Journal of Student-Run Clinics

Evaluation and Optimization of Diabetic Retinopathy Screenings for Uninsured Latinx Patients in a Resource-Limited Student-Run Free Clinic

Jennifer Bu — 2024-01-18

Background: Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient population, evaluated the performance, and conducted a needs assessment of DR screenings at the University of California, San Diego Student-Run Ophthalmology Free Clinic, which provides care to predominantly uninsured, Latino patients.

Methods: Retrospective chart review was conducted of all patients seen at the free clinic since 2019 with a diagnosis of type II diabetes. Date and outcome of all DR-related screenings or visits from 2015 onward, demographics information, and DR risk factors such as A1c and insulin dependence were recorded. Predictors of diabetic retinopathy and frequency of DR screenings for each patient were analyzed using multiple logistic regression, t-test for equality of means, and Pearson’s correlation.

Results: Of 179 uninsured diabetic patients receiving care at the free clinic, 71% were female and average age was 59. 83% had hypertension, 93% had hyperlipidemia, and 79% had metabolic syndrome. Prevalence of non-proliferative DR was 34% and that of proliferative DR was 15% in diabetic patients. The free clinic capacity in recent years plateaued at just under 50% of patients seen for DR screening or visit per year, though average wait time was over 2 years between visits. Patients with higher no-show rates had less frequent DR screenings. Chronic kidney disease and poor glycemic control were the strongest predictors of DR.

Conclusion: The student-run free ophthalmology clinic has been effective in providing screening and follow-up care for DR patients. Creation of a protocol to identify which patients are at highest risk of DR and should be seen more urgently, addressing no-shows, and implementation of a tele-retina program are potential avenues for improving clinic efficiency in a resource-limited setting for vulnerable populations.

Providing Prenatal Care in a Student Run Free Clinic

Chloe Warpinski — 2024-02-07

Background: Prenatal care is a cornerstone of maternal and child health. This paper describes the creation of a free prenatal clinic for uninsured families following recognition of a significant disparity in birth outcomes in Alachua County, Florida including: the development of essential community re- source collaborations, clinical operations in a dual aim patient care-medical education site, preliminary outcomes after one year of clinical operation, identified challenges, and next steps for our growing program.

Methods: A retrospective chart review of all sixteen patients enrolled with the student run free prenatal clinic in its first year of clinical operation. Analysis included assessment of the prenatal care course using descriptive statistics. Specific dimensions assessed include timing of transition of care to a traditional obstetrics clinic, clinical findings and diagnoses identified at the prenatal clinic, and birth out- comes during the study period and report findings as descriptive statistics.

Results: The clinic has demonstrated the ability to identify and treat numerous pathologies which may impact maternal-fetal morbidity and mortality. The clinic has seen very high rates of patient retention and has demonstrated successful transition of patients to higher levels of care when indicated. Finally, the clinical model provides an uncommon opportunity for medical and physician assistant students to care for patients throughout the first 32 weeks of pregnancy and receive additional training in point-of-care ultrasound, diagnostics, and medical decision making.

Conclusion: While the small sample size limits the ability to assess the effectiveness of the prenatal clinic intervention, there are numerous promising features based on preliminary results.

Experiential Learning With Continuous Glucose Monitors: A Novel Curriculum for Volunteers in a Student-Run Free Clinic

Annie E Altman-Merino — 2024-02-14

Background: Growing evidence suggests that medical students and faculty preceptors have limited familiarity with continuous glucose monitors (CGMs), which may negatively affect how care teams counsel patients and monitor the use of CGMs. Although studies have shown that structured training for care teams may improve knowledge and comfort with various healthcare tools, to our knowledge, no study has attempted to do so for CGMs.

Methods: We designed a user experience course for medical students and faculty mentors to address this gap at a student-run free clinic. This course allowed twenty participants to wear a CGM for two weeks and participate in three interactive didactic sessions and group reflections. We evaluated how knowledge and comfort with CGMs among participants changed after the course with a survey and focus group.

Results: The cohort showed improvement in self-reported confidence in using the device, teaching patients how to use the device, and interpreting data (p<0.001). The majority of participants demonstrated improvement across all survey domains with higher post-intervention scores than pre-intervention scores. Qualitative analysis of group reflections elucidated three primary themes across participant experiences: the emotional impact of wearing the device, attitude changes with prolonged use, and behavior modification in response to glucose data.

Conclusion: This novel educational initiative may improve knowledge about CGMs, ability to counsel patients to use the device, and understanding patients' experiences among medical students and faculty mentors. We plan to expand this educational opportunity to additional clinic volunteers, include patient perspectives, and share the curriculum with other student-run clinics.

Assessment of Opioid Overdose Risk and Response Readiness Among Patients at a Clinic for Uninsured Patients

Benjamin Wrucke — 2024-02-27

Background: The opioid epidemic has been worsening. Fortunately, studies show that bystanders can effectively administer naloxone to reverse opioid overdose, and overdose education programs result in improved ability to respond to overdose. However, there has been limited research investigating opioid overdose risk and response preparedness among patients without insurance. This descriptive report aimed to assess risk of opioid overdose among patients without insurance in addition to their family members and close contacts and assess whether these patients, as crucial bystanders, were prepared to respond to opioid overdose.

