Remote Management of a Panel of Socially Vulnerable Patients through a Student-run Free Clinic

This resource contains protocols for Student-Run Free Clinics (SRFCs) providing remote care to vulnerable patient populations. The protocols were developed by the Rutgers Robert Wood Johnson Medical School HIPHOP Promise Clinic (abbreviated “Promise Clinic”), an SRFC serving uninsured residents of New Brunswick, New Jersey. The creation of these protocols was a collaborative effort between Promise Clinic and many community organizations responding to the COVID-19 pandemic. The COVID-19 pandemic has already inflicted a horrific case count and death toll in the United States, with New Jersey experiencing the second highest number of cases and deaths of any state as of June 2020 [1]. Middlesex County, where New Brunswick is located, had over 15,000 cases of COVID-19, with many occurring in low-income neighborhoods [2]. 

In response to the pandemic, which has had disproportionately negative outcomes in underserved populations, the administrative board and student leaders of Promise Clinic mobilized to 1) identify COVID-19 risk and educate patients about the disease, 2) provide acute care, chronic care, and mental wellness check-ins remotely, and 3) identify and address critical social needs, including food insecurity and eviction concerns. Promise Clinic’s model uses Student Doctor teams—which each consist of an M1-M4 student member-- who provide longitudinal care to 1-2 patients. During the pandemic, a shared internal website was developed to preserve team coordination and disseminate resources as they were developed. Teams called their patients every two weeks to check in on their needs using the phone script (Resource #1) to guide the phone calls (for Spanish-speaking patients, a certified student interpreter assisted with these calls and utilized the translated form of this call script). Students were also provided with a safety protocol (Resource #2) with specific instructions to guide students should their patient experience an emergency during the phone call (e.g. an acute psychiatric episode). Phone calls were made using either the clinic’s phone, number-protected student phones, or the HIPAA-secure video/phone conferencing application called Doximity Dialer. The Operations and Quality Improvement committees tracked which patients were contacted using the Weekly Patient list (Resource #3). Teams that had contacted their patients would then chart their note and present their findings to a supervising physician during a video conference call held on Thursday evenings. The supervising physician would provide feedback and discuss the follow-up plan with the team. Due to the decentralized nature of providing care remotely, it was necessary to develop clear and specific protocols to guide student doctor teams through a variety of situations. In addition to the protocols described above, the Operations committee and other subcommittees also developed new pandemic-specific protocols for managing Patient Assistance Program medication refills and providing contactless grocery delivery for homebound food-insecure patients. 

Since March 2020, 39 out of a total of 53 patients have received regular care via this process. Twelve patients have been lost to follow-up or moved out of the state of New Jersey, and two patients have transitioned to health insurance. No new patients have been recruited during the pandemic, due to the inability to conduct a full physical exam in person. Over 100 prescriptions have been provided for patients, and three patients have received at least one direct food package drop-offs due to inability to leave their homes. One patient has been hospitalized due to COVID-19, and their care was closely managed by their student doctor team using the Hospitalization/Discharge protocol. Since the beginning of this initiative, student doctors have reported a deeper understanding and contextualization of the difficulty of providing medical care to vulnerable populations. We hope to share these protocols with other SRFCs, as they have improved our ability to provide care remotely during the pandemic. These resources have encouraged student autonomy in managing the primary care needs of socially vulnerable patients remotely.