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How An Academic Direct Primary Care Clinic Served Patients from Vulnerable Communities.

Winston Liaw1, Ben King2, Henry Olaisen2

  • 1From the Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (WL, BK); Agency for Healthcare Research and Quality, Rockville, MD; American Academy of Family Physicians, Washington, DC (HO); Elation Health, San Antonio, TX (SP); Texas Water Development Board (AK); Elation Health, Houston, TX (NC); Department of Clinical Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (BR); Suvida Healthcare, Houston, TX (OMV); American Academy of Family Physicians, Overland Park, KS (SW); University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX (SS). winstonrliaw@gmail.com).

Journal of the American Board of Family Medicine : JABFM
|August 14, 2024
PubMed
Summary

Direct primary care (DPC) clinics can serve vulnerable populations, as evidenced by an academic DPC clinic that cared for patients in high-vulnerability census tracts. This counters the notion that DPC models only attract affluent patients.

Keywords:
Census TractHealth InsurancePrimary Health CareSocial VulnerabilityVulnerable Populations

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Area of Science:

  • Healthcare access
  • Primary care models
  • Health equity

Background:

  • Direct primary care (DPC) is a healthcare model with a periodic fee.
  • Critics express concern that this fee structure may exclude vulnerable populations.
  • Understanding the demographics of DPC patients is crucial for assessing its accessibility.

Purpose of the Study:

  • To describe the demographics and appointment patterns of patients at a now-closed academic DPC clinic.
  • To compare the social vulnerability index (SVI) of census tracts with DPC patients to those without.

Main Methods:

  • Linked electronic health record data with the Social Vulnerability Index (SVI).
  • Described patient demographics (age, sex, language, diagnoses) and appointment frequency.
  • Used t tests and Mann-Whitney U tests to compare SVI and census variables between tracts with and without clinic patients.

Main Results:

  • The study included 322 patients and 772 appointments; most patients were female and over a third spoke Spanish.
  • Patients were seen an average of 2.4 times, with a mean of 3.68 diagnoses per patient.
  • Census tracts with DPC patients had significantly higher SVI scores (indicating greater vulnerability) compared to tracts without DPC patients (median 0.60 vs. 0.47, p < 0.05).

Conclusions:

  • The academic DPC clinic served individuals residing in vulnerable census tracts.
  • This finding challenges the perception that DPC clinics primarily serve affluent populations.
  • Despite its closure due to obstacles, the clinic demonstrated the potential for DPC to reach underserved communities.