Methods: Patients without insurance at a student-run free clinic completed an anonymous, voluntary survey during in-person appointments. Data were collected for eight months from 2021-2022. One-proportion Z-test compared respondent rates of opioid use with overall statewide community rates reported by the Wisconsin Department of Health Services (DHS) Opioid Dashboard. Subgroup analysis further described the data collected, and hypothetical number needed to screen (NNS) calculations explored possible screening methods for naloxone distribution.

Results: Seventy-two patients responded to the survey. The past-year rate of medically prescribed opioid use in the study population (12.5%) did not differ from the rate statewide (15.8%; p=0.44). Zero respondents reported personal opioid overdose in the past year, but six overdoses had been witnessed. Among respondents with family or close contacts who use opioids, 50% of those respondents who do not carry naloxone do not know where to get it, but 75% of those respondents who are not trained on how to respond to overdose would like to be. Lastly, screening for family or close contact opioid use offered the lowest hypothetical NNS of screening methods considered.

Conclusions: Patients without insurance at student-run free clinics, including those with family members or close contacts who use opioids, likely represent a target population for opioid overdose education and naloxone distribution.

Examining Factors Impacting Encounter Length and Missed Appointments at a Student-Run Free Clinic: A Retrospective Analysis

Joy Li — 2024-03-01

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.

Ophthalmology Encounters During the COVID-19 Pandemic in a Student Run Free Clinic

Anindya Samanta — 2024-03-12

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.

Anxiety and Depression Prevalence in Free Clinic Patients

Jack Kovarik — 2024-04-14

Background: Disparities in mental health services are often observed in under-resourced low-income communities, which are at an increased risk for compromised mental health. By surveying patients at JayDoc Free Clinic, a student-run free clinic (SRFC) in Kansas City, Kansas, this study sought to as-sess the prevalence of depression and anxiety and compare screening outcomes among various de-mographic groups seeking safety-net care.
Methods: From May through November 2022, patients aged 12 and older were offered a Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and demographic survey. Demo-graphic variables included household income, gender, insurance status, and race and ethnicity. GAD-7 and PHQ-9 questionnaire scores were categorized into minimal, mild, moderate, or severe catego-ries. Relationships between demographic variables and scores on screening questionnaires were an-alyzed using multivariable analyses, with linear regression and analysis of variance one-way tests for significance (p-value <0.05).
Results: Of 232 participants who consented to the study, 222 completed the GAD-7 and 228 com-pleted the PHQ-9. In comparison to 2019 United States national data, the percentage of respondents experiencing anxiety and depression was greater across all severity classifications. Approximately 18.1% reported symptoms of moderate to severe anxiety and 21.5% reported symptoms of moderate to severe depression, compared to national distributions of 6.1% and 7%, respectively. Of 232 participants, 54 completed the demographic survey. There was no correlation between PHQ-9 scores or GAD-7 scores and gender, household income, insurance status.
Conclusion: While no association was identified between screening outcomes and demographic var-iables, the findings that the prevalence of anxiety and depression at JayDoc SRFC is greater than na-tional rates reaffirm the need for accessible mental health services for patients receiving care at SRFCs. This study provides insight into the status of mental health in an SRFC patient population and discusses mental health screening implementation at SRFCs.

Development of a Medication Refill System - A Collaboration Between Telemedicine and Pharmacy Departments

Stephen Denton — 2024-05-09

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.

Patient-Level Factors Associated With Referral Rates to Mental Health Services in a Network of Student-Run Free Clinics: A Pooled Cross-Sectional Study

Elijah Moothedan — 2024-05-31

Background: Student-run free clinics (SRFC) may offer needed mental health care to low income and uninsured populations who may have greater risk of mental illness. To date, there is limited literature assessing what patient-level factors are predictors of referrals to mental health services.

Method: Medical record data came from a SRFC network on patients with depression, anxiety, and/or bipolar disorder (n=1,180). The dependent variable was whether patients received a mental health service referral, defined as an accepted internal referral to the study site’s mental health resources or external referral to a community mental health center. We conducted a binary logistic regression model to assess the relationship between various patient-level factors (age, primary language, insurance status, sex, race, ethnicity, and education status) and an accepted mental health referral.

Results: Approximately 65.5% of patients received and accepted a mental health referral. Older patients had higher referral odds while males and high school diploma/vocational/associate degree holders had lower odds. There were no statistically significant differences in the odds of receiving a mental health referral by ethnicity, race, insurance status, or primary language.

Conclusion: Elderly individuals were more likely to be accept referrals for mental health services, whereas male patients or those with a lower educational attainment were less likely to receive and accept such referrals. Future research should examine the role of patient attitudinal factors (e.g., perceived efficacy of mental health services, treatment preferences) and clinician-level factors on referral to mental health services.

Assessing the Social Determinants of Health of Patients from a Student-Run Free Clinic to Improve Appointment Attendance Post COVID-19

Kennedy Stoll — 2024-06-19

Background: In clinics offering care to underserved and underinsured populations, patients who do not present for scheduled appointments (‘no-shows’) constitute a recurrent problem. As student clinicians, we are responsible for working to identify and mitigate contributing barriers to care. The Mollie Wheat Memorial Clinic (MWMC) conducted a qualitative study to better understand the demographics of the population served and evaluate their barriers to care.

Methods: Patients who presented to MWMC (show) were surveyed about demographic information and barriers to care. Over the same time interval no-shows were contacted via phone for brief interviews detailing reasons for absence. A text message reminder system was first implemented for the May 14, 2022, clinic date, and a text message was sent to each patient 24 hours before his or her scheduled appointment. MWMC tracked changes in patient show/no-show rates following reminder implementation.

