Following up for Free: Chronic Disease Prevalence and Morbidity among the Uninsured

From the 2019 HVPAA National Conference

Dr. Abu-Sayeef Mirza (University of South Florida), Ms. Noura Ayoubi (University of South Florida), Ms. Madeline MacDonald (University of South Florida), Mr. Justin Swanson (University of South Florida), Dr. Shams Rahman (Bethune Cookman University), Dr. Laurie Woodard (University of South Florida), Dr. Rahul Mhaskar (University of South Florida)

Introduction

Approximately 60% of the U.S. adult population now live with at least one chronic condition and about 42% have more than one chronic condition.1,2 Care for patients with chronic conditions consumed approximately 86% of all health care spending in 2010.3 Unfortunately, over 10% of all Americans are uninsured and many rely on charitable services for medical care.4,5 According to the National Association of Free and Charitable Clinics (NAFC), there are over 1,200 free medical clinics and 10% are run by students from approximately half of all U.S. medical schools.6 There is limited knowledge about the prevalence and risk of chronic disease among the poor and uninsured frequenting free clinics.

Methods

A retrospective chart review was conducted to collect data on chronic diseases from electronic and paper-based medical records at 9 free clinics in the Tampa Bay area. Charts containing clinic visits from January 2016 to December 2017 were included and analyzed. Proportion for prevalence, adjusted odds ratio (AOR), and 95% confidence intervals (CI) for associations between patient characteristics and chronic conditions are reported. Charlson comorbidity index (CCI) was also calculated for each patient to assess mortality risk.

Results

From January 1, 2016 to December 31, 2017, a total of 8857 patients were managed at 9 free clinics. After omitting missing variables, 5074 (58%) were women, 3408 (54%) were Hispanic, and 2019 (46%) were unemployed. In terms of follow-up, 4207 (48%) were seen more than once, and 2613 (30%) were seen more than twice. The mean number of visits was 2.51. Follow-up visits were most common among patents with the following documented conditions: hypertension (1350, 63%), diabetes (840, 65%), hyperlipidemia (890, 73%), depression (529, 67%), anxiety (462, 68%), arthritis (344, 63%), asthma (336, 66%), anemia (260, 73%), coronary artery disease (130, 59%), cancer (147, 71%), COPD (101, 64%), CVA (102, 71%), MI (55, 63%). The average CCI for all patients was 0.84 with the CCI being 0.64 for patients seen only once, and 1.06 for patients seen for 2 or more visits. Further univariable analyses including chi-square and correlations are reported.

Conclusions

Uninsured patients with multiple comorbidities and elevated mortality risk continue to follow up with free clinic providers. Future public health programs should target the common diseases experienced by uninsured patients. Future studies are needed to study effective management of these multiple comorbidities in the free clinic setting. By describing the clinical characteristics of uninsured patients, we can paint a more accurate picture of the state of American health care as we struggle to pay for the price of poverty.