delivery brought about by the coronavirus disease 2019 (COVID-19) pandemic. Our single-center institution serving uninsured patients in central Missouri switched from in-person visits to strictly telehealth visits with the onset of the pandemic. This study investigated the impact of the pandemic and the switch to telehealth on the clinic return rates by ethnicity, race, gender, rurality, and age. The pandemic led to a 47.4% reduction in the number of monthly patient encounters. Of the established SRFC population (N = 309), only 87 patients (28.2%) returned for a telehealth visit during the COVID-19 pandemic. Older patients (≥ 45 years old) were more likely to return (OR 1.71, 95% CI 1.02-2.85) for care via telehealth after the onset of the pandemic than younger patients (< 45 years old). No differences in the likelihood of returning for a telehealth visit were identified by race, ethnicity, gender, or rurality. Telehealth offers an effective solution to the complex problems faced by SRFCs during the COVID-19 pandemic and has not added barriers to care with regards to race, ethnicity, gender, or rurality at our SRFC.

Influenza vaccine community outreach: Leveraging an interprofessional healthcare student workforce to immunize marginalized populations.

Vulnerable populations such as the uninsured, unemployed, and unhoused face significant morbidity and mortality from influenza but are less likely to receive the annual vaccine and have limited access to medical care. We describe an interprofessional, student-run vaccine outreach program (VOP) in Davidson County, Tennessee that lowers barriers to vaccination through free vaccination events in nontraditional community locations. We provide this framework as a model to expand novel, seasonal, or outbreak-oriented vaccine outreach to resource-poor populations. Demographic data were collected from the patients who received an influenza vaccine between 2015 and 2019 through an optional survey to determine whether these events were reaching unhoused, uninsured, and/or unemployed individuals. Of 1,803 patients, 1,733 (96.1%) completed at least one field of the demographic form. Overall, 481 (27.8%) were individuals without homes or living in temporary housing and 673 (38.8%) were unemployed. Most patients, 1,109 (64.0%), did not have health insurance at any point during the prior two years. With the addition of a nurse practitioner student to VOP leadership, the 2018-2019 VOP reached the most unhoused or temporarily-housed (228, 32.3%), unemployed (313, 18.5%), and disabled (60, 8.5%) patients. The VOP can be adapted to meet community needs, funding, and volunteer interest. The VOP model may be applicable to a SARS-CoV-2 vaccine, especially since the economic impact of COVID-19 has increased unemployment rates and housing instability. Healthcare students serve as an eager, underutilized resource who can be leveraged to disseminate vaccines to individuals with limited access to care.

Implementation of a medical student-run telemedicine program for medications for opioid use disorder during the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic led to the closure of the IDEA syringe services program medical student-run free clinic in Miami, Florida. In an effort to continue to serve the community of people who inject drugs and practice compassionate and non-judgmental care, the students transitioned the clinic to a model of TeleMOUD (medications for opioid use disorder). We describe development and implementation of a medical student-run telemedicine clinic through an academic medical center-operated syringe services program. METHODS: Students advertised TeleMOUD services at the syringe service program on social media and created an online sign-up form. They coordinated appointments and interviewed patients by phone or videoconference where they assessed patients for opioid use disorder. Supervising attending physicians also interviewed patients and prescribed buprenorphine when appropriate. Students assisted patients in obtaining medication from the pharmacy and provided support and guidance during home buprenorphine induction. RESULTS: Over the first 9 weeks in operation, 31 appointments were requested, and 22 initial telehealth appointments were completed by a team of students and attending physicians. Fifteen appointments were for MOUD and 7 for other health issues. All patients seeking MOUD were prescribed buprenorphine and 12/15 successfully picked up medications from the pharmacy. The mean time between appointment request and prescription pick-up was 9.5 days. CONCLUSIONS: TeleMOUD is feasible and successful in providing people who inject drugs with low barrier access to life-saving MOUD during the COVID-19 pandemic. This model also provided medical students with experience treating addiction during a time when they were restricted from most clinical activities.