The Impact of a Student-Run Free Clinic on Reducing Excess Emergency Department Visits

Abstract

Background: Access to primary care directly impacts inappropriate emergency department (ED) utilization. This relationship has been studied in free clinics, but little work has been done regarding the impact of student-run free clinics (SRFCs). This study investigates the effects of an SRFC in Nashville, Tennessee on reported ED utilization patterns, patient satisfaction with healthcare, and primary care access. 
Methods: The study population included all patients seen at the 12 South Community Clinic from April 2013 to January 2014. A 7-item paper questionnaire, including items on recent ED usage, satisfaction with current level of healthcare, and access to physicians, was distributed to new patients during their first clinic visit; returning patients received a 5-item follow-up questionnaire. New patient survey responses were compared with returning patient survey responses as aggregate data using unpaired t-tests, and descriptive statistics were used to calculate percentages. 
Results: The response rate was 94.9% (130/137) for new patients and 83.9% (115/137) for returning patients (N=274). The average reported number of ED visits in a three-month period was 0.47 in new patients and 0.24 in returning patients (p=0.0345). Access to the clinic significantly increased the overall level of healthcare satisfaction from 33.3% (35/105) of patients feeling very or completely satisfied prior to their first visit to the free clinic to 71.8% (79/110) of patients feeling very or completely satisfied on return visit (p<0.0001). Since establishing care at the clinic, 98.2% (112/114) of returning patients reported easier access to a physician.
Conclusions: The study design was limited by using data from a quality assurance project; identified, individual-level information was not used, and comparison of individual subject responses was not possible. It is unknown how many individuals may have participated in both or only one group or how many individuals may have repeated data points in the returning patient group. Despite these limitations, results suggest that given ongoing primary care access gaps, SRFCs may serve a role in impacting excess ED utilization, patient satisfaction, and access to care in medically underserved and underinsured populations.