Results: From January 1^st, 2021 to December 31^st, 2022, 60 “show” patients were surveyed. 43.64% of patients lived below the poverty line, 59.32% lacked health insurance, 83% owned a reliable car, and 90% felt confident in their ability to attend appointments. No-show rates before and after text message reminder implementation were not significantly different.

Conclusion: Survey demographic data suggests that MWMC patients lack optimal healthcare because of financial reasons and do not struggle with transportation to the degree we expected. Despite text message reminders, no-show rates remained high. Based on these results, we have concluded mechanisms working for other clinics aren’t necessarily effective in free, rural-focused clinics such as MWMC. We have proposed further research in community settings such as food pantries as this could potentially reach patients who do not come to the clinic because of logistical or financial reasons.

Improving Documentation of and Access to Diabetic Retinopathy Screening at a Student-Run Free Clinic

Aleksandra Zarska — 2024-07-07

Background: Diabetic retinopathy (DR) affects approximately 9.6 million people in the United States (US) and is the leading cause of vision loss in working-age adults. However, less than 50% of people with diabetes in the US undergo the recommended screening. We aimed to assess need for DR screening (DRS) at the University of Michigan Student-Run Free Clinic (UMSRFC) and examine current DRS documentation practices to inform quality improvement initiatives at the clinic.

Methods: We conducted a needs-assessment survey of 67 patients to examine access to eye and vision care among patients seen at the UMSRFC between January and April 2023. Descriptive analysis of survey data was performed. A retrospective chart review of all patients seen at the clinic between March 2021 and March 2023 was conducted to evaluate documentation of DRS in the medical record. These results informed the development of a DRS initiative at the clinic.

Results: Of the 67 patients surveyed, 17 had a diagnosis of diabetes. Twenty-six patients reported an eye problem, of which 16 (62.0%) reported blurry vision, 9 (35.0%) reported floaters, and 1 (4.0%) reported dark/empty areas in their vision. Chart review yielded 404 patients, of which 70 had a diagnosis of type 2 diabetes. Twenty-eight (40.0%) had any mention of a diabetic eye exam in their chart, and 12 of these were up to date with the American Diabetes Association (ADA) screening guidelines. Twenty-three (33.0%) patients had any mention of a referral to an optometrist or ophthalmologist in their chart. On the DRS day, three patients were screened for DR. No cases of DR were identified.

Conclusion: Survey and chart review data indicated a need for increased DRS and improved documentation practices of DRS at the UMSRFC. A DRS initiative was successfully implemented at the UMSRFC under the oversight of an ophthalmologist.

Otolaryngology in Medical Education: Hands-on Training at an SRFC Community Site Improves Medical Student Knowledge and Skills

Abigail Groszkiewicz — 2024-08-09

Background: There are known otolaryngology education gaps and exposure inequalities in existing medical school curricula. It has been shown that students participating in otolaryngology instruction sessions emerge with increased knowledge and confidence in skills. The population our student-run free clinic serves is high-risk for head and neck cancers, and evidence has shown that clinical exams are a very effective tool for early detection of these lesions. In this study, our clinic offered head and neck cancer screening events to meet community needs as well as student training nights to meet student education needs.

Methods: Medical students of all training levels were invited to participate. Participating students first completed a pre-training interests and skills assessment survey and a knowledge test. Students then attended a training night led by otolaryngology residents that included an educational lecture and hands-on skills practice. Afterwards, students re-took the knowledge test. One week later, students participated in the live screening event at the clinic. Afterwards, students completed another interest and skills assessment survey.

Results: Sixty students attended our three student training nights. Pre-participation (n=53), 52.5% of students were interested in otolaryngology as a specialty, most students felt little to no confidence in performing a general head and neck exam (66%) or taking a head and neck cancer history (81%), and the average knowledge test score was 58% correct. The post-training (n=41) average knowledge test score increased to 78.3% correct, a statistically significant increase (p < 0.001). Post-event participation (n=20), most students reported increased interest in otolaryngology (75%), and improved confidence in performing an exam (95%) and taking a history (95%).

Conclusions: Participation in our student training night and head and neck cancer screening event increased students’ interest in otolaryngology as a specialty, their confidence in otolaryngology physical exam skills and their knowledge about head and neck cancer.

Evaluating Hypertension Management at a Student Run Free Clinic in Alabama

Josiah Sowell — 2024-08-16

Background: Healthcare remains unavailable for many persons who are un- or under-insured. Equal Access Birmingham (EAB) is a student run free clinic that provides urgent, primary, and specialty care to the Birmingham area. The purpose of this study was to evaluate EAB’s effectiveness in hypertension management.

Methods: A total of 137 patient records were identified with hypertension. After exclusion criteria were applied, the cohort consisted of 66 patients. The average number of clinic visits per patient was 6.4 (standard deviation [SD] ± 4.1).

Results: Systolic blood pressure decreased from 151.3mmHg to 140.6mmHg (p=0.0028, t(64)=2.95, 95% confidence interval [CI] 3.82, 17.57). Diastolic blood pressure decreased from 90.7mmHg to 85.5mmHg (p=0.0120, t(64)=2.37, 95% CI 1.18, 9.27).

