Ten Years of Community Partnerships at a Student-Led Free Clinic: Lessons Learned

Debra Howenstine, MD

Natalie Long, MD

​

University of Missouri

Department of Family and Community Medicine

Disclosures

• No conflicts of interest to declare.

MedZou Community Health Clinic

• Associated with the University of Missouri – Columbia School of Medicine
• Opened in October 2008
• Primary Care clinics once per week on Thursday evenings
• Average of 45 patients per month
• Psychiatry care integrated once per month
• Specialty clinics once per month on Monday evenings
• Dermatology, Musculoskeletal (PM&R), Diabetes (endocrine and ophthalmology)
• Neurology, Transgender care and Women’s Health clinics occur every other month

Overview

• Initially planned to transitional care to local FQHC clinic
• Now providing ongoing, longitudinal primary care
• Student leadership primarily composed of M1/M2s
• 1 year term on Board of Directors

​

• Student directors notoriously enthusiastic and full of new ideas…

​

Story of the Mammogram Van

​

​

Story of the Mammogram Van

• Grant Opportunity- Informal one paragraph application due tomorrow!
• Requested $13,000, received $18,000

​

​

Alumni Magazine sent to all MU alumni:

​

“MedZou to provide Free Mammogram Services”

​

“MU women’s group gives $18,000 to MedZou”

But..

• Mammograms and annual examinations not an unmet need

​

• Purchasing and running a mobile mammography unit not feasible

​

​

​

Story of the Mammogram Van

• Philanthropic group: funding had to be used as requested.

​

• Banquet already scheduled to honor MedZou

​

• Data quickly collected from multiple agencies on unmet women’s health needs and grant application rewritten

​

Mammogram Van: Lessons Learned

• Enthusiasm must be balanced with oversight

​

• Faculty involvement in program development / grant proposals provides an opportunity for students to learn that
• needs assessments are critical
• feasibility of implementation needs to be considered

Women’s Health Program

• Outcome of Women’s Health grant award

​

• Collaborated with the FQHC, Health Department and Planned Parenthood in identifying unmet needs

​

• Started as a case management program connecting women with needed services, specifically colposcopy and LEEP

Planned Parenthood Fiasco

• Price negotiations identified Planned Parenthood as lowest cost for colposcopy

​

​

​

And then….

So…

​

We developed an MOU with the University negotiating discounted prices for procedural services not covered by State Women’s Health Programs

​

Lessons Learned

• Memorandums of Understanding
• Nonbinding agreement between two or more parties outlining the terms and details of an understanding, including each parties' requirements and responsibilities.
• Needed to clarify roles and responsibilities of your organization and community organizations
• Sets expectations
• Can be adjusted based on changing needs

​

​

Women’s Health - Funding Woes

• Colposcopy and LEEP are expensive procedures
• Student leadership researched costs and feasibility of performing colposcopy on site
• Faculty commitment to attend clinics every other month

​

• Able to save money and afford more expensive LEEPs

Women’s Health

• This past year began directly providing services such as colposcopy and cervical biopsies
• Colposcope donated from FQHC
• Other equipment used on loan
• New grant just received which will allow for additional purchase of equipment

PreP for our patients

• Student interest in providing Pre-Exposure HIV Prophylaxis for MedZou patients.
• Conducted patient survey documenting interest
• Found way to obtain medication without cost. Worked with Health Department on protocol.
• Cost of lab for monitoring $338/yr –With 13 pts, over 50% of total annual lab budget

PreP: Lessons Learned

• Not all good ideas can be immediately be implemented
• Need was identified
• Resources explored
• Financial sustainability essential
• Barrier to implementation clarified
• Future implementation feasible if barrier can be eliminated.

​

Take Home Points

New Programs Involving Community Partners Should:

• Address an unmet need
• Provide benefit to patients and community
• Be financially feasible
• Sustainable

Questions?