Reopening a Student-Run Free Clinic During the COVID-19 Pandemic to Provide Care for People Experiencing Homelessness

Abstract

Problem Student-run free clinics (SRFCs) provide health and outreach services to underserved populations while offering medical students opportunities for service and education. Many SRFCs were forced to suspend in-person operations in early 2020 due to the COVID-19 pandemic. Before March 2020, JeffHOPE, the SRFC at Sidney Kimmel Medical College at Thomas Jefferson University, operated an evening clinic at 5 locations throughout Philadelphia each week. Approach JeffHOPE’s response to challenges posed by COVID-19 focused on a redesign for a pilot clinic at a shelter site that expressed interest in resuming operations. The student leaders conducted a needs assessment with shelter stakeholders, including administrators and long-term residents, to identify service priorities. They also developed a list of key components for safe patient engagement and care delivery. A hybrid telehealth approach was developed to reduce in-person exposure for patients and volunteers and to involve preclinical medical students remotely. Three iPads were acquired via an internal grant. Outcomes The pilot clinic reopened in September 2020. Over the first 13 weeks of operation, 44 unique patients received care across 98 visits. Of these visits, 21 were in-person only with a clinical student and preceptor, while 77 also used the hybrid telehealth model to connect via iPad with a preclinical student. Patient visit volume was approximately 35%–40% of the pre–COVID-19 level. Of the 58 total volunteers, 11 were preclinical students who participated remotely. Next Steps Three additional JeffHOPE clinic sites have reopened since December 2020 using this hybrid telehealth model. Patient feedback, via surveys and interviews, will determine which components are retained. Other SRFCs should be encouraged to innovate and develop plans for safe resumption of services, with an appropriate approach and organizational support, despite the challenges posed by the pandemic.

Students as Community Vaccinators: Implementation of A Service-Learning COVID-19 Vaccination Program

“…Here we discuss the development, implementation, and evaluation of an innovative service-learning COVID-19 vaccination program. While there is growing body of literature about medical student contributions to the COVID-19 response [ 5 , 6 , 7 , 8 , 10 , 12 , 15 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], our work is the largest student-lead, community-based vaccination program described to date. It reveals that medical students are effective front-line vaccinators during a global pandemic and can attain a valuable learning experience from this service.…”

“…Most notably, perhaps, was the accelerated graduation and deployment of senior medical students as new physicians [10,11]. Students have also screened patients for COVID-19 [12], provided telemedicine support [13], worked at patient call centers [14], and facilitated the reopening of student run free-clinics [15].…”

“…Most notably, perhaps, was the accelerated graduation and deployment of senior medical students as new physicians [ 10 , 11 ]. Students have also screened patients for COVID-19 [ 12 ], provided telemedicine support [ 13 ], worked at patient call centers [ 14 ], and facilitated the reopening of student run free-clinics [ 15 ]. Collectively these examples show that although medical students are generally accepted to be non-essential workers [ 16 ]; they do represent a large pool of untapped providers with tremendous potential.…”

Experience and Attitudes Toward Telehealth in Student-Run Free Clinics (SRFC)

“…Primarily, this consists of preventive care and chronic disease management services 9 to those who are uninsured, 10 refugees, 11 or experiencing homelessness. 12 The underserved populations who utilize these clinics may face barriers to telehealth use due to social risk factors, including unmet transportation needs, food insecurity, and housing instability. While telehealth may help overcome transportation barriers, other factors may impede telehealth use in at risk populations including patient poverty level, inadequate access to technology and high-speed internet, as well as limited clinic resources.…”

A Medical Student-Run Telehealth Primary Care Clinic During the COVID-19 Pandemic: Maintaining Care for the Underserved

“… 20 Multiple telehealth models have been trialed by SRFCs during the COVID-19 pandemic to maintain access to care among vulnerable populations. 21 - 23 One of these studies reported a decrease in no show rates following the implementation of telehealth, albeit with limited data only spanning 2 months. 21 Here, we provide an in-depth discussion on the implementation of a telehealth model with fully remote visits and the impact on clinic attendance rates.…”