Conclusions: In patients with consistently recorded vital signs that followed up with regular clinic visits, blood pressure over time was significantly reduced. However, many patients were lost to follow up.

Overcoming Influenza Vaccination Barriers Through Community Outreach by a Student-Led Mobile Health Clinic

Ema Karakoleva — 2024-08-17

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.

Addressing Vaccination Gaps through Student-Led Initiatives: A Study of Stanford Vax Crew's Impact

Caroline Murtagh — 2024-08-30

Background: Although vaccines are critical to disease prevention, substantial gaps persist in adult vaccination coverage in the United States due, in part, to material and social barriers. Farmworkers face unique challenges to accessing vaccination services, such as migratory residence, immigration status, low levels of insurance, and geographic distance from clinics, many of which were exacerbated during the coronavirus disease 2019 (COVID-19) pandemic. Student-driven, community-focused programs offer a potential mechanism to enhance vaccine equity. Stanford Vax Crew is a student-led organization that partners with community organizations to host pop-up vaccine clinics, which aim to (1) address the material barriers that impact vaccination status, (2) establish trust in vaccine services, and (3) equip future medical professionals with skills to engage in community health initiatives.

Methods: This paper describes the strategies used by the organization to reach surrounding communities with vaccines, especially agricultural workers. It assesses the reach of the program through analysis of demographic data collected at pop-up clinics.

Results: From August 2021 to March 2023, the majority of COVID-19 vaccine recipients were middle-aged adults (61%) of Hispanic ethnicity (82%) working in the agricultural, forestry, or fishing industries (58%). In total, 1377 COVID-19 vaccines were administered by Stanford Vax Crew.

Conclusions: Findings suggest that Stanford Vax Crew's partnerships with diverse institutions helped facilitate access and build trust, thereby enhancing vaccine uptake. Partnership with agricultural employers and community-based organizations targeted farmworkers, which enabled the group to host clinics on farms immediately before and after work hours, which proved especially effective for reaching agricultural workers.

Investigating the Link Between Chronic Health Conditions and Mental Health Symptoms Among Low-income Patients Seen at a Student-Run Free Clinic

Samuel Vincent — 2024-09-04

Background: Individuals with chronic health conditions (CHCs) experience more anxiety and depression symptoms than those without CHCs. However, there is a dearth of research examining these relationships among low-income and minoritized populations. This current study investigated whether specific CHCs (i.e., diabetes, hypertension, hyperlipidemia) are linked to greater depression and anxiety symptoms among low-income, uninsured, and primarily Latine adults seen at a student-run free clinic (SRFC).

Methods: Participants were 149 adults (aged 19-78 years) seen at a SRFC serving low-income community members. Participants were primarily female (63.0%) and Spanish-speaking (67.0%). Anxiety and depressive symptoms were measured using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). The presence of CHCs were extracted from participant medical records.

Results: The presence of CHCs were associated with lower anxiety symptoms and the presence of hypertension and hyperlipidemia were linked to lower depression symptoms.

Conclusions: Overall, this study demonstrates the importance of investigating relationships between mental and physical health conditions using understudied samples as findings observed among mostly White, higher income samples may not generalize. Research conducted in SRFCs may improve knowledge of understudied populations, such as low-income and ethnically diverse patients. Cultural factors may have contributed to these unexpected results (e.g., stigma-related underreporting of mental health symptoms, inadequate methods to assess culture-specific symptoms). These findings suggest the need for future research to explore alternative methods of assessing mental health symptoms among low income, ethnically diverse populations.

Association Analysis of Demographic Factors and the Likelihood of Self-reporting Mental Illness at Student Run Clinics

Mahant Malempati — 2024-09-09

Background: Patients in the student-run clinics operated by the Tulane University School of Medicine report higher rates of previous diagnoses of mental illness (45.3%) when compared to the national average (22.8%). The diverse group of patients who utilize these resources have various demographic factors that may influence the likelihood of reporting a mental illness. Our objective is to analyze data from Tulane University School of Medicine’s student-run clinics to identify associations of self-reported psychological diagnoses with demographic and psychosocial factors.

Methods: Data collected from surveys filled out by students interviewing patients in student-run clinics (n=1494), chi-square analysis, and multivariate regression analysis were conducted to evaluate associations between self-reported psychiatric illness with demographic and psychosocial factors.

Results: In the chi square analysis, patients who were age 18-39, reported using psychiatric medications, identified as White, were female, did not report being homeless, had a previous suicide attempt, had a history of trading drugs for sex or money, were a victim or witness of a violent or traumatic event, and had a history of physical, emotional, and sexual abuse were more likely to report a mental health condition. Patients aged 60-99, who were African American, male, reported homelessness were less likely to report a history of a mental health conditions. Persons who identified as male were the only category statistically associated with decreased odds of reporting a mental health diagnosis. In the regression analysis, patients aged 18-39, aged 40-59, who were female, white, who had a suicide attempt, and had a history of incarceration were likely to report a mental health diagnosis.

Conclusions: Patients with specific demographic and psychosocial characteristics were more likely to report a mental health diagnosis.

Improving the Training Process for Student Providers in a Student-Run Free Clinic: Assessing the Impact of a Small Group, Peer-Led Training Process

Bailey Hassman — 2024-09-23

Background: Student-run free clinics give students crucial opportunities to improve their skills as future medical professionals. However, many students at our institution feel unprepared to take on student provider roles despite completing a training curriculum. This study describes an improved way to train student providers using a small group, peer-led training process.

