Background: Street Health is a student-run free clinic with the goal of serving people experiencing homelessness in Norfolk, Virginia and the surrounding area. The purpose of this quality improvement project was to assess the demographics, common medical conditions, and treatments provided to Street Health patients during the clinic’s first 15 months. Methods: Data was collected from the 136 patients seen at Street Health from 1/1/2019 to 3/15/2020 which included demographic information, vital signs, labs, reason for visit, diagnosis, and treatment plan. Results: The median age was 52 years and 70.5% of patients were male. The majority of patients were African American (71.5%) and many were uninsured (33.7%). The most common conditions that patients presented with were categorized as: musculoskeletal (47.4%), cardiovascular (19.8%), and skin (18.1%). Although 55 patients reported having a chronic medical condition, oftentimes, the primary reason for visit was for acute symptoms such as joint pain or skin lesions. Of the 55 patients who reported having a chronic medical condition, 18 of those were psychiatric. Conclusion: By understanding what clinical conditions our patients are most in need of treatment for, Street Health hopes to provide targeted care and implement interventions specific to the needs of our population. This study highlights the need to treat the acute concerns that homeless patients seek care for in addition to thoroughly assessing for underlying chronic conditions. To adequately care for chronic conditions in the homeless population, Street Health must foster trust among its patients, and partnerships must be formed to provide longitudinal care.

Background: The Mitchell Wolfson Sr. Department of Community Service (DOCS) is a medical student-run organization offering free healthcare to underserved patients in Florida via ten annual health fairs and four weekly clinics. The South Dade Health Fair (SDHF) serves a rural, migrant population with poor healthcare access with operations successfully maintained throughout the COVID-19 pandemic. This study aims to analyze the health metric trends of patients attending SDHF before and during the COVID-19 pandemic. Methods: De-identified data from three pre-pandemic fairs (2017-2019) and three during-pandemic fairs (2021-2023) was extracted from REDCap and analyzed in SPSS using independent samples t-tests. Key metrics included blood pressure, glucose levels, body mass index, lipid profiles, and T-scores. Results: Over six years, 394 patients received care across 467 encounters (291 pre-pandemic, 176 during-pandemic). Most attendees were females (71.1% pre-pandemic, 65.9% during-pandemic) in their mid-40s. Cohorts were demographically similar except for preferred language and health insurance type. In the during-pandemic cohort, there were significant increases in mean systolic BP (123.5 to 133.4), total cholesterol (176 to 188), LDL (99 to 108), and non-fasting glucose (94.1 to 124.6), and significant decreases in mean HDL (52 to 49) and T-score (0.01 to -0.81).There was a statistically insignificant trend toward an increase in mean BMI between the two cohorts. A sub-analysis of patients who attended both pre-and-during-pandemic fairs yielded similar results. Conclusions: Our data demonstrate statistically significant changes in parameters that portend worse cardiovascular outcomes in the aggregate cohort and amongst repeat patients. These findings suggest a need for interventions to address hypertension, diabetes, dyslipidemia, and osteoporosis in this community.

Background: Nearly half of United States adults were unvaccinated for influenza in 2022. Suboptimal vaccination rates remain a public health challenge affecting individual and community health. Influenza vaccination hesitancy (IVH) and limited access are especially prevalent among underserved communities. A promising way to combat IVH is through student-led community interventions. The organization Student-Run and Collaborative Outreach Program for Health Equity (SCOPE) at the Penn State College of Medicine (PSCOM) collaborated with community leaders to provide free influenza vaccinations in Central Pennsylvania (PA). We aim to analyze the impact of a student-led clinic on vaccination access and characterize vaccination-related community perceptions and behaviors. Methods: This was a retrospective study. Two health fairs, “Family Wealth Through Health” (FWTH) and HANNA Pantry (HP), in rural PA and urban PA, respectively, were held at the beginning of the flu season (September-October 2022). Surveys assessing vaccine recipient demographics, vaccination status in the previous year, and motivation/intent to vaccinate, were administered. Results were analyzed using chi-square and t-tests. Results: Of 51 respondents, 18 (35.3%) were from FWTH and 33 (64.7%) from HP. Race differed significantly (p<0.001) between sites but age (p=0.203) and sex (p=0.754) did not. One-fifth were unvaccinated the prior year, with reasons being “forgetting,” “health,” “cost,” and “time.” Six participants received vaccinations despite not planning to. Over half reported “doctor’s office” as preferred location for vaccination, others being “pharmacy”, “community health clinic”, “work”, and “store.” Over 20% received earlier-than-planned vaccination at our clinic. Finally, coronavirus disease 2019 (COVID-19) impacted 13.3% of respondents’ willingness to get vaccinated, significantly correlated with prior vaccination status (p=0.011) but not vaccination plans in the current season (p=0.628). Conclusions: Direct influenza vaccination delivery by medical students in rural and urban Central PA improved vaccination uptake, access, and timeliness. Qualitative analysis revealed sociodemographic factors affecting IVH warranting consideration by student-led clinics.

