University of Iowa students paying fewer clinic visits

Enrollment, alternatives behind student health ebbs and flows

Dr. Kathleen Wittich, Medical Director of Student Health and Wellness at the University of Iowa, photographed in one of
Dr. Kathleen Wittich, Medical Director of Student Health and Wellness at the University of Iowa, photographed in one of the department's exam rooms in Iowa City. (Liz Martin/The Gazette)

Judging by the symptoms, University of Iowa health consultant Trish Welter said she doesn’t think the nosebleeds are serious.

“It sounds like your cold could be the trigger for your particular nosebleeds,” Welter wrote in response to a question posted on the UI Student Health and Wellness website earlier this month.

That question sits among dozens on the site, along with links to a “sex@iowa” blog, a virtual sleep-improvement program and information about campus flu clinics.

The website also offers an array of health tips, connects users to a UI Student Health and Wellness Twitter account, and makes it easy to schedule an appointment online – although fewer UI students actually are doing so.

According to recent UI student health use numbers, general clinic visits have dropped 26 percent, from 19,445 in the 2011 budget year to 14,397 in fiscal 2013. Overall student health use – including both provider and nursing visits – is down 16 percent, from 34,660 in the 2011 budget year to 29,037 in the past budget year.

At the University of Northern Iowa, student health visits and transactions also are down year over year, while student health use at Iowa State University is on the rise. ISU officials credit the increase, in part, to a corresponding jump in overall student enrollment.

In Iowa City, UI student health officials said the declines could be due to a combination of factors, including fewer available providers, more over-the-counter treatment options, new technologies providing alternatives to doctor visits, and more off-site alternatives such as flu shot clinics.

“Our website has more information and places for questions, so they can use that as a means to not come in for a visit,” explained Kathleen Wittich, medical director for UI Student Health and Wellness.

The student health clinic also has fewer physicians and physician assistants in attendance than it did years ago, something UI officials are working to address.

“We are trying to ensure for patients who need or want advice or care, that we provide that care,” Wittich said.

"Looking to increase the numbers"

When students arrive at college, becoming familiar with the health care options isn’t always a priority. But it could become one as soon as cold season strikes or as academic pressures mount, and student health officials are trying to spread awareness about the health care services on campus.

Student Health offers free and reduced-cost clinical and health services to students for anything from the common cold to nutrition counseling.  Its primary medical care is just like that of any health care clinic, with board-certified physicians available to address “almost any health concern.”

The universities offer student health insurance policies, for those needing coverage. Officials at all three regent universities said it’s too soon to know how the Patient Protection and Affordable Care Act could affect student health visits.

“College might be the first time that the student has sought health care without the assistance of a family member,” Wittich said. “So we are trying to help them navigate the system and encourage and promote good lifestyle habits.”

UI student health figures for "additional services" support the theory that health care alternatives and outreach programs are affecting clinic visits. Website hits, for example, jumped from 305,720 in the 2011 budget year to 392,232 in fiscal 2013.

And contacts via outreach and workshops climbed from 19,450 in 2011 to 21,646 in 2013.

“But visits are always necessary,” Wittich said. “There is no substitute for seeing someone in-person. Physicians are limited without seeing a person in front of them.”

A dip in available providers at UI Student Health also might be partly to blame for the decrease, said Jim Kellogg, director of UI Student Health and Wellness.

“We didn’t have as much capacity as we would have liked,” Kellogg said. “But now we are moving in the right direction.”

He said the clinic remains one physician short of being fully staffed.

“But we hope to get that filled soon,” Kellogg said, adding that marketing also should help boost visits. “Through advertising and outreach, we are looking to increase the numbers.”

"We are certainly feeling it"

UI enrollment rose by 673 from the start of the 2010-11 academic year to the beginning of 2012-13 — which means student population fluctuations are not behind UI trends in student health use. But at ISU, officials said student numbers are at least partly connected to demand for student health services.

“This is our third year in a row with record enrollment,” said Michelle Hendricks, director of ISU’s Student Health Center. “And we are certainly feeling it.”

So far this fall, student health center visits are up about 16 percent, Hendricks said. From the 2011-2012 academic year to the 2012-2013 year, total medical clinic visits increased 6.2 percent, according to ISU statistics.

But enrollment isn’t the only factor that affects student health use, Hendricks noted. Seasonal illness rates also can drive numbers up.

“But clearly, with the growing student body, the expectation is that all our student services will be used at a higher rate,” Hendricks said. “So we are tuned into that and planning for that.”

The center is focused right now on optimizing staff “to see as many students as we can.” Officials are looking for efficiencies, and even ways to expand, Hendricks said.

“We are using every square inch of the current facility,” Hendricks said.

ISU doesn’t offer an online patient portal – such as MyChart for UI students – but Hendricks said its electronic medical record system has the capability. The goal, she said, is to have something up and running by next summer that would allow students to check test results online or communicate with a provider.

“That is at the top on our list of technology projects we want to pursue,” she said.

ISU student health staffers also use the website and social media to connect with students.

“We want them to know that we are here and we are available, and if they seek services early, we can help them prevent absences in school and help in their successful pursuit of education,” Hendricks said.

That’s the sentiment at UNI, where student health use has seen a slight dip – such as its enrollment.

“To me, it’s a direct correlation,” said Shelley Matthews, director of UNI’s Student Health Clinic. “We have fewer students, so we are going to see fewer students come into the clinic.”

Matthews said her staff offers online health tips and on-call nurse availability. But she doesn’t think those services have much effect on UNI student visits. And she doesn’t think they should.“We highly encourage students to make an appointment if they’re not feeling well,” she said.