CP16 - The Impact of a Student-run Free Clinic on the Dermatological Health of an Uninsured Patient Population in Norfolk, Virginia

Poster Type: Research

Category: Expanding Access to Care and Other Services

Research Objectives: This research aims to highlight the significant need for improved access to dermatological screening and follow-up for individuals without health insurance. This analysis also aims to identify the demographics of Eastern Virginia Medical School's HOPES Dermatology Clinic. Analysis of diagnoses, procedures, and follow-up rates are also investigated.

Study Design/Methods: Data was collected using the HOPES Practice Fusion electronic medical record “Chart Reports” tool to create a query for total dermatology visits from 2012-2019. This data was recorded without personal identifying information. The variables recorded are as follows: Patient Record Number, service date, age, Spanish-speaking (yes/no), English-speaking (yes/no), medications prescribed, cryotherapy performed (yes/no), biopsy performed(yes/no), excisions performed (yes/no), KOH prep performed (yes/no), steroid injection performed (yes/no), recommended follow up (yes/no), did follow up occur if recommended? (yes/no), was a referral outside of HOPES made? (yes/no), and diagnoses.

Principal Findings and Quantitative/Qualitative Results: 215 total patients were provided dermatological care at HOPES (19 Spanish-speaking and 194 English-speaking). The median age was 50 years old. 321 diagnoses were made, indicating many patients had multiple diagnoses. The most common diagnoses include atopic dermatitis (26), seborrheic keratosis (21), and acne (17). 28 skin cancer diagnoses were made: 13 basal cell carcinomas, 8 squamous cell carcinomas, 1 case of melanoma, and 1 case of nonmelanoma skin cancer. 101 medications were prescribed; steroids were the most prescribed. 24 cryotherapy procedures, 27 biopsies, 9 excisions, 5 KOH preparations, and 14 steroid injections were performed. The follow-up rate was 78%.

Conclusions on Impact on Health Centers: This project provided a better understanding of the HOPES Dermatology patient population including demographics, diagnoses, medications, services, and follow-up rate. The significant number of skin cancers diagnosed emphasizes the need for continued education about sun-protective behaviors. More research needs to be done to improve the follow-up rate. Factors that should be considered as barriers to follow up may include access to transportation and clear provider-patient communication about the importance of continued care. 10% of the HOPES dermatology patient population is Spanish-speaking. In order to provide equity, verbal and written education in Spanish should be emphasized and implemented using skilled interpreters.

Author(s):

Erin Bartholomew, MD, Class of 2022, Eastern Virginia Medical School

Katie O'Connell, MD Candidate, class of 2022, Eastern Virginia Medical School