J. Eng1, T. Jaraczewski1, D. Wilson1, J. Prom1, M. Leissring1, J. Gellings1, M. Schroeder1, R. Lundh2, B. Thorson4, B. Horner3, K. Iverson1 1Medical College Of Wisconsin, Surgery, Milwaukee, WI, USA 2Saturday Clinic for the Uninsured, Milwaukee, WI, USA 3Bread of Healing Clinic, Milwaukee, WI, USA 4Free and Community Clinic Collaborative, Milwaukee, WI, USA
Introduction:
Lack of insurance leads to delays in diagnosis and treatment resulting in poorer surgical outcomes. Free and charitable clinics are crucial for bridging the gap to care for patients without insurance. Capturing the perspectives of the clinics that serve these patients is important to understand the nuances of caring for this marginalized population. This study sought to utilize focus groups to elucidate the processes and experiences of staff in Milwaukee-area free clinics as they navigate and facilitate access to surgical care for patients without insurance.
Methods: Three focus groups were conducted from May-June 2024 with participants recruited from eleven free clinics in the greater Milwaukee area. The group sizes ranged from three to twelve participants and were held at different clinic locations around Milwaukee County. Participants included physicians, nurses, and administrative staff. Rapid thematic analysis was conducted with deductive coding. After initial coding, codes were collapsed as appropriate and axial coding was employed to group codes into refined themes. All themes were supported with direct quotes. Validation was performed through member checking during the focus groups and post hoc review by experts on the study team.
Results: Five key themes were identified during analysis (Figure 1): demographic/social determinants of health, barriers to care, band-aids, facilitators, and hopes and dreams. Each theme was composed of various subthemes that further explained the intricacies of obtaining surgical care for the uninsured. Barriers to care had the largest number of subthemes including health literacy, fragmented system, financing, bureaucracy of the system, and mistrust/stigma. Within “hopes and dreams” common ideas included a centralized source for clinic workers to know how to work up a potential surgical problem, improved coordination between health systems, simplification of current protocols, and a patient navigation program. Interconnections between themes were highly prevalent and, generally, described a nuanced and overly complex system for both patients and providers.
Conclusion: Understanding the current process and clinic experience in acquiring surgical care for uninsured patients is critical for identifying gaps and opportunities to improve care. This study highlights the perspectives of the front-line workers who care for the marginalized, uninsured population of Milwaukee County. Overall, the study sheds light on complexities ranging from the patient level to the bureaucratic level. Findings from this study will be utilized within a larger project to develop a formal pathway streamlining surgical access for the uninsured.