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      Patient Outcomes from Student-Run Health Services: An Integrative Review

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          Abstract

          Background

          Student-run clinics (SRCs) offer an innovative approach to expand healthcare access and equity and increase clinical placement opportunities for students. However, research on the health benefits and/or outcomes of such clinics is currently fragmented.

          Methods

          An integrative review was conducted to capture and synthesize findings across a range of study types involving varied student disciplines, student delivered intervention types, and health conditions addressed or care areas of focus. Only published and peer reviewed studies were included. Studies needed to report outcomes in a defined study group measured over time, or report SRC data with explicit comparisons to non-SRC settings. Data were analyzed using inductive content analysis to identify major themes and natural clustering of health outcomes measured.

          Results

          Fifty-one articles were selected for review based on the eligibility criteria. Studies were predominantly from the United States, and most (n = 34, 67%) adopted a case review methodology for measuring outcomes. Health outcomes were evaluated in relation to a range of health conditions that, for the purposes of this review, were considered to naturally cluster into eight categories: diabetes, hypertension, functional health/quality of life, depression, hospital utilization, substance use, weight, health screening/vaccinations, and others.

          Conclusion

          This integrative review sought to evaluate the health outcomes accrued by patients in student-run health clinics. Taken as a whole, the literature suggests positive health outcomes resulting from student-run clinics across a range of health conditions. Greater confidence in care-related findings would be achieved from future research utilizing more robust and prospective study designs.

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          Most cited references91

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          The integrative review: updated methodology.

          The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process. Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated. A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review. An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.
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            Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

            Summary Background Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), age-standardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis. Funding Bill & Melinda Gates Foundation.
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              Study design, precision, and validity in observational studies.

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                Author and article information

                Journal
                J Multidiscip Healthc
                J Multidiscip Healthc
                jmdh
                Journal of Multidisciplinary Healthcare
                Dove
                1178-2390
                30 March 2022
                2022
                : 15
                : 641-665
                Affiliations
                [1 ]Centre for Health and Social Practice, Waikato Institute of Technology , Hamilton, New Zealand
                [2 ]School of Occupational Therapy, Otago Polytechnic , Hamilton, New Zealand
                [3 ]Department of Kinesiology, Pennsylvania State University , University Park, PA, USA
                [4 ]Centre for Sport Science and Human Performance, Waikato Institute of Technology , Hamilton, New Zealand
                [5 ]School of Nursing, Midwifery and Social Science, Central Queensland University , Rockhampton, QLD, Australia
                [6 ]School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast , Sippy Downs, QLD, Australia
                [7 ]School of Nursing, Midwifery & Public Health, University of Canberra , Canberra, ACT, Australia
                [8 ]School of Medicine & Dentistry, Griffith University , Southport, QLD, Australia
                Author notes
                Correspondence: Patrick Broman, Waikato Institute of Technology , Tristram Street, Hamilton, New Zealand, Tel +64 272070249, Email patrick.broman@wintec.ac.nz
                Author information
                http://orcid.org/0000-0003-3491-4137
                http://orcid.org/0000-0002-0176-4876
                http://orcid.org/0000-0002-0174-3813
                Article
                348411
                10.2147/JMDH.S348411
                8979421
                35387392
                1359ee86-592d-4185-b936-7e2feb34c5f2
                © 2022 Broman et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 08 November 2021
                : 12 January 2022
                Page count
                Figures: 2, Tables: 4, References: 95, Pages: 25
                Categories
                Review

                Medicine
                student-run clinic,student-led clinic,student-delivered,patient outcomes,interprofessional education,medical education

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