Primary Care Continuity Improves Diabetic Health Outcomes: From Free Clinics to Federally Qualified Health Centers

Abstract

Introduction: There are a number of well-established barriers to accessing primary care. The LINKED Study set out to improve primary care usage through 1-on-1 counseling and referrals for patients with diabetes being treated at local free clinics. We hypothesized that this educational intervention paired with expedited referral would increase the use of federally qualified health centers (FQHCs) as a source of health care and ultimately lead to improved diabetic health.Methods: Medical student volunteers counseled participants on the importance of primary care. The participants then completed surveys about diabetic health, socioeconomic status, and general demographics. Participants were subsequently assigned to 1 of 2 FQHCs; designated care coordinators facilitated appointments. At the end of a 9-month action period, participants repeated the initial surveys, now including appointment history and health data (hemoglobin A1c (

Effect of student-led health interventions on patient outcomes for those with cardiovascular disease or cardiovascular disease risk factors: a systematic review

“…This enables hyperlipaemia control to be determined by multiple measures which increases the reliability of the results. Although, medical student appointments were associated with statistically significant increases in BMI amongst patients with diabetes, body weight was not reported to support whether this negative result is clinically meaningful or not [39,44]. Two retrospective studies did not report how weight was measured (i.e.…”

“…Additionally, this lack of reporting on what the students did sometimes impacted on how the patient outcomes could be interpreted. For example, whether medical students counselled patients, dispensed medication or provided both services were not reported [39,44]. Without this detail, it was difficult to determine if the medical intervention could have resulted in weight loss and reduction in BMI as the reported patient outcomes.…”

“…Two studies observed an increase in BMI of 0.5 kg/m 2 (n = 19, p = 0.04, 44) and 0.3 kg/m 2 (n = 238, p = 0.025) [39] when less than two medical appointments [44] or a 12 month program of medical care and group education [39] were provided respectively by medical students for patients with diabetes. Baseline and outcome weight, an important co-marker of health alongside BMI amongst patients with diabetes, were not reported amongst these two studies.…”

“…Student-led health interventions were primarily located in a clinic setting [31][32][33][34][35][36][37][38][39][40][41][42][43][44]. Of the student-led clinics, five studies described the service provided as a "free clinic" [33,36,41,42,44]. The exceptions to the clinic-based student-led services included one study that provided student-led home visits [45] and one study that provided a student-led discharge consultation [30].…”

Social Determinants of Health and Primary Care: Intentionality Is Key to the Data We Collect and the Interventions We Pursue

“…This special issue also features 4 unique SDOH interventions that span different places, people, and processes. Mehta et al 14 directly tackled a lack of health insurance and the cost of medical care when delivering in free clinics 1-on-1 counseling for high-risk patients with diabetes and referring them to local federally qualified health centers. They found that this warm hand-off led to improved glycemic control and more stable health care access for these patients at federally qualified health centers.…”