Dunedin's free clinic: an exploration of its model of care using case study methodology

Abstract

INTRODUCTION: Models of care are important therapeutic modalities for achieving the goals of health care teams, but they are seldom explicitly stated or investigated. AIM: To describe the model of care at Dunedin's free clinic, and assess whether this model catered to the particular needs of enrolled patients. METHODS: A mixed methods study was conducted using case study methodology to construct the clinic's model of care from multiple data sources, and to create a profile of patients' needs. A nested case study of patients with diabetes examined patients' social vulnerability characteristics. The pattern matching analytic technique was used to assess the degree of alignment between the model of care and patients' needs. RESULTS: Patients were not only high users of both primary and secondary health care, but also of justice and social welfare sector services. The care of patients with diabetes was complicated by coexisting social vulnerability and medical comorbidities. Surveyed patients placed high value on interpersonal dimensions of care, the Christian ethos of the clinic, and the wider range of services available. DISCUSSION: This study suggests a degree of 'fit' between the clinic's model of care and the needs of enrolled patients. A model of care that caters to the needs of patients with complex needs is important for securing their engagement in health services. KEYWORDS: Health services research; health status disparities; primary health care; qualitative research; vulnerable populations