Methods: Participants in the control group completed our institution’s current training process consisting of viewing e-modules and observing a clinic visit. Participants in the experimental group took part in small group, peer-led training sessions. All study participants completed pre- and post-training surveys to assess their confidence in navigating the electronic health record, performing physical exams, and patient interviewing and in their sense of overall preparedness. Participants’ pre-training to post-training confidence change scores were calculated for each question, and the two groups’ results were compared using Mann-Whitney-U tests.

Results: Results revealed a statistically significant increase in confidence in performing physical exams and navigating the electronic health record for students in the experimental group compared to the control group. While both groups saw an increase in confidence in overall preparedness to serve as a student provider and in patient interviewing, no significant differences were observed between the two groups.

Conclusions: While both groups showed increases in confidence change scores for all components surveyed, participants in the small group, peer-led training process reported a larger increase in their confidence to perform physical exam and electronic health record navigation skills after the training intervention than the control group participants. Small-group, peer-led training sessions give students opportunities to receive early hands-on exposure to technical skills. The findings of this study can lead to lasting improvement in our institution’s provider training process while serving as a model for other student-run clinic programs to better prepare student providers to care for at-risk populations.

Developing Trauma-Informed Capacities in Healthcare Students Staffing Free Clinics

Phillip Yang — 2024-10-03

Background: Adverse childhood experiences (ACEs) are common traumatic events experienced during childhood that can have significant and cumulative lifelong impact on health, mental health, and life opportunities. Individuals with marginalized identities experience more ACEs and have greater ACEs-related health burden. Free clinics provide free or low-cost ambulatory care to largely underserved or marginalized communities. Student-staffed free clinic volunteers should be knowledgeable about ACEs and should possess attitudes and engage in practices that promote trauma-informed care.

Methods: Two medical students were trained as ACE Interface Master Trainers and administered a training based on the ACEs N.E.A.R. Science curriculum to medical and nursing student free clinic volunteers and leaders. The 1.5-hour training included the Neurobiology and Epigenetics of trauma, health consequences associated with ACEs, and the impact of Resilience in mitigating health consequences of ACEs. Pre-/post-surveys were utilized to measure changes in collective hope, perceived trauma knowledge, and trauma-informed attitudes.

Results: The training was administered virtually to one group of medical students and three groups of nursing students (N = 89) between May and October 2020. Two-sample t-tests of the pre-/post-surveys demonstrated statistically significant increases in two of the six collective hope items, six of the six perceived trauma knowledge items, and six of the seven trauma-informed attitudes items.

Conclusions: Our study demonstrated that healthcare students volunteering at free clinics have high baseline levels of collective hope, perceived trauma knowledge, and trauma-informed attitudes. A brief and purposeful training on ACEs by peers or near-peers can be effective to further promoting trauma-informed capacities for student-run free clinic volunteers. Future work is needed to ascertain the sustainability of trauma-informed care growth from this training and to measure the effects on care practices.

Assessing the Effectiveness of Outreach Measures at a Student-Run Free Clinic

Shalmali Mirajkar — 2024-10-23

Background: Student-run, free clinics (SRFCs) seek innovative and cost-effective outreach strategies to recruit new patients and raise awareness of their services. The current literature presents several approaches to increase community engagement, but the formal evaluation of these outreach efforts is scarce. The present study aims to fill this gap by measuring the effectiveness of outreach efforts on patient visits, which was implemented over the past year at an SRFC in Omaha, Nebraska.

Methods: A retrospective review of clinic traffic and outreach efforts deployed at our SRFC for 13 months. Six formal outreach methods were identified and included in the analysis. Patient recruitment was measured by calculating the difference in total patient volume 30 days before and after the implementation of an outreach effort. An effort’s efficacy was evaluated by calculating the financial expenses and time spent per patient recruited for the corresponding outreach methodology.

Results: Two-thirds of the efforts resulted in increased patient volume, with the additional third being associated with decreased traffic. The most successful outreach effort, which resulted in an average increase of 9 patients, only required the investment of 0.67 hours per patient, with no financial cost. The least successful effort required 2 hours and cost $11 per patient.

Conclusions: This study provides an approach to evaluate the efficacy of outreach efforts to increase patient recruitment at our SRFC. The financial expenditure, volunteer time, and corresponding efficacy of previous efforts should be considered prior to their re-utilization. Additionally, these findings support future prospective tracking of patient recruitment and retention data to optimize the quality and quantity of patient care. By addressing these challenges, clinics can better serve their target population and fulfill their mission of providing quality medical care to underserved communities.

A Roadmap to Integrating Dermatologic Care at a Student-Run Free Health Clinic

Yacine Sow — 2024-01-03

Student-run free health clinics (SRFCs) play an important role in providing a safety net healthcare system for uninsured patients by offering primary healthcare or preventative medical services. Patients at free clinics may have to be referred out for medical complaints better managed with specialty care. Integrating these services at SRFCs can address barriers to accessing specialty care. Free dermatologic care offers an opportunity to provide care to patients who may otherwise ignore symptoms, which can lead to reduced quality of life and a worse prognosis in some conditions. We detail a roadmap to integrate dermatologic services at an SRFC by providing operational considerations such as assessing needs, developing a clinical workflow, engaging dermatologists and the community, and sustaining student involvement. We also discuss the potential for a dermatology clinic to foster interest in the specialty among students underrepresented in medicine, given the current call to action to increase racial and ethnic diversity in the dermatologic workforce.

