Advocates for Evidence-Based Health Policy Speakers
CHC’s Deliver Quality
Yet another study demonstrates that it is not the location where a patient sees their doctor, but rather the relationship between the physician and the patient that influences the quality of care delivered.
Community Health Centers (CHCs) are more likely to care for minorities, the uninsured, and patients with Medicaid. They have been shown to reduce health disparities in the communities they serve. CHCs, however, have regular challenges with staff recruitment. A recent national survey showed that 13.3 percent of family practitioner positions and 20.8 percent of obstetrician positions were vacant. This study sought to provide an assessment as to whether these staff challenges lead to poorer performances on patient reports of health care quality.
Using the 2006 Health Care Quality Survey of the Commonwealth Fund, 2,837 respondents aged 18 to 64 participated in 25-minute telephone interviews. The study was limited to respondents who reported a private doctor’s office or a CHC has their regular source of care. However, not all respondents have a particular physician they see when they go for care. They were asked about reminders for preventive care visits, cholesterol checks, diet/exercise/healthy weight counseling, amount of time spent with the doctor, the thoroughness of the doctor, and their involvement in their care and treatment plan. In terms of the sample demographics, patients seen in CHCs were younger, less likely to be White, more likely to have family incomes below 200 percent of the federal poverty level, were more likely to be uninsured, and were more likely to be overweight and obese.
More significantly, in adjusted models, having a regular doctor eliminated all differences between CHCs and private doctor’s offices in patient reports of quality. Patients with a regular doctor were much more likely to report receiving preventive visit reminders, cholesterol checks, and diet/exercise/weight counseling, with odds ratios of 3.33 (95% CI, 1.86-5.98), 3.91 (95% CI, 2.13-7.16), and 2.84 (95% CI, 1.57-5.14) respectively. Patients with a regular doctor were much more likely to report that the doctor spent enough time (OR 3.32, 95% CI, 1.82-6.05), the doctor is extremely thorough and careful (OR 2.32, 95% CI, 1.20-4.50), they were involved in as much as they want in decisions about their care and treatment (OR 2.28, 95% CI, 1.25-4.14), and that they receive the care they need when they need it (OR 2.28, 95% CI, 1.27-4.10). Being uninsured was independently associated with lower rates of reporting that the doctor spends enough time. Respondents with a chronic condition were less likely to report that their doctor was thorough and careful. Asian-Pacific Islanders were significantly less likely to report being involved in decisions about their care. Females reported a lower likelihood of being able to get care when needed.
Commentary
As Community Health Centers (CHCs) are shown to directly address health disparities, any influence on their ability to care for more patients requires great attention from policy makers. When properly manned and regular providers are available, CHCs provide excellent care. However, not only is federal support needed for increased number of CHCs and increased services, but a focus on future growth is imperative to the outreach of CHCs. Both medical schools and residency training programs can form partnerships with CHCs to not only provide increased patient care, but to also expose more physicians to potential careers focusing on the underserved. As is evident from the lack of applications for the National Health Service Corps, funding through scholarship and loan repayment is not the only incentive that is necessary to pull medical students towards the CHCs. Perhaps a change of attitude is needed through medical education and academic medicine to instill in a sense of service in young physicians.
by
Kameron L. Matthews, MD, Esq.
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