Background: Patients seeking care at student-run free clinics tend to have complex medical histories and require access to a variety of resources and specialties. Student-run free clinics, as a result, often will collaborate with other organizations, health systems, and interprofessional healthcare workers to provide patients with a wide range of services to meet those needs. Unfortunately, student-run free clinics across disciplines continue to experience difficulties with providing patients with access to referrals comparable to what might be available in traditional fee-for-service settings. Some particular challenges include maintaining longitudinal partnerships with local health systems, ensuring patient follow-up, and holistically meeting a wide spectrum of patient concerns. Each student-run free clinic is unique in its clinical focus and operations, resulting in differing capacities to meet the various needs of their communities. Purpose: To describe generalizable strategies for overcoming challenges related to providing patients with access to referral services based on interprofessional discussions from the “Bridging the Gap” session at the Society of Student-Run Free Clinics 2023 Annual Meeting. Summary: Three main areas to improve referral services were identified: 1) utilizing internal referrals and incorporating data-tracking, 2) developing a community-centered database of healthcare resources and social services, and 3) addressing specific patient needs, including transportation to and from appointments. Future evaluation of these interventions should be completed to determine the efficacy and impact on patient outcomes.

Background: Homeless Health, Education, Awareness and Leadership in Street Medicine (HEALS) is a nonprofit, medical student-run organization. The mission of HEALS is to address the medical and psychosocial needs of people experiencing homelessness (PEH). Through street medicine outreach initiatives, HEALS works to improve health outcomes associated with unstable housing and limited access to healthcare. The HEALS Foot and Vaccine Clinic was developed to screen for and treat vascular insufficiency, chronic and acute wounds, and foot-related pathologies, and provide vaccinations to prevent infectious illnesses. This clinic also aimed to prevent exposure-related injuries by providing proper footwear and direct access to care. Aim: Our objective is to create a reproducible foot and vaccine clinic model for student-run clinics to address the needs of PEH through interprofessional collaboration and service learning. Methods: The event was funded through a crowdfunding campaign and donations and was hosted at a local shelter. Medical students and physicians employed by the medical school partnered with five community outreach programs to provide medical care. The Department of Health (DoH) administered vaccinations against common viral diseases. Results: Through crowdfunding campaigns, $6,646.00 was raised to contribute to the cost of boots, hygiene kits for attendees, and cleaning supplies, budgeted at $5,198.00. Forty-seven individuals experiencing homelessness were provided with foot care and twenty-six vaccines were administered. The DoH administered twelve hepatitis A, five coronavirus disease 2019 (COVID-19), and nine influenza vaccinations at this event. Successive members of HEALS have since replicated this model to replicate foot and vaccine clinics and expand outreach to the neighboring county, yielding increased event attendance and funding. Using this model, student-run free clinics may implement similar initiatives within their own communities to address the complex needs of PEH.

Background: The Saturday Clinic for the Uninsured (SCU) has an on-site dispensary that provides free medications to patients. Many patients request urgent refills when they run out leaving them without medications prior to their appointments. A prior study showed a reminder phone call can effectively assist with medication refills.1 However, little data exists for how to develop such a system at a free clinic. Our team implemented this methodology utilizing a system where patients were contacted before their medications ran out to arrange refills and analyzed its effectiveness. Methods: All clinic patients receiving medications from the on-site dispensary had their expected refill date logged. Patients 3 weeks away from needing a refill had their chart reviewed to determine if they should be contacted. When indicated, patients were contacted one time via telephone by students to assess their needs and schedule refills. System outcomes were gathered over 18 weeks and analyzed to determine the number of potential medication gaps prevented and system success rate. Results: 131 patient charts were reviewed for potential follow-up. 58 patients were contacted, of which 32 patients were reached and spoken with resulting in 32 refills scheduled. The system prevented 24.4% of potential medication gaps with a system success rate of 55.2%. Conclusion: This system successfully reduced medication gaps among patients. The most and least effective methods for scheduling refills were by directly speaking with patients and leaving voicemails respectively. A trend observed was a decrease in urgent patient calls regarding medication gaps. Future directions include making multiple contact attempts, using multiple contact methods including texts and emails, and evaluating adherence.

