Rhode Island Free Clinic's Experience
The Rhode Island Free Clinic in Providence, RI, provides an array of coordinated, comprehensive medical services with the belief that everyone deserves access to healthcare, regardless of income or background. With the volunteer medical talents of over 500 area physicians, nurses, and specialists, and a dynamic team of AmeriCorps VISTA Members, the Free Clinic provides culturally competent, quality care to the Ocean State’s medically uninsured adults.
In addition to ongoing free primary care, the clinic provides free ophthalmology specialty care, adding to our larger comprehensive medical team and services, which allows us to provide patients with a whole-patient experience. The ophthalmology team screens for eye disease, including external eyelid disease, anterior segment inflammation, cataract changes, and macular degeneration. The comprehensive medical eye screening helps diagnose and direct treatment for patients with diabetes and high blood pressure, making the posterior segment evaluation vital. Outfitting RIFC with appropriate diagnostic and treatment equipment as well as management of eye disease, is untenable due to economics and staffing. A relationship was established with a local hospital system, Lifespan/Rhode Island Hospital, with the Brown Ophthalmology residency program. Local ophthalmologists who volunteer at RIFC also participate in providing free follow-up care in certain instances.
Rhode Island Free Clinic:
Screening Program
Goal - The overarching goal is to improve the accessibility of eye disease detection and management among a vulnerable and at-risk population. This clinic also aims to perform diabetic retinopathy and hypertensive retinopathy screening with the additional objective of identifying other eye diseases.
Equipment – Electronic health records are documented with eClinicalWorks. The instruments and materials present in the exam room are a visual acuity chart, a tester, a slitlamp biomicroscope, a tonometer, and various dilating drops if indicated. A direct and indirect ophthalmoscope, 20, 78, and 90 diopter lenses are also present. Interpretation language services are always available.
Screening Exam - A multilingual medical assistant collects the patient’s current medical history. The assistance of an interpreter is always available. The medical assistant performs a visual acuity test, with and without a pinhole, followed by a Tonopen tonometry test to record IOP. The patient is examined by the physician, and if indicated, the patient’s eyes are dilated. The physician then performs as comprehensive a slitlamp biomicroscopic eye exam as possible.
Interpreting Screening Results – After carefully reviewing the findings from the exam, the physician discusses the diagnosis directly with the patient.
Communicating Results to Patients and Clinicians – The exam findings and diagnostics are communicated to the patient on the day of the exam. If no further workup or treatment is indicated, a follow-up appointment is made at the free clinic in conjunction with routine medical care. Should a clinical condition warrant further evaluation and/or treatment, the patient is referred as noted above. Eye care and ophthalmology services, being imagebased and a data-rich specialty of medicine, are poised for the application of artificial intelligence support, particularly in this RIFC model.
Billing – This clinic does not bill patients. It operates entirely through sustained philanthropic and institutional funding, with no direct billing to patients. Support is provided by private donors, local foundations, and partner hospitals, which collectively cover the cost of equipment, supplies, and clinician volunteer time. This funding structure ensures that all vision care services remain free to our patient population.
Scheduling Follow-up Care – The clinic ensures that patients are scheduled for follow-up care or given referrals when needed. As noted, patients are typically referred to the Rhode Island Hospital Eye Clinic, where they are evaluated further by a larger team with more advanced medical equipment.
Measuring Screening Outcomes – Screening outcomes are measured by following any potential progression of disease with routine physical eye exams as part of our larger comprehensive medical evaluations.