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Evaluating Structural Barriers to Quality Care in the SHOW Free Clinic

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Homelessness is a pervasive in American society. The causes of homelessness are complex, but health and homelessness are inextricably linked. Student-run free clinics care for underserved populations, including people experiencing homelessness, but they have multiple agendas—to provide care but also

Homelessness is a pervasive in American society. The causes of homelessness are complex, but health and homelessness are inextricably linked. Student-run free clinics care for underserved populations, including people experiencing homelessness, but they have multiple agendas—to provide care but also to give students hands-on experience. It is plausible that these two agendas may compete and give patients sub-par quality of care.
This study examines patient care in the SHOW free clinic in Phoenix, Arizona, which serves adults experiencing homelessness. This study asks two questions: First, do clinicians in Phoenix’s SHOW free clinic discuss with patients how to pay for and where to access follow-up services and medications? Second, how do the backgrounds of patients, measured by scales based on the Gelberg-Anderson behavioral model for vulnerable populations, correlate with patient outcomes, including number of unmet needs in clinic, patient satisfaction with care, and patient perceived health status? To answer these questions, structured surveys were administered to SHOW clinic patients at the end of their visits. Results were analyzed using Pearson’s correlations and odds ratios. 21 patients completed the survey over four weeks in February-March 2017. We did not identify any statistically significant correlations between predisposing factors such as severity/duration of homelessness, mental health history, ethnicity, or LGBTQ status and quality of care outcomes. Twenty nine percent of surveyed patients reported having one or more unmet needs following their SHOW clinic visit suggesting an important area for future research. The results from this study indicate that measuring unmet needs is a feasible alternative to patient satisfaction surveys for assessing quality of care in student-run free clinics for homeless populations.

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2017-05

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Comparative Analysis of Interprofessional Clinic Models: Recommendations for Best Practice Implementation

Description

As the complexity of healthcare continues to rise, the need for change in healthcare delivery is more prominent than ever. One strategy identified by the World Health Organization (WHO) for responding to these increasing complexities is the use of interprofessional

As the complexity of healthcare continues to rise, the need for change in healthcare delivery is more prominent than ever. One strategy identified by the World Health Organization (WHO) for responding to these increasing complexities is the use of interprofessional practice and education to improve patient outcomes, reduce costs, and enhance the patient experience of care (Triple Aim). Interprofessional collaboration among diverse disciplines is evident on the Phoenix Biomedical Campus, integrating a wide variety of institutions and multiple health profession programs; and at the Student Health Outreach for Wellness (SHOW) free clinic, -- a successful tri-university, student-led, faculty mentored, and community-based model of interprofessional learning and care -- based in downtown Phoenix. This project conducted a comparative analysis of interprofessional components of 6 different clinical models in order to provide recommendations for best practice implementation. These models were chosen based on availability of research on interprofessionalism with their clinics. As a result, three recommendations were offered to the SHOW clinic for consideration in their efforts to improve both patient and educational outcomes. Each recommendation was intentionally formulated for its capacity to increase: interprofessionalism and collaboration between multiple disciplines pertaining to healthcare, among healthcare professionals to promote positive patient and educational outcomes. These recommendations include implementing an interprofessional education (IPE) course as a core component in an academic program's curriculum, offering faculty and professional development opportunities for faculty and mentors immersed in the interprofessional clinics, and utilization of simulation centers. Further studies will be needed to evaluate the impact these specific interventions, if adopted, on patient and educational outcomes.