Calling All Coyotes: An On-Call Model for Student-Run Free Clinics

Tiffany Bender — 2024-02-05

To mitigate transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the pandemic, many ambulatory healthcare practices were either deferred or temporarily discontinued. Concern surrounding exposure risk to the virus has also deterred patients from seeking elective or preventative care. Similarly, medical schools were forced to rapidly adapt and develop protocols to protect students that suspended direct patient contact, especially if this experience was deemed elective to their primary academic requirements. At the intersection of these challenges to providing safe patient care and didactic training for students were student-run free clinics. The Coyote Clinic is a medical student-run clinic affiliated with the University of South Dakota Sanford School of Medicine and Avera Medical Group Health Care Clinic that provides free, basic healthcare services and screening to uninsured community members of the greater Sioux Falls, South Dakota area. On the heels of the coronavirus disease 2019 (COVID-19) pandemic, a decreased patient volume forced multiple instances of closures at the Coyote Clinic. In an effort to catalyze the return of patients to the clinic and enhance the educational enrichment for the student volunteers, a novel on-call workflow was devised that prioritizes walk-in patients. This on-call model is more attractive to attending physician volunteers and offers an alternative learning avenue for trainees. Here, we describe the new model we have implemented at the Coyote Clinic for other student-run free clinics that may be facing similar barriers in re-establishing themselves in their communities.

Building a No Cost Undergraduate Community Speech Clinic

Meagan Spencer — 2024-03-11

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.

Establishing the First Student-Run Clinic to Provide Free Health Care to a South Texas Colonia

John Nicholas Cauba — 2024-04-08

The University of Texas Rio Grande Valley School of Medicine (UTRGVSoM) opened its student-run clinic (SRC) in March 2018 to provide free health care for the residents of Pueblo de Palmas colonia in Hidalgo County. Located along the United States-Mexico border near some of the country's poorest and most medically underserved communities, UTRGVSoM has the unique opportunity to extend quality primary care to those who otherwise would go without. The physical location of the clinic was determined by a partnership with Proyecto Desarrollo Humano, a nonprofit organization within the Pueblo de Palmas colonia. The free clinic, located in the town’s community center, opens its doors to the public every month on a chosen Saturday. This article hopes to detail the experience of being the first SRC to operate inside a Texas colonia.

Recruitment of Hard-To-Reach Populations in Randomized Controlled Trials Using Medical Students and Electronic Con-sents

Austin Jones — 2024-05-09

Viral hepatitis is concentrated in populations with low healthcare system engagement, including non-white, rural, non-English speaking, and low socioeconomic status persons. Recruiting these participants for clinical trials has immense implications for trial feasibility and generalizability. Through the example of a trial delivering a behavioral intervention to patients with hepatitis C virus (HCV) in a network of medical student-run clinics, we describe the implementation of a student-run HCV testing program in the community and describe novel strategies to improve the recruitment of hard-to-reach participants using medical student counselors and electronic consents.

Standardization of Clinic Flow to Improve Patient Experience in a Student-Run Free Clinic

Neal Modi — 2024-05-15

The Saint Louis University Health Resource Center, a student-run free clinic, has seen a rapid expansion in both the number of services supplied by the clinic and the number of patients seen at clinic. While we are excited to serve more patients, the increase in volume has resulted in increased wait times and clinic throughput, the most frequent complaint of patients. To combat these growing concerns, we standardized the route patients take through the services the clinic provides and embedded this flow into a new statusboard that automatically logs the amount of time patients spend with each service and in the clinic overall. This information feeds directly into a process map of the clinic that better visualizes clinic processes. The utilization of a standardized statusboard resulted in a significant 12 minute and 44 second reduction in the median time patients spend in clinic and identified key decision points where bottlenecks occur in clinic flow. It also resulted in a statistically significant improvement in patent satisfaction. Our results demonstrate that standardizing clinic flow via an automated statusboard improves clinic efficiency, reduces throughput time, and can also significantly improve patient satisfaction. The resulting process map can also identify areas needing intervention and opportunities to continue expanding. As we continue to gather data on where clinic patients are spending the most time, we will continue to optimize services to provide the best experience possible for our patients.

Building a Patient Navigation Program to Improve the Student and Patient Experience at a Student-Run Free Clinic

Priscila Arellano Zameza — 2024-05-20

Introduction: Patient navigation programs improve patients’ access to care. The existing literature on patient navigation programs affiliated with Student-run Free Clinics (SRFCs) is limited. The Patient Navigation Program (PNP) was developed to give health professions students early experience in patient-centered care while helping patients overcome barriers to care. First-year student volunteers at our SRFC, the Delivering Equal Access to Care (DEAC) clinic, have limited opportunities to participate in direct patient care. A subset of our patient population faces additional challenges accessing health-related services, resulting in a need for coordinated care. This descriptive report describes a sustainable patient navigation program designed to improve the student and patient experience at an SRFC.

Methods: One medical director and three third-year medical students supervised all participants. First-year students from the Doctor of Medicine (MD) and Physician Associate (PA) programs applied for Patient Navigator (PN) positions, and upper-level students from the MD and PA programs applied for Navigation Manager (NM) positions. Two mandatory student trainings were provided, one led by the program’s medical director and the other by an associate professor in Psychiatry and Behavioral Medicine. Patients were referred from the primary care service. A voluntary, program satisfaction survey was emailed to PNs at the end of the year.

