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Kibria F.,Smith College | Peters J.L.,Harvard University | Shulman C.,Brown University | Joseph V.,Clinica Esperanza Hope Clinic | De Groot A.S.,University of Rhode Island
Rhode Island medical journal (2013) | Year: 2014

Hypertension affects more than 50 million people in the United States. A recent national health study (NHANES) found that the proportion of certain Hispanic ethnic groups with stage 1 and stage 2 hypertension was greater than for whites. In order to identify areas of improvement, as well as to examine trends in patient outcomes, Clínica Esperanza/Hope Clinic (CEHC), a free clinic for the uninsured, recently conducted a study to evaluate how well the clinic's hypertensive patients are treated, according to current guidelines for hypertension, as compared to other clinics in the U.S. that serve the uninsured. For five out of the six health measures documented, at least 50% of CEHC hypertensive patients met or exceeded the goal values; these numbers are on par with if not better than other national comparators. This study has provided encouraging baseline data, upon which CEHC plans to make further improvements.

Bicki A.,Clinica Esperanza Hope Clinic | Silva A.,Clinica Esperanza Hope Clinic | Joseph V.,Clinica Esperanza Hope Clinic | Handoko R.,Clinica Esperanza Hope Clinic | And 8 more authors.
Journal of Community Health | Year: 2013

Non-urgent healthcare problems are responsible for more than 9 million visits to the emergency department (ED) in US hospitals each year, largely due to patients' lack of access to a primary care physician. To avoid costly and unnecessary ED usage for non-urgent health problems, a walk-in clinic run by nurses (CHEER Clinic) was developed as an extension of the services provided by an existing free clinic in a low-income neighborhood of Providence, RI, with the goal of providing uninsured patients with a convenient, no-cost means of accessing healthcare. An evaluation and cost-effectiveness analysis of the clinic's first 5 months of operation were performed. During this pilot period, 256 patients were seen. When incorporating the quality-adjusted-life-year value of preventive services rendered, an estimated $1.28 million in future healthcare costs was avoided. Dividing these cost-savings by the clinic's operational cost yielded a mean return on investment of $34 per $1 invested. Adding nurse-run walk-in hours at a free clinic significantly expanded access to healthcare for uninsured patients and was cost-effective for both the clinic and the patient. Ultimately, replication of this model in community clinics serving the uninsured could reduce ED burden by treating a substantial number of non-urgent medical concerns at a lower cost than would be incurred for treatment of the same problems in EDs. © 2013 Springer Science+Business Media New York.

Buckley J.,Brown University | Yekta S.,University of Rhode Island | Joseph V.,Clinica Esperanza Hope Clinic | Johnson H.,University of Rhode Island | And 6 more authors.
Journal of Community Health | Year: 2014

Metabolic syndrome is an increasingly common condition that can contribute to the development of type 2 diabetes and cardiovascular disease. 35 % of adults living in the United States meet the criteria for having metabolic syndrome, with that number being even higher in populations with health disparities. We describe a ‘healthy lifestyles’ program implemented at a free clinic serving a predominantly Hispanic cohort of low-income, uninsured individuals living in Providence, Rhode Island. The “Vida Sana/Healthy Life” (Vida Sana) program uses low literacy, language-appropriate materials and trained peers to educate participants about healthy lifestyles in a setting that also provided opportunities for social engagement. 192 of 126 (65.6 %) participants in Vida Sana completed 6 out of 8 sessions of the Vida Sana program over a 12-month period. At the completion of the program, nearly 90 % of Vida Sana participants showed an increase in their health literacy, and at least 60 % of participants decreased each of the risk factors (blood sugar, cholesterol, body mass index or waist circumference) associated with metabolic syndrome. © 2014, Springer Science+Business Media New York.

Chau J.,University of Rhode Island | Kibria F.,Smith College | Landi M.,Rhode Island College | Reilly M.,Clinica Esperanza Hope Clinic | And 4 more authors.
Rhode Island medical journal (2013) | Year: 2014

The Food and Drug Administration has approved two human papillomavirus (HPV) vaccines for use by men and women in the United States. The vaccines not only protect against HPV infection, but also reduce the risk of cervical cancer in women. Despite the widespread availability of these vaccines, vulnerable populations such as those with low incomes have been reported to have limited access to and knowlege about HPV vaccines. In order to evaluate and improve HPV vaccination uptake in a population of uninsured, low-income Spanish- speaking individuals attending a free clinic in Rhode Island, we administered a questionnaire regarding knowledge, attitudes, and practices (KAP) and performed an education intervention. We found that knowledge of HPV infection and cervical cancer among the patients sampled was low when comparing Hispanics to non-Hispanics (47.2%, 85.7%, respectively) but willingness to vaccinate oneself or one's child was very high after a brief video- based intervention.

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