Exploring Barriers to Patient Care in a South Carolina Free Clinic

Access to healthcare remains a persistent challenge for medically underserved populations who rely on free medical clinics for primary care services, particularly in non-Medicaid expansion states such as South Carolina. Free clinics serve as critical safety-net providers, yet patients frequently encounter barriers that limit access, continuity, and quality of care. The purpose of this Doctor of Nursing Practice (DNP) project was to explore and identify the structural, social, and interprofessional barriers to patient care within a South Carolina free medical clinic to inform targeted, evidence-based interventions. A mixed-methods needs assessment design was used, combining a retrospective chart review of forty active clinic patients with semi-structured interviews conducted with twenty patients during routine clinic visits. Quantitative data included clinical indicators, appointment adherence, and referral completion, while qualitative interviews explored patient-perceived barriers related to transportation, health literacy, language, work and childcare obligations, trust, and access to services. Findings revealed that barriers to care were multifaceted and interrelated, with limited health literacy, language differences, transportation challenges, and socioeconomic instability emerging as the most prevalent obstacles. Additional system-level barriers included limited access to specialty care, inconsistent follow-up, and operational constraints inherent to volunteer-dependent clinic models. These barriers contributed to missed appointments, delayed care, variable chronic disease management outcomes, and inconsistent preventive screening rates. The data generated from this project were subsequently used to inform the development and submission of an American Heart Association Social Impact Fund grant application, which aims to address identified cardiovascular risk factors and care gaps through targeted, sustainable interventions within the free clinic setting. Overall, the findings underscore that barriers to care in free clinics extend beyond clinical treatment and are deeply rooted in social determinants of health, communication challenges, and system fragmentation. This project highlights the critical role of nurse-led, community-based strategies in improving follow-up, strengthening continuity of care, and advancing health equity for medically underserved populations, while providing a replicable framework for future quality improvement and research efforts in similar free clinic environments.