Date of Conferral



Doctor of Nursing Practice (DNP)




Sue E. Bell


Patients who are unable to comply with their health care regimen are almost 3 times more likely to have an adverse health outcome and are more likely to suffer irreversible progression of a chronic disease process. Increasing patient return clinic visits is essential, not only to curtail rapidly rising costs of health care but also to improve patient outcomes. This project focused on an uninsured patient population of a clinic in a rural community in the southeastern United States. The purpose of the project was to conduct a systematic review of the literature and identify the barriers and motivating factors for chronic care return primary care visits among uninsured patients. The theoretical models supporting the project were the health belief model and the chronic care model. A search of scholarly databases resulted in 366 articles meeting the inclusion criteria of peer-reviewed English-language literature published since 2014 that focused on outpatient care among uninsured populations. All identified articles were reviewed, and several interventions emerged as options to increase patient return rates: care transition and coordination services, patient education, patient follow up, pharmacy assistance programs, food assistance programs, and integration of computer-based literacy interventions. The clinic administrators determined that the best option for the site would be implementation of an on-site food program. The findings of this project have potential to create social change in clinics for uninsured in the community by addressing food insecurity and providing patients an incentive to return for care every 6 months.

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