CONTRIBUTIONS OF COMMUNITY HEALTH CENTERS: A SYSTEMATIC REVIEW OF THE LITERATURE

1. CONTRIBUTIONS OF COMMUNITY HEALTH CENTERS:A SYSTEMATIC REVIEW OF THE LITERATURE Tara Hancock California state long beach School of social work may 2012

2. Introduction • Results of the Systematic Review of Literature showed that current research indicated: • The proximity and availability of Community Health Centers (CHCs) was correlated with higher rates of healthcare access by underserved populations • A reduction of healthcare disparities related to race/ethnicity, gender and socioeconomic status was noted in comparison to other healthcare settings • A high quality of care that includes medical