Free Care Is Not Enough: Barriers to Attending Free Clinic Visits in a Sample of Uninsured Individuals with Diabetes.

Abstract

Free care does not always lead to improved outcomes. Attendance at free clinic appointments is unpredictable. Understanding barriers to care could identify innovative interventions. The purpose of this study was to examine patient characteristics, biophysical outcomes, and health care utilization in uninsured persons with diabetes at a free clinic. A sample of 3139 patients with at least one chronic condition was identified and comparisons were made between two groups: those who attended all scheduled appointments and those who did not. Geographic distance to clinic and multiple chronic conditions were identified as barriers to attendance. After one year, missing more than one visit had a positive correlation with increased weight, A1C, and lipids. Additionally, patients who missed visits had higher blood pressure, depression scores, and numbers of medications. Future research should further enhance understanding of barriers to care, build knowledge of how social and behavioral determinants contribute to negative outcomes in the context of rurality. Innovative methods to deliver more frequent and intensive interventions will not be successful if they are not accessible to patients.