Department of Family Medicine, University of South Florida Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL, 33612, USA.
University of South Florida Morsani College of Medicine, Tampa, USA.
J Community Health. 2022 Aug;47(4):604-609. doi: 10.1007/s10900-022-01083-7. Epub 2022 Apr 2.
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.
尽管为无保险人群提供的医疗保健有所改善，但健康差距仍然存在。我们调查了佛罗里达州一个城市的三个免费诊所的患者，以更好地了解影响他们寻求医疗服务的因素。调查问题是基于先前证明会影响医疗保健利用的因素制定的。一个焦点小组验证了该工具。患者在六周内通过三个免费诊所，包括一个学生经营的免费诊所（SRFC），自行完成书面调查。使用卡方和 Fisher-Freeman-Halton 精确检验、Kruskal-Wallis 检验、Mann-Whitney U 检验和 Spearman's rho 对结果进行编译和分析，适当时使用。对显著发现计算了优势比（p<0.05）。患者完成了 323 份调查。免费诊所就诊频率与女性性别、西班牙裔种族、较高收入和较差健康状况呈正相关。黑人种族与就诊频率较低有关。就诊频率在诊所之间存在差异。参加 SRFC 的患者更有可能光顾另一家诊所。患者满意度与就诊频率无关。在其他诊所寻求护理与就业有关。急诊室利用率与男性性别呈正相关。患者列出了距离和能够获得免费诊所未提供的护理作为在另一家诊所寻求护理的主要原因。在这个样本中，免费诊所的利用与人口统计学和社区因素有关。免费诊所应在设计其护理服务时考虑这些因素。SRFC 应进一步评估他们在安全网中的运作方式。