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2017-05

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COMMUNITY NEEDS ASSESSMENT FOR SHOW DETERMINING THE HEALTH STATUS AND RISK FACTORS OF PERSONS EXPERIENCING HOMELESS IN MARICOPA COUNTY

Description

Introduction/Purpose: This paper describes the process of the community needs assessment phase of program implementation for the Student Health Outreach for Wellness (SHOW) clinic. Homeless individuals are more likely (than non homeless individuals) to experience serious illness, depression and mental

Introduction/Purpose: This paper describes the process of the community needs assessment phase of program implementation for the Student Health Outreach for Wellness (SHOW) clinic. Homeless individuals are more likely (than non homeless individuals) to experience serious illness, depression and mental illness. Access to health care has been identified as a barrier to receiving appropriate health care to manage the diseases and conditions clients may have. SHOW's vision is to operate on Saturdays utilizing Health Care for the Homeless (HCH) to offer extended primary health care hours, along with offering health promotion programming to address the biopsychosocial components of their health. Ultimately, this aims to reduce the homeless population's need to visit emergency room departments for non- urgent, primary care visits. Methods: To validate the need for this clinic's operation of programming and health services, a community needs assessment was conducted to collect data about the population's current health status. Forty-three people (n=43) ages 20-76 (M = 44.87) were surveyed by a trained research team using interview questionnaires. Results: The results show a prevalence of self\u2014reported physical and behavioral conditions, and support that this population would benefit from extended hours of care. Mental and behavioral health conditions are the most prevalent conditions (with the highest rates of depression (41.86%) and anxiety disorder (32.56%)), followed by the common cold (23.36%) and back pain (16.28%). The average reported emergency department (ED) visits within the past six months was 1.18 times. Almost everyone surveyed would visit a free medical clinic on the Human Services Campus (HSC) staffed by health staff and health professional students on the weekends (93.18%). Conclusion: Overall, the community needs assessment conducted for SHOW supports the need for weekend access to health care facilities and an interest in health programming for this population.

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2015-05

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Health education programming for individuals experiencing homelessness utilizing the Health Belief Model.

Description

The Student Health Outreach for Wellness (SHOW) is a free, student-led interprofessional clinic and community outreach initiative that aims to serve individuals experiencing homelessness in Phoenix, AZ. Individuals experiencing homelessness face many situational and financial barriers to finding healthcare. In

The Student Health Outreach for Wellness (SHOW) is a free, student-led interprofessional clinic and community outreach initiative that aims to serve individuals experiencing homelessness in Phoenix, AZ. Individuals experiencing homelessness face many situational and financial barriers to finding healthcare. In order to better understand these barriers, a community needs assessment (CNA) was conducted in Fall 2014 on the Human Services Campus (HSC), a hub of resources for the population. Results indicated chronic disease is moderately prevalent (37.21% and 27.91% reported obesity and hypertension, respectively, among others). Since chronic diseases can lead to more severe health issues, it is imperative to address, manage, and avoid these conditions. Health education programs are a key component of the SHOW clinic model and a means to address chronic disease. The Health Belief Model (HBM) is a theory-based behavior change model used in programs to increase patient adherence to and promotion of preventative health behaviors. SHOW health education programs will use the constructs of this model to inform program development. Since many student volunteers are not well-versed in health education literature, a SHOW Program Development Guide based on the HBM has been created. The guide will help ensure SHOW delivers high-quality and efficacious programs that have a long-lasting impact on patients now and as the organization continues to grow.

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2016-05

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Yoga as a Means of Stress Reduction in the Homeless Population in Urban Communities: A Feasibility Study

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Abstract Objective: The purpose of this study was to determine the feasibility (e.g., practicality and demand) of a 4-week series of yoga classes in a homeless shelter. Participants: Five current residents of Central Arizona Shelter Services (CASS) and the Chief

Abstract Objective: The purpose of this study was to determine the feasibility (e.g., practicality and demand) of a 4-week series of yoga classes in a homeless shelter. Participants: Five current residents of Central Arizona Shelter Services (CASS) and the Chief of Programming at CASS. Methods: Each shelter resident participated in a 5-minute interview answering questions regarding the demand of implementing a yoga program at CASS. The Chief of Programming participated in a 30-minute interview answering questions regarding the practicality of implementing a 4-week series yoga program at the homeless shelter. Results: CASS residents reported a strong desire to attend a yoga program. The Chief of Programming at CASS reported that implementing a yoga program would conflict with the overall goal of the shelter. Conclusion: Implementing a 4-week series yoga program is not feasible at CASS although there is a strong demand for a yoga program among the homeless population of the Phoenix metro area.

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2016-12