Continuity of care in a student-run free clinic

Medical students training in exam room

The modern-day U.S. health care system acknowledges that in order to proficiently meet all needs of the patient population, it must make patient-centered care the focal point of treatment approaches. When providers closely cooperate with patients, they establish a framework of patient values and provide higher quality treatment. As health care continues to expand to new environments of care delivery, health care stakeholders must define and evaluate the incorporation of patient-centered care.


One setting of health care delivery is the student-run free clinic (SRFC). These clinics provide invaluable clinical experience for about 70% of medical students, while serving as a source of health care for medically underserved or uninsured patient populations.  
 

Evaluating patient-centered care in student-run free clinics

Cory Roth, a fourth-year medical student at The Ohio State University College of Medicine, and Robert Cooper, MD, associate professor of Emergency Medicine at The Ohio State University College of Medicine, evaluated the ability of SRFCs to support continuity of care, an important pillar of the patient-centered model.

Through the Columbus Student-Run Free Clinic Longitudinal Care Program (LCP), sponsored by the Ohio State College of Medicine, Roth and Dr. Cooper studied the effect that regular chronic care may have on a patient’s risk for developing atherosclerotic cardiovascular disease (ASCVD). Focusing on continuity of care and coordination, the LCP matched each free clinic patient with one fourth-year medical student volunteer provider over a span of 12 months. The program also provided medication and lifestyle coaching via quarterly check-ups.

Using electronic medical health records, Roth and Dr. Cooper retrospectively studied three patient populations: LCP participants, episodic visitors and infrequent visitors. Establishing a baseline, he examined co-morbidities, smoking status, blood pressure and other markers that influence risk for ASCVD.

“We chose ASCVD risk as our primary outcome because it consists of modifiable risk factors susceptible to change through coaching, thus serving as a good measure of longitudinal chronic care benefits,” says Dr. Cooper.

Their study found that those who received LCP care at the same time intervals of those who did not presented equally lowered risks for ASCVD. Roth and Dr. Cooper concluded from this finding that the LCP’s continuity of care principle had no substantial effect on patient outcomes. However, they found that the outcomes of these patient groups were significantly better than those who received episodic care nine months apart or more. The team concluded that fourth-year medical students can lead a team that provides high-quality care in a free clinic environment. However, they recommend long-term studies to fully define the effect of care continuity in SRFCs.

“We suggest that SRFCs continue to assess the patient care outcomes for two reasons: a central tenet of service learning is a reciprocal benefit between both parties involved, and evidence-based practice is an essential dogma of modern patient care,” says Roth. 
 

Committed to health care delivery reform

Roth’s and Dr. Cooper’s efforts to streamline the mechanisms of care delivery within SRFCs allow these programs to better equip medical students to provide quality, patient-centered care in primary care environments.

It’s important to note the role that SRFCs may have in restructuring the current U.S. health care system. Though current health care reform emphasizes preventive care, the U.S. medical community contains a shortage of primary care providers as many pursue tertiary care positions. Not only have SFRCs been proven to improve student knowledge, skills and efficacy, these programs tend to steer more medical students to pursue primary care. In addition, SFRCs provide medical students with early exposure to diverse populations, including the homeless and refugees. Students can then utilize the lessons learned throughout their careers to better understand and care for their patients.



“In recent years, primary care has expanded to focus on patients’ housing needs, mental health needs, food needs and social needs,” says Dr. Cooper. “Medical students going into primary care will be expected to work within a multidisciplinary team to address all the social determinants of health of a patient.”

The team will continue to cultivate multidisciplinary team values in an effort to mitigate these access barriers to care.

“We believe that social determinants of health are the critical component of continuing to improve our patients’ health SSRFCs. To that end we are focusing on a team-based approach involving students from multiple disciplines,” Dr. Cooper says. “We recently started a psychiatry clinic and law clinic at the Columbus Free Clinic to both provide these necessary services to our patients, but also to teach our students the importance of an interprofessional team based approach that focuses on patients’ social needs as much as their medical needs.”