Background: Ophthalmology services at student run free clinics (SRFC) serve an important role for the socioeconomically underserved within a city. The coronavirus disease 2019 (COVID-19) pandemic has worsened gaps in care for ophthalmology tertiary clinics, but its effects on ophthalmology encounters at SRFCs are not known.
 Methods: This was a retrospective chart review from a single center that compared patient encounters in the ophthalmology SRFC six months prior to its closure (pre-COVID group) with patient encounters in the ophthalmology SRFC six months after its reopening (post-COVID closure group).
 Results: There was a decline (47.3%) in the number of encounters in the post-COVID closure group (n=20) when compared to the pre-COVID group (n=38). While the number of encounters for routine screening stayed about the same in both groups, there was a 90.5% decline in encounters with active disease (21 pre-COVID vs. 2 post-COVID closure). Sub-group analysis of the pre-COVID group showed that patients with active disease tended to have worse vision (-0.33 logMAR, p=0.034 OD; -0.27 logMAR, p=0.048 OS) than those undergoing routine screening.
 Conclusions: Patients in West Texas with active eye diseases are not presenting to SRFC after its reopening. Early recognition of this is critical to address the potential gap in care in a vulnerable population.

Aim: This study aimed to explore the clinic learning models through student perspectives using that insight to explore how these students viewed a newly established speech clinic program and understand the organizational and learning benefits and limitations of the clinic and how it can be improved for future service for student learning.
 Methods: This exploratory study utilized an observation analysis to understand how the student-led functioning of the clinic fits into both the learning models of Bloom’s Taxonomy and Bandura’s Triadic Reciprocal Model of Causality and the factors that contribute most to these learning models. These models were chosen due to the systemic and progressive nature of learning that reflects the academic mission of the university’s accrediting body: the Southern Association of Colleges and Schools Commission on Colleges. A mixed closed and open-ended student questionnaire was utilized to gain insight into themes that influence the student-led learning model.
 Results: The clinic was overall seen as a place of relationship building and skills development. The main contributors to this relationship-building and skills development lie in the ability of students to apply what they have been learning in the classroom to a functional situation, as well as the opportunity to serve the community and build confidence and leadership skills.
 Conclusion: Student leadership roles in the clinic are leading to self-efficacy which is seen in the highest level of Bloom’s Taxonomy and Bandura’s Triadic Reciprocal Model of Causality.

Background: St. Vincent's Clinic (SVC) is a free, student-run clinic affiliated with the University of Texas Medical Branch that has been an invaluable resource in providing free healthcare services to marginalized populations in Galveston, Texas. The clinic offers a wide variety of specialty services along with free resources such as transportation and medication assistance, telehealth options, and interpreter services. Despite these resources, the clinic has faced challenges with consistently high no-show rates and long encounter lengths, impacting overall efficiency and patient care. We aimed to explore factors that may contribute to these challenges and uncover opportunities to improve patient satisfaction and optimize clinic efficiency.
 Methods: A retrospective chart review was conducted on all patients seen at SVC across all specialty clinics between March 2021 and March 2023. Patient demographics, appointment status, encounter length, language spoken, department specialty, and appointment modality were recorded. A series of statistical analyses were conducted on collected variables, including chi-square analysis, unpaired t-tests, and single-factor analysis of variance (ANOVA) tests, to assess significant associations.
 Results: The average encounter length varies significantly across different spoken languages and specialty clinics, but no significance was observed between different appointment modalities. The no-show rates were significantly different depending on the appointment modality, specialty clinic, and patient language spoken. Notably, while the encounter length was significantly shorter for English-speaking patients, Spanish-speaking patients had a lower no-show rate and were more likely to keep scheduled appointments.
 Conclusions: Language barriers and specialty clinic types can impact the encounter lengths and no-show rates, highlighting the need for targeted interventions such as proper resource allocation. Limitations include potential data discrepancies from factors such as human error or variations in documenting appointments. Future research should explore patient perspectives and experiences to improve patient satisfaction and overall optimize clinic operations.

Background: Student-run free clinics (SRFCs) are increasingly becoming multidisciplinary care centers for underserved and uninsured patients across our communities. While SRFCs continue to advance research on various fronts to improve the quality of patient care provided, there remains scant literature on the involvement of resident and fellow physicians, or rather advanced trainees across disciplines in general, in the SRFC setting. As a result, there is a limited understanding of how best to include them and their skillsets within SRFCs and to design opportunities mutually beneficial for both SRFCs and advanced training programs.
 Purpose: To initiate a call-to-action for SRFCs to invest resources toward better characterizing the involvement of advanced trainees across SRFCs and the impacts they can potentially impart upon both the SRFC’s educational and patient care experiences.
 Summary: There remains limited information available pertaining to the involvement and impact of advanced trainees in SRFCs. As a result, these remain suboptimally-tapped areas of research and SRFCs are well-positioned to potentially bridge critical gaps in knowledge. Potential approaches to this include 1) querying advanced trainees currently involved in SRFCs on their motivations for being involved, 2) encouraging advanced trainees to discuss how other trainees may similarly become involved and to help with securing their participation, and 3) surveying training program leadership at institutions with SRFCs on how mutually beneficial partnerships between SRFCs and training programs might be established. In better characterizing their roles, SRFCs have an opportunity to fuel significant changes in health education and patient care.