title: Primary Care Continuity Improves Diabetic Health Outcomes: From Free Clinics to Federally Qualified Health Centers.
abstract: There are a number of well-established barriers to accessing primary care. The LINKED Study set out to improve primary care usage through 1-on-1 counseling and referrals for patients with diabetes being treated at local free clinics. We hypothesized that this educational intervention paired with expedited referral would increase the use of federally qualified health centers (FQHCs) as a source of health care and ultimately lead to improved diabetic health.
  
  
  
  Medical student volunteers counseled participants on the importance of primary care. The participants then completed surveys about diabetic health, socioeconomic status, and general demographics. Participants were subsequently assigned to 1 of 2 FQHCs; designated care coordinators facilitated appointments. At the end of a 9-month action period, participants repeated the initial surveys, now including appointment history and health data (hemoglobin A1c (%) [HbA1c], body mass index).
  
  
  
  Sixty-eight participants were enrolled. The average time since a diagnosis of diabetes mellitus was 8.3 years (standard deviation [SD], 8.4 years), and 25% of participants used insulin. Mean baseline HbA1c for participants with a recorded value (n = 55) was 9.5 (SD, 2.5). FQHC appointments were scheduled by 68% of participants; 38% of the participants attended ≥2 appointments. The most common reported barriers to accessing primary care were no prior health insurance (85.3%) and cost of medical care (72.1%). In our follow-up assessment there was a statistically significant decrease in HbA1c for those linked to FQHCs (9.5 [SD, 2.3] to 8.3 [SD, 2.2]; n = 21).
  
  
  
  This study demonstrates the utility of a linkage program from free clinics to FQHCs. Those individuals with diabetes receiving health care from an FQHC demonstrated improved glycemic control.
authors.affiliation: From the Department of Medicine, University of Chicago Medical Center, Chicago, IL (PPM); and the Department of Family Medicine (MJW) and the Center for Integrative Health and Wellness (DH), The Ohio State University College of Medicine (FAM, JS-T, EW, KH), Columbus.
authors.forename: Priya P
authors.initials: PP
authors.lastname: Mehta
authors.affiliation: From the Department of Medicine, University of Chicago Medical Center, Chicago, IL (PPM); and the Department of Family Medicine (MJW) and the Center for Integrative Health and Wellness (DH), The Ohio State University College of Medicine (FAM, JS-T, EW, KH), Columbus.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Santiago-Torres
authors.affiliation: From the Department of Medicine, University of Chicago Medical Center, Chicago, IL (PPM); and the Department of Family Medicine (MJW) and the Center for Integrative Health and Wellness (DH), The Ohio State University College of Medicine (FAM, JS-T, EW, KH), Columbus.
authors.forename: C Ellis
authors.initials: CE
authors.lastname: Wisely
authors.affiliation: From the Department of Medicine, University of Chicago Medical Center, Chicago, IL (PPM); and the Department of Family Medicine (MJW) and the Center for Integrative Health and Wellness (DH), The Ohio State University College of Medicine (FAM, JS-T, EW, KH), Columbus.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hartmann
authors.affiliation: From the Department of Medicine, University of Chicago Medical Center, Chicago, IL (PPM); and the Department of Family Medicine (MJW) and the Center for Integrative Health and Wellness (DH), The Ohio State University College of Medicine (FAM, JS-T, EW, KH), Columbus.
authors.forename: Frini A
authors.initials: FA
authors.lastname: Makadia
authors.affiliation: From the Department of Medicine, University of Chicago Medical Center, Chicago, IL (PPM); and the Department of Family Medicine (MJW) and the Center for Integrative Health and Wellness (DH), The Ohio State University College of Medicine (FAM, JS-T, EW, KH), Columbus.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Welker
authors.affiliation: From the Department of Medicine, University of Chicago Medical Center, Chicago, IL (PPM); and the Department of Family Medicine (MJW) and the Center for Integrative Health and Wellness (DH), The Ohio State University College of Medicine (FAM, JS-T, EW, KH), Columbus. Diane.Habash@osumc.edu.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Habash
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D001786:Blood Glucose / Q000032:analysis; D003266:Continuity of Patient Care; D003376:Counseling; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006297:Health Services Accessibility; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011446:Prospective Studies; D058996:Quality Improvement; D012017:Referral and Consultation; D012923:Social Class; D000070319:Student Run Clinic; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Community Health Centers; Diabetes Mellitus; Glycated Hemoglobins; Populations; Social Determinants of Health; Underserved