Zhang Michael, Garcia Alejandro, Bretones Gisela
Miami Rescue Mission Clinic, Miami, FL, United States.
School of Health Sciences, Miami Dade College, Miami, FL, United States.
Front Public Health. 2019 Aug 2;7:212. doi: 10.3389/fpubh.2019.00212. eCollection 2019.
Although the ranks of the uninsured in the United States have decreased in recent years, some states still lack Medicaid expansion programs, leaving many Americans, especially the indigent and homeless, without adequate healthcare coverage. Free-for-care clinics are oftentimes the last safety net for these vulnerable populations. Because these clinics have limited funding, a thorough understanding of the patients they serve is necessary to effectively direct their resources. The objective of the present study is to investigate the characteristics and clinical profiles of patients utilizing a free clinic in Miami, Florida. Aggregate EMR data reflecting consecutive adult patient visits to the Miami Rescue Mission Clinic in Miami, Florida between January 1st, 2018 to March 15th, 2019 ( = 846) were reviewed for sociodemographic characteristics and chronic disease prevalence. Prevalence rates were compared by sex and to county estimates from the Florida Behavioral Risk Factor Surveillance System. The most common conditions were mental health (19.3%), circulatory system (14.7%), and musculoskeletal system disorders (13.9%). Males had a greater prevalence of depression (difference = 6.6%; 95% CI [1.5 to 10.7%]; χ = 6.2; = 0.013) and overall mental illness (22.0 vs. 10.4%, difference = 11.6%; 95% CI [5.7 to 16.4%]; χ = 13.2; = 0.0003) compared to females, and male sex was identified as an independent risk factor for mental illness on multivariate logistic regression analysis (OR = 2.8; 95% CI [1.7 to 4.7]; < 0.001). There was also a higher prevalence of depression (difference = 6.41%; 95% CI [2.1 to 10.2%]; χ = 8.0; = 0.0047) and HIV (difference = 1.4%; 95% CI [0.3 to 3.0%]; χ = 7.3; = 0.007) in male patients compared to county estimates. Rates of hypertension, diabetes, elevated cholesterol, asthma, and COPD were lower in the clinic population compared to the surrounding county. There is an acute need for mental health services in this population. The lowered prevalence of other chronic conditions is due to underdiagnosis and loss to follow-up. Such analyses are important in guiding policy decisions for meeting the health needs of vulnerable, at risk populations.
尽管近年来美国未参保人群的数量有所减少，但一些州仍缺乏医疗补助扩大计划，致使许多美国人，尤其是贫困者和无家可归者，得不到足够的医疗保障。免费诊疗诊所往往是这些弱势群体的最后一道安全网。由于这些诊所资金有限，因此有必要全面了解其所服务的患者，以便有效地分配资源。本研究的目的是调查佛罗里达州迈阿密一家免费诊所患者的特征和临床概况。回顾了2018年1月1日至2019年3月15日期间（n = 846）成年患者连续就诊于佛罗里达州迈阿密市迈阿密救援团诊所的综合电子病历数据，以了解社会人口学特征和慢性病患病率。按性别比较患病率，并与佛罗里达州行为风险因素监测系统的县估计值进行比较。最常见的疾病是心理健康问题（19.3%）、循环系统疾病（14.7%）和肌肉骨骼系统疾病（13.9%）。与女性相比，男性抑郁症患病率更高（差异 = 6.6%；95%可信区间[1.5%至10.7%]；χ² = 6.2；P = 0.013），总体精神疾病患病率也更高（22.0%对10.4%，差异 = 11.6%；95%可信区间[5.7%至16.4%]；χ² = 13.2；P = 0.0003），多因素逻辑回归分析确定男性是精神疾病的独立危险因素（比值比 = 2.8；95%可信区间[1.7至4.7]；P < 0.001）。与县估计值相比，男性患者抑郁症患病率（差异 = 6.41%；95%可信区间[2.1%至10.2%]；χ² = 8.0；P = 0.0047）和艾滋病毒患病率（差异 = 1.4%；95%可信区间[0.3%至3.0%]；χ² = 7.3；P = 0.007）也更高。与周边县相比，诊所人群中高血压、糖尿病、高胆固醇、哮喘和慢性阻塞性肺病的患病率较低。该人群对心理健康服务有迫切需求。其他慢性病患病率较低是由于诊断不足和失访所致。此类分析对于指导满足弱势群体健康需求的政策决策非常重要。
