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Touro California Student-Run Free Clinic: An Investigation of Actual vs Target Patient Demographic and the Impact of Osteopathic Manipulative Medicine in the Vallejo, California, Community
Jamall, S. [1]
Ang, B. [4]
Kimpo, J. V. [1]
Liu, B. [2]
Donn, E. [1]
Szeto, H. [1]
Devanney, J. [1]
Pearce, M. [3]

Journal: Journal of Osteopathic Medicine Date: 2017/11, 117(11):Pages: e125-e127. doi: Subito , type of study: retrospective study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2017.141/html)

Keywords:

demographics [12]
OMT [2951]
osteopathic manipulative treatment [2973]
patients [80]
retrospective study [213]
USA [1086]

Abstract:

Hypotheses: (1) The student-run free clinic (SRFC) serves the medically underserved population (patients without primary care provider [PCP] access) of Vallejo. (2) The SRFC primarily provides osteopathic manipulative medicine (OMM) to the community compared with other clinic services. Methods: Data were analyzed based on registration forms in patient files from April 2010, the year of the clinic's founding, through July 2017. These data were transferred from hard copies of 424 consenting patients’ files into a spreadsheet using Microsoft Excel. Patients responded to a host of demographic questions, including age (categorized in this study as adults <65 years of age or >65 years of age as determined by the generally accepted age to distinguish elderly from nonelderly patients), ethnicity, and whether they currently saw a PCP. The service given during their clinic visit (history and physical examination [H&P] or OMM) was also recorded, and all collected responses were compared. Data Analysis: The majority of SRFC patients were found to be patients with access to a PCP and who were more likely to receive OMM as their clinic service. Patients without access to a PCP were more likely to receive H&P-based services. This finding suggests that these patients, often with existing treatment plans (for hypertension, diabetes, and/or obesity) through their current PCPs, may be seeking OMM services that they cannot otherwise access. The fact that patients without PCP access were not the majority of clinic visits suggests that SRFC's target population is not yet being adequately addressed. Therefore, we reject our first hypothesis that the SRFC primarily cares for the medically underserved, but we accept our second hypothesis that the SRFC primarily provides OMM to its community. Results: χ2 analysis was performed comparing the 2 age groups, adults <65 years old and >65 years old against PCP access (n=424, P<.0001). Patients with PCP access were also compared with their service provided (either H&P or OMM) at the clinic (n=400, P<.0001). The majority of patients seen by the student-run free clinic tended to be patients who already had PCP access (n=424, 60.1%). This was also suggested by the significant relationship found when comparing elderly vs non-elderly patients with PCP access. The relationship between PCP access and clinic service received was also found to be significant, such that patients with PCP access were more likely to receive OMM treatment during their visit (n=400, 59.8%) than patients without PCP access (37.3%). Patients with PCP access were further compared with a diagnosis of a single condition (hypertension, diabetes, or obesity) or a mixed condition including 2 or more of these diseases (n=232, P<.0448). Conclusion: The data suggest that the student-run free clinic currently sees more patients who have access to a PCP than those who do not. Additionally, patients with PCPs were more likely to receive or request an appointment to receive OMM than those without a PCP. The consistent presence of patients with access to a PCP at the clinic alongside their concurrent treatment plans managed elsewhere may indicate that they seek osteopathic manipulative medicine as an adjunctive or additional treatment modality that they are unable to access elsewhere. While this helps attest to the unique appeal and role of the clinic in the community, the data also suggest that the student-run free clinic should take steps toward more effectively reaching its intended target demographic, the medically underserved in Vallejo. We have chosen to examine these data as a foundation for both understanding our impact and refocusing the efforts of the student-run free clinic to more adequately evaluate the health needs of Vallejo's medically underserved and extending our relationships with local community organizations and leadership. By addressing the needs of these populations, the SRFC will be able to tailor its efforts more closely to the needs of its community, and in the long-term, better preventive care resources may result in patients being less reliant on costly emergency department and urgent care services. In finding ways to offer these services as a part of our clinic, we hope to continue integrating the basic needs of the community with student-driven health care to better serve our mission's target population.

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