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Learnings from an Academic DPC Serving Vulnerable Communities

A 2024 study published in the Journal of the American Board of Family Medicine sheds light on how an academic direct primary care (DPC) clinic attempted to effectively serve vulnerable populations. The research focused on the University of Houston's (UH) DPC clinic, which was established to address healthcare disparities in Houston, a city marked by high uninsured rates and a shortage of primary care services.

Direct primary care is an innovative model of primary care delivery which operates entirely outside the traditional, insurance-based healthcare system. All care is covered under a single monthly “membership” or subscription fee.

The University of Houston's DPC clinic, a unique academic initiative, aimed to provide affordable healthcare to vulnerable populations in Harris County, Texas. Using Elation Health's EMR system, the clinic collaborated with Dr. Sara Pastoor, Elation's Head of Primary Care Advancement, to analyze patient data for this research. The study highlights the clinic's impact and, unfortunately, insurmountable challenges.

The clinic served 322 patients over eight months, with 37% speaking Spanish and many residing in socially vulnerable census tracts. Patients averaged 2.4 visits, addressing chronic conditions like hypertension and obesity. This counters the stereotype that DPC models cater only to affluent populations. However, sustainability proved challenging. Despite affordable fees ($60/month), study authors cited variables like inflation, COVID-19, and loss of the anchoring physician leading to the clinic's closure in late 2022.

The findings underscore the potential of DPC to serve low-income communities but highlight the strategic challenges of supporting this kind of innovation within the rigid structure of academic institutions. This research offers valuable insights for future DPC models aiming to bridge healthcare gaps for underserved populations, along with a cautionary tale when attempting to nest a flexible and innovative delivery model within an institutional machine.

About the Author

Elation’s Head of Primary Care Advancement and leader in primary care advocacy, Dr. Pastoor is board-certified and a clinically-active family medicine physician. As an experienced primary care innovator in military medicine, academic medicine, private practice, and employer-sponsored delivery models, Dr. Pastoor is an accomplished primary care champion and leader in patient-centered workflow, EHR optimization, and health system transformation.

Profile Photo of Dr. Sara Pastoor, MD, MHA