Access to musculoskeletal specialists and resources in free and charitable clinics: a survey of clinic directors.

OBJECTIVE: To evaluate the capabilities and resources of free and charitable clinics in the United States to deliver musculoskeletal care to an indigent population. DESIGN: A voluntary, anonymous, cross-sectional survey. SETTING: Electronic mailing list for the National Association of Free and Charitable Clinics in September 2011, and in person at the Annual Summit for the National Association of Free and Charitable Clinics in October 2011. At the time of survey, 427 member-clinics were eligible for participation. PARTICIPANTS: One hundred forty-five (34%) respondents were included in data analysis. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Answers to a questionnaire regarding access to musculoskeletal care. RESULTS: The average annual clinic volume was 5690 patient visits. Low back pain was the most common orthopedic complaint. Access to musculoskeletal specialty consultants was rated as poor or worse in 83% of clinics surveyed. The majority of respondents (63%) believed that their staff was able to treat only half or fewer of the patients who presented with musculoskeletal complaints in their clinic. The resource most needed to treat these conditions was musculoskeletal physician consultants. CONCLUSIONS: Indigent populations have a strong need for musculoskeletal care, but affordable access to physiatrists and other musculoskeletal specialists is extremely limited. Personnel at surveyed clinics believed that the greatest need to improve care is better access to these specialty physicians.

Environmental policies, politics, and community risk perception: case study of community contamination in Casper, Wyoming.

OBJECTIVES: We identify and explain factors that affected a community's perception of risk due to extensive industrial contamination and people's distrust of government agencies regarding the environmental investigations. METHODS: Intrinsic bounded case study methodology was used to conduct research about extensive environmental contaminations due to activities of an oil refinery in North Casper, Wyoming, and the citizens' response. Data were collected from multiple sources that included public testimonies, observations, public hearings and meetings minutes, newspaper articles, archived records obtained from federal and state environmental and health agencies, as well as industry records obtained through Freedom of Information Act (FOIA) requests. FINDINGS: The overarching theme that emerged was lack of trust due to several critical events and factors such as no response or delay in response time to community concerns, lack of transparency, perceived cover up, vague and fragmented communication by government and state officials, perception of pro-industry stance, and perceived unfair treatment. DISCUSSION AND CONCLUSION: People's perception of environmental risks and their willingness to accept official explanations and outcomes of environmental investigations are strongly affected by their direct experiences with government agencies and the evidence of influence the powerful industries exert over relevant investigations. The government cannot successfully address public and community concerns about environmental health impacts of contaminations and in turn the public perception of risk unless it adopts and implements policies, procedures, and protocols that are clear, timely, transparent, and free from industry influence.