Results: Seven of the eight PNs completed their 12-month commitment and one PN transitioned into another DEAC clinic leadership role before the end of the year. Seven PNs completed the survey, and all indicated wanting to stay involved with the program in some capacity. Four of seven (57%) respondents were interested in continuing with their current patient due to perceived ongoing needs. Perceived impact of PNP on patients’ health includes obtaining additional health services, reliable transportation, and someone to discuss health concerns.

Discussion: Over half of PNs joined DEAC clinic leadership at the end of their 12-month commitment, pointing to the potential of patient navigator programs to develop committed leaders at SRFCs. Building a sustainable program like PNP at another SRFC is feasible and has potential for meaningful student and patient impact.

Making a Difference One Night at a Time: An Annual Fundraiser for a Student-Run Free Clinic Raises Over $25,000

Alexandra F Corbin — 2024-05-28

Introduction: The Lighthouse Free Medical Clinic (LFMC) is a student-run clinic (SRC) in Buffalo, NY, providing free healthcare to uninsured and underserved patients. The LFMC relies primarily on community fundraising events for financial support, with the Annual Winter Gala serving as its main source of funding. In February 2023, the Gala successfully raised over $25,000.00 in profit, surpassing previous records by adopting several new fundraising strategies. These funds will significantly exceed the clinic's annual operating budget, enabling the expansion of patient services and the continued delivery of high-quality healthcare.

Planning & Night of Gala: The student leaders of the LFMC meticulously planned the Gala, which involved soliciting donations from local businesses for basket raffles, organizing entertainment during the cocktail hour, and arranging a live auction featuring items donated by community members.

Gala Impact: The 2023 Gala attracted 376 guests and generated a profit of $25,973.40. The event featured 47 basket raffles and 21 live auction donations. The resulting profit will be allocated to various expenses of the LFMC’s operations, including laboratory supplies, outsourced laboratory procedures, provider insurance policies, a food delivery initiative, patient transportation services, miscellaneous costs, and the expansion of future clinic initiatives.

Conclusion: This descriptive report details the planning, implementation, and future directions of the Gala fundraising event. It serves as a valuable template for other SRCs across the nation, offering guidance on funding strategies to support their clinic operations.

Success and Challenges of Establishing a Teledermatology Pilot Service at a Student-Run Clinic

Hannah Rashdan — 2024-06-12

Background: Dermatologic issues are the primary reason people experiencing homelessness (PEH) seek care.¹ Furthermore, the closure of clinics and shelters during the coronavirus disease 2019 (COVID-19) pandemic highlighted care disparities and the need for telehealth services.^2,3 Though teledermatology is feasible and reliable, many PEH do not have access to dermatologists, often due to few dermatologists accepting public health insurance programs.⁴ This study investigated the challenges and successes of a teledermatology pilot within an existing student-led clinic for PEH, the diagnostic concordance between onsite primary care providers (PCP) and teledermatologists, as well as the quality of life of PEH with dermatologic issues to better understand the impact of cutaneous conditions of the unhoused.

Methods: A teledermatology consultation service was established at a student-led clinic in Austin, Texas. Teleconsultations were conducted with offsite dermatology residents using a secure messaging platform. PCP diagnoses were recorded prior to the teledermatologist consultation. Patients completed the Dermatology Life Quality Index survey upon visit completion.

Results: We had several successes in implementing this teledermatology pilot service, including smooth integration of the service, sustainability through cross-class collaboration, earlier in-person follow-up, and dermatologic education for PEH. However, we also encountered challenges, including limited patient volume with ongoing construction and remote site location, inadequate patient access to medication with no onsite pharmacy, and limited medical literacy.

Conclusions: In this pilot program, reasonable patient volume suggests this model is sustainable for both student-led clinics and dermatology residents. PCPs can limit use of this service to diagnostic and therapeutic dilemmas given the high concordance in diagnoses. Future directions include increasing the magnitude of patients served and collaborating with the student-run clinic team to address upstream social determinants of health. We hope this pilot study provides evidence that this teledermatology model is replicable in other clinic settings and potentially with other specialties.

Implementing a Reproducible Foot and Vaccine Clinic Model to Address Healthcare Needs of People Experiencing Homelessness

Caitlin Wuebbolt — 2024-06-24

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.

Impact of Patient Education on Establishing Trust as the Medical Student Provider: A Student Run Free Clinic Experience

David Salchert — 2024-08-06

Background: Effective doctor-patient relationships are crucial for quality healthcare, and trust is central to this dynamic. Trust in healthcare comprises competence, empathy, communication, and shared decision-making. Patient education sessions offer a platform to enhance patient trust, especially amongst novice providers. This study investigates the impact of patient education sessions led by medical students on patient trust within the context of a student-run free clinic.

Methods: At our student-run free clinic, we conducted a cross-sectional survey to collect patient data, including background information, trust in healthcare, and opinions on education sessions at a student-run free clinic.

Results: Amongst the enrolled 24 participants, the demographics revealed a diverse racial composition, with a significant portion having not completed high school and the majority being either unemployed or on disability. Following attendance at patient education sessions, a high percentage of participants reported positive experiences, including improved rapport with medical student providers and a likelihood of returning for future services and following medication recommendations.

