Factors Influencing Healthcare Utilization Among Patients at Three Free Clinics.

Despite improvements in healthcare for uninsured persons, health disparities remain. We surveyed patients at three free clinics in an urban Florida community to better understand the factors that influence where they seek healthcare. Survey questions were developed based on factors previously demonstrated to affect healthcare utilization. A focus group validated the instrument. Patients self-administered written surveys over a 6-week period at three free clinics, including a student-run free clinic (SRFC). Results were compiled and analyzed using Chi-square and Fisher-Freeman-Halton Exact tests, Kruskal-Wallis test, Mann-Whitney U test, and Spearman's rho, as appropriate. Odds ratios were calculated for significant findings (p < 0.05). Patients completed 323 surveys. Free clinic visit frequency was positively related to female gender, Hispanic ethnicity, higher income, and poorer health. Black race was related to less frequent visits. Visit frequency differed among the clinic sites. Patients attending a SRFC were more likely to utilize another clinic. Patient satisfaction was not related to visit frequency. Seeking care at other clinics was related to employment. Emergency room utilization was positively related to male gender. Patients listed proximity and ability to receive care not offered at the free clinic as the primary reasons for seeking care at another clinic. In this sample, free clinic utilization was related to demographic and community factors. Free clinics should consider these factors when designing their care delivery. SRFC's should further evaluate how they function in the safety net.