UTILIZATION OF FREE HEALTH CLINICS IN AN UNDERSERVED

UTILIZATION OF FREE HEALTH CLINICS IN AN UNDERSERVED POPULATION Christina Kim, Marium Khan and Theresa Osunero

Background Information: U. S. Statistics 2009: 50. 7 million 1 uninsured From 2008 – 2009: people sponsored by employment-based health insurance decreased 3. 3%1 $2. 5 trillion spent on health care in 20092 Unemployment rate rose to 9. 6%, compared to 4. 5% in 20072

Background Information Causes of an increase in the uninsured population: Decrease in employment-based health insurance Increase in the cost of health care Patient Protection and Affordable Care Act: Still leaves approximately 23 million people without insurance coverage

Free Health Clinic Defined Private, nonprofit, community-based organization Primary and secondary medical care Dental care Pharmaceutical Laboratory Mental health services

Purpose of Free Health Clinics Over 1, 000 free clinics distributed across the United States 3 Nationally, free clinics serve 38% of the uninsured population 2008 - 2009, visits to community health centers by uninsured patients increased by 21%4 Providing a safety net for underserved populations

Demographics of Patients Nationally Low-income Uninsured Disproportionately female Age: 20 -44 years old 5 Nearly half came from rural areas 6

Top Three Conditions Top three chronic conditions diagnosed: 1. Cardiovascular disease 2. Hypertension 3. Diabetes Nearly one third of the uninsured nonelderly U. S. adults had at least one chronic condition 7 Approximately three times more likely to seek care for chronic conditions compared to insured patients who go to physician offices 5

Champaign County Christian Health Center (CCCHC) Mid-sized organization that provides free, holistic, quality health care from volunteer physicians to anyone who lacks health insurance 8 Opened Fall 2004, once a week for three hours in the evening Served over 2, 000 patients in Champaign County 9

Purpose of Research Study Determined the demographic characteristics of the uninsured people who utilized the free health clinic Determined the purpose for client visits

Methods Collected over 2, 000 paper medical records from all patient visits from 2004 – 2009 Chi-square analysis performed using SPSS 17. 0 Conditions categorized into ICD 10 Chapters Data collected: Address, year of birth, gender, blood pressure, height, weight, smoking status, health history, social service needs, and medical condition

Results: Patient Reason for Visit Table 1. Patient Visits Patient Reasons for Visit Percent of Patient Visits Medical Condition 72. 5 Test or Exam 21. 1 Prescription Refills Percentage of patient visits is based on data collected at CCCHC 6. 4

Results: ICD-10 Chapters Percentage of Client Visits Clinic Top ICD-10 Chapters % of Patient National Top ICD-10 Chapters Visits % of Visits Diseases of the Respiratory System 16. 3 Diseases of the Respiratory System 10. 6 Diseases of Circulatory System 14. 9 Mental and Behavioral Disorders 7. 2 Mental and Behavioral Disorders 12. 4 Endocrine, Nutritional, and Metabolic Disorders 7. 0 Disease of the Musculoskeletal System and Connective Tissue 9. 4 Symptoms, Signs, and Abnormal Clinical and Laboratory 6. 9 Diseases of the Digestive System 7. 9 Findings, Not Elsewhere Classified 6. 6

Results: Health Condition Breakdown Into Percentages Table 3. Health Condition Breakdown in Percentages Patient Characteristics Clinic County Illinois U. S. BMI Average Normal weight Overweight Obese 28. 7 42. 5 26. 0 31. 5 n/a 45. 8 35. 9 18. 5 n/a 35. 5 37. 1 27. 4 26. 5 36. 0 36. 2 26. 9 BLOOD PRESSURE Normal Pre-Hypertension 36. 0 37. 5 28. 0 76. 9 n/a 23. 1 71. 0 n/a 29. 0 43. 7 25. 0 31. 3 SMOKING STATUS Smoker 36. 8 19. 0 18. 8 17. 9 DEPRESSION 6. 3 4. 9 6. 5 6. 7

Results: Demographics of Patient Population Table 4. Demographic Breakdown in Percentages Patient Characteristics Clinic County Illinois U. S. Male 44. 0 50. 9 49. 3 Female 56. 0 49. 1 50. 7 Average 39. 3 28. 0 35. 9 36. 7 18 -64 90. 0 70. 4 63. 0 62. 8 65 + 6. 2 10. 1 12. 4 100. 0 20. 3 13. 4 15. 3 GENDER AGE (years) UNINSURED

Discussion: Conditions No one condition exceedingly common Most frequent reason for visit Physical exam (17%)

Discussion: Demographics Clinic patients were female (56%) Patients at the clinic were 18 -64 years olds (90%) County residents (70%)9