Conclusion: This study highlights the significant role of patient education sessions in fostering trust between patients and providers, improving health behaviors, and enhancing the broader healthcare system's credibility. It demonstrates how such sessions empower patients, leading to better medication adherence and timely medical assistance seeking, while also suggesting their potential for implementation across various healthcare settings to improve patient engagement and healthcare services.

Risk Stratification-Guided Patient Navigation Model for Student-Run Health Fairs

Kristen Mascarenhas — 2024-08-23

Background: The patient navigation model has been used to connect patients who attend community health fairs with follow-up care. Optimizing the organizational structure of a patient navigation model centered around risk stratification may be important for improving rates of successful healthcare coordination and access. This report describes the experience and lessons learned from implementing and optimizing a patient navigation model to fit the needs of a low-income and ethnically diverse South Florida community.
Methods: A patient navigation model based on an algorithmic risk stratification system was created and implemented with the focus on tailored follow-up and specialized navigator training to achieve successful patient contact and follow-up.
Results: Incorporating patient risk stratification which was used to guide student navigator training and follow-up guidelines led to a hands-on learning experience for medical students with skills that could be applied to clinical practice as well as higher achievement of successful patient contact and navigation outcomes. Over the three years that navigation outcomes were monitored, this system allowed students to successfully complete the navigation process with 52.5% of patients who attended health fairs.
Conclusion: The structure based on risk stratification and set follow-up timeline all contributed to greater success in teaching medical students how to connect patients to local community resources as well as achieving patient contact and navigation outcomes in our patient navigation program serving the South Florida community.

An Outline of Integrating Vision Screening at a Student-Run Free Health Clinic

Carol Beatty — 2024-09-30

Visual impairment (VI) is a pervasive issue associated with a significant financial burden, diminished health outcomes, and an overall reduced quality of life. This condition disproportionately affects uninsured patients as they face limited access to affordable care. For this reason, FaithCare Clinic, a free, student-run clinic in Augusta, Georgia that serves uninsured and underinsured patients at least two standard deviations below the poverty line, implemented a vision screening and referral protocol to better serve its patients. Patients were approached after check-in for their appointment, but prior to seeing the physician, and were screened with a Snellen Eye Chart and Amsler Grid to assess for refractive error and other types of VI. If they screened positive, they were referred to low cost, local resources for further care. Data was collected over a period of 17 months with 47.8% of the patients seen in clinic offered vision screening. Of the patients offered screening, the majority accepted (79.1%). Half of patients screened were cleared while the other half were referred for further care. These results illustrate that patients of a free clinic are willing to undergo vision screening and can benefit from its offering due to the high rates of VI in this population. Visual disabilities are a heavy burden, especially on the uninsured and underinsured populations. Implementing vision screening in free clinics across the country can identify and facilitate additional care in an at-risk population with minimal training and few additional resources.

The Creation of a Free Outpatient Surgical Clinic: A Descriptive Report

Natalie Schelbar — 2024-10-12

Student run free clinics (SRFCs) are continuing to grow in scope and number given the significant benefits to both learners and disadvantaged patients. Despite recent growth, very few provide any form of surgical services. In order to address inequalities in patient access to care and clinical outcomes, it is imperative to include disadvantaged surgical patients, including in the settings of SRFCs. The Kansas City based chapter of Socially Responsible Surgery (SRS) opened a free, volunteer based, student and resident run outpatient surgical clinic. In this article we describe detailed steps to the establishment of the SRS Clinic to lay the framework for other SRFCs or chapters of SRS to continue to grow the number of free clinics able to provide surgical services.

Pushing and Establishing New Frontiers: An Examination of Publication Patterns From 2015-2023 in the Journal of Student-Run Clinics

Oliver T Nguyen — 2024-05-19

Background: The Journal of Student-Run Clinics (JSRC) has published research from student-run clinics (SRCs) for almost ten years. However, to date, no study has aimed to summarize publishing trends observed at JSRC. Thus, we aimed to characterize these JSRC publications in order to identify patterns in published research topics, identify research gaps, and inform future research priorities.

Methods: We adapted scoping review methodology and included all articles published in the JSRC from 2015 to 2023. For each article, we assessed for publication year, article type, university affiliated with the SRC, region of the United States (US) the SRC is located in, disease focus, outcomes studied, data collection methods used, sample size, interventions involved, analytic approaches used, and concept domains involved. Concept domains were determined using a taxonomy from the Agency for Healthcare Research and Quality (AHRQ) to identify patterns in topical content from published articles.

Results: This review included 167 articles. Over time, we observed an increasing trend of overall publication volume (e.g., 5 in 2015 vs 23 in 2023). Studies typically occurred in the primary care context with fewer studies in other outpatient specialties (e.g., ophthalmology, physical therapy). The most common domains were workforce (21.3%), workflows (17.4%) and practice/quality improvement (17.4%). Empirical studies typically used surveys (52.1%) or chart reviews of patient records (38.5%) for data sources. Less than half of the studies aimed to assess the impact of an intervention.

Conclusion: This review highlighted significant strides made on research in SRCs. Future studies reporting intervention may benefit from adhering to established reporting guidelines. Additional studies are needed across several areas, including understanding the impact of non-primary care SRCs, assessing quality of care and clinical outcomes, and employing qualitative and/or mixed methods approaches when studying interventions’ impact on patients and volunteers.