Better Understanding Barriers to Uninsured Patient Appointment Attendance at a Student Run Free Clinic Benjamin Morrissey Christopher Mecoli Robin Schroeder, MD Steven Keller, PhD UMDNJ-New Jersey Medical School Newark, NJ

Introduction to the Student Family Health Care Center (SFHCC) Student Run Free Clinic, founded 1967 in Newark, NJ Database of over 1200 patients Annually see around 120 unique patients Structure of clinic Schedule Format Services

Introduction Project impetus – Perception of high rate of missed appointments – Desire to better utilize clinic resources Hypothesis – What factors are affecting the missed appointments?

Goal 1: To determine if our impressions concerning a high rate of missed appointments at student run free clinic is in fact true Reviewed appointment schedules for last year and patient charts for demographic information Data revealed 41% missed or cancelled appointment National average – variable Data about student run free clinics?

Goal 2: To determine what factors are influencing missed appointments Can’t take care of patients if they don’t come to clinic How do we improve appointment attendance?

Hypotheses – Availability of transportation – Cost of transportation – Communication with clinic – Previous experience with clinic – Job commitment – Family commitment – Time of appointment – Distance traveled – Reminder phone calls

Methods Open ended telephone interviews, followed by prompted questions with patients having appointment from 11/17/2009 and 2/2/2010 Missed vs. Attended – 21 out of 29 patients who missed appointment interviewed – 21 out of 27 patients who attended appointment interviewed

Clinic Demographics vs. Study Demographics Clinic PopulationStudy population interviewed with missed appointment Study population interviewed with attended appointment Male45%33%43% Female55%67%57% African American60%67% Hispanic29%10%5% Caucasian3%14%5% Asian4%0% Other/Unknown4%10%24% <18 years old3%5%10% %42%30% %53%50% 65+6%00 Interviewed-21/29 patients21/27 patients

Factors Affecting Appointments

Discussion Family obligations (Missed 29%, Attended 10%) – Caring for infants or children – Elderly with chronic illness, assist in daily activities Job commitment (Missed 38%, Attended 14%) – Uncertain works schedules – Long lead time to appointment with chronic care Availability of transportation (Missed 19%, Attended 0%) – Higher n is needed – Difficult to affect this factor

Where to go from here Plans – Increase sample size – Interventions Child care Hold open appointments? – Expanding to other student run free clinics Unique results to our population?

Questions?