Discussion: Medical Conditions (ICD-10) 1. Diseases of the Respiratory System (16. 3%) Accounted asthma for symptoms as well as diseases such as 2. Diseases of the Circulatory System (14. 9%) Hypertension (28%) Single most common medical condition diagnosed at clinic 3. Mental & Behavioral Disorders (12. 4%) Depression (12%) Could be attributed to the stress of living in poverty and being uninsured

Discussion: ICD-10 Diseases of Circulatory System Elevated percentage of hypertension, obesity, and smoking seen in clinic patients Leading contributors to developing cardiovascular disease High prevalence unknown Percentage of Patients Diagnosed with Hypertension Clinic County Illinois 28. 0 23. 1 29. 0 Percentage of Patients Diagnosed Obesity Clinic County Illinois 31. 5 18. 5 27. 4 Percentage of Smokers Clinic County Illinois 36. 8 19. 0 18. 8

Discussion: Homeless Population 121 non-residential addresses Common places known to shelter the homeless: Local churches Homeless shelters Other community organizations Worse health conditions and more health care needs Higher rates of medical conditions than the general clinic population

Limitations Hours Only about 5% of the total uninsured population in the county Lack of standardization and inconsistency in documentation Records did not provide ethnicity, which restricted comparisons to previous studies Census 2000 demographic information was used which may have been outdated at the time of the analysis

Conclusion Clinics should offer a full spectrum of services Future studies could explore Improvement of a health care delivery system High prevalence of smoking Obesity Self-reported social service needs Utilization of the clinic by the area’s homeless population

References 1. U. S. Census Bureau. Income, poverty, and health insurance coverage in the United States: 2009. Washington, DC: U. S. Department of Commerce, 2010. 2. Davis, Karen (2010). New Report on National Health Expenditures Underscored Need for Comprehensive Health Care Reform. The Commonwealth Fund. Retrieved from http: //www. commonwealthfund. org/Content/News-Releases/2010/Feb/New-Report-on-National-Health-Expenditures-Underscores-Need-for-Comprehensive-Health-Care-Reform. aspx 3. Bureau of Labor Statistics. Local area unemployment statistics. Washington, DC: United States Department of Labor, 2010. 4. Redlener I, Grant R. America’s safety net and health care reform—What lies ahead? New England Journal of Medicine. 2009 Dec 3; 361(23): 2201 -2204. 5. Rosenbaum S, Jones E, & Shin P. Community health centers: Opportunities and challenges of health reform. The Henry J. Kaiser Family Foundation, 2010. Available at http: //www. kff. org/uninsured/8098. cfm. 6. Keis RM, De. Geus LG, Cashman S, et al. Characteristics of patients at three free health clinics. Journal of Health Care for the Poor and Underserved 2004; 15: 603 -617. Wilper AP, Woolhandler S, Lasser KE, et al. A national study of chronic disease prevalence and access to care in uninsured U. S. adults. Annals of Int Med 2008 Aug 05; 149(3): 170 -176, 7 p, 4 charts 8. Champaign County Christian Health Center (on-line). Available: www. ccchc 2003. org/home. 9. U. S. . Census Bureau. State and county quick facts: Illinois. Washington, DC: U. S. Department of Commerce, 2010 10. Issacs SL & Jellinek P. Grant Watch Report: Is there a (volunteer) doctor in the house? Free clinics and volunteer physician referral networks in the United States. Health Affairs 2007; 26(3): 871 -876. 11. Nadkarni MM & Philbrick JT. Free Clinics and the Uninsured: The increasing demands of chronic illness. Journal of Health Care for the Poor and Underserved 2003 May; 14(2): 165 -174. 12. County Health Rankings. Snapshot 2010 Champaign, IL. Retrieved from http: //www. countyhealthrankings. org/illinois/champaign 13. U. S. Census Bureau. Illinois: 2006 -2008 American community survey 3 -year estimates. Washington, DC: U. S. Department of Commerce, 2008. 14. U. S Census Bureau. Current Population Survey: Annual Social and Economic Supplement 2007. Washington, DC: U. S. Department of Commerce, 2008 15. Behavioral Risk Factor Surveillance System. County level prevalence data. Champaign, 2007 -2009. Springfield, IL: Illinois Department of Public Health. 16. Center for Disease Control and Prevention. High blood pressure facts. Atlanta, GA: National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention, 2010. 17. Behavioral Risk Factor Surveillance System. Prevalence and Trends Data. Centers for Disease Control and Prevntion, 2009. 18. Behavioral Risk Factor Surveillance System. Illinois and Strata area prevalence data. Champaign, 2007 -2009. Springfield, IL: Illinois Department of Public Health. 19. Community Health Status Indicators. Vulnerable Populations – Champaign County, IL. Department of Health and Human Services, 2009. 20. Hing E, Hall MJ, & Xu, J. National Health Statistics Reports. National hospital ambulatory medical care survey: 2006 Outpatient department summary. Atlanta, GA: Centers for Disease Control and Prevention, 2008.

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Thank you to the Provost Office and the Undergraduate Research Symposium