Using student run free clinic as a referral center for the follow-up of uninsured health fair patients Novneet Sahu, Justyna Marcinow, Jeffrey Noll, Matthew Stuart, Robin Schroeder University of Medicine and Dentistry of New Jersey – New Jersey Medical School INTRODUCTION Hypertension and diabetes are major health concerns in urban communities. Early detection and treatment of these diseases is of paramount importance. For this reason, it has been suggested that mass community screenings can allow for diagnosis and early treatment. Previous attempts at introducing large mass screenings, however, have not produced desired reductions in morbidity or mortality. The effect of health fairs has been poorly studied. One of the most important barriers to health fair effectiveness has been a low follow-up rate. To overcome this barrier, we linked health fairs run by University of Medicine and Dentistry of New Jersey – New Jersey Medical School (UMDNJ-NJMS) students to the Student Family Health Care Center (SFHCC), a student-run, free clinic. Through university-wide collaboration we were able to provide referral appointments to student groups conducting health fairs. We developed referral criteria that students use to determine if referral to the clinic is necessary. Patients attending health fairs that meet criteria for referral were given a specific date to return for follow-up before they left the health fair. METHODS Setting and Participants This study was carried out in collaboration with the Student Family Health Care Center (SFHCC), a student-run clinic. This non-profit organization was established to meet the needs of the medically underserved in the Newark community. The SFHCC provides patient care two nights per week and all services are provided by volunteer medical students under the supervision of board-certified family physicians. There is no charge for an office visit, however, patients may be billed for laboratory and diagnostic services. A charity care program is available for those who do not have the ability to pay for these services. The SFHCC served during the study as the designated referral site for uninsured screening participants. A team of second year medical students from New Jersey Medical School trained in measuring vital signs and performing blood glucose readings performed health screenings at various community locations in the Newark, NJ area. From July 2011 to December 2011, 192 health fair participants at 4 health fairs were screened. Screenings attracted a variety of health fair participants and offered blood pressure and blood glucose measurements. Two health fairs were visited to determine standard of practice. Another two health fairs were visited to implement the referral process and are described in Figure 1. Protocol Our team of medical students worked with faculty physicians at NJMS to develop a protocol for referring health fair participants to the SFHCC. Only patients without any form of health insurance were referred to the SFHCC. A list of local primary care providers was provided for insured patients who met the referral criteria. Blood pressure at health screenings was measured with a standard blood pressure cuff. Diabetes screening was conducted with a random blood glucose measurement using an Accu-Chek Advantage glucometer and Accu-Chek Comfort Curve test strips. Blood pressure and elevated blood sugar criteria are diagrammed in Figure 2. DISCUSSION AND FUTURE DIRECTIONS Health fairs are often criticized for low follow-up rates. Although poorly studied, numbers ranging from 5-20% are often cited by health workers. In this study we achieved a follow-up rate of 44%. One reason for low follow-up may be that patients are uninsured. However, even with designated follow-up appointments, less than half of the patients made it to their appointments. There appears to be other access to care obstacles that need to be investigated further. One of the challenges to this model is centralizing referrals of health fair patients. Many different student groups on campus hold health fairs but not all of them contact the SFHCC to determine follow-up dates in order to refer patients during their health fairs. The next steps in this model are to designate a central source for cataloging health fairs and dispersing follow-up visit dates to student organizations so that they may increase the effectiveness of their health fairs. Other future goals include expanding the diseases covered in this referral process. Currently this model does provide a primer for effectively increasing the outreach impact of a student-run free clinic. ACKNOWLEDGEMENTS This work was generously supported by the Dr. Richard Pozen and Mrs. Ann Silver Pozen Community Service Scholarship Award and the New Jersey Medical School Department of Family Medicine. Many thanks to Dr. Steven Keller for much appreciated assistance for insight into the design of this project. Blood Pressure at Health FairCategoryIntervention /80-89Pre-hypertensionPatient education only at health fair /90-99Stage I HTN-Clinic visit for a BP measurement -If BP is still high then admit as clinic patient -If pre-hypertensive return for another BP reading -If not hypertensive discharge with patient education >160/100Stage II HTNSame as above >180/120Hypertensive CrisisRefer to the Emergency Department Blood Glucose at Health FairIntervention Patient education at the health fair and instructions to follow up at subsequent health fairs >200 with symptomsClinic visit to draw blood for HbA1C -Patients admitted to clinic if HbA1C was above 6.5 -Otherwise, discharged with education FIGURE 2: Blood pressure and random glucose criteria for interventionFIGURE 1: Health Fair Patient Analysis B’Nai Shalom Synagogue West Orange, NJ 69 Patients Metropolitan Annual Fair Irvington, NJ 52 Patients 121 Patients Screened 85 Insured36 No Insurance 27 Healthy6 Blood Pressure3 Blood Sugar 9 Patients Referred to Clinic 5 Did not follow up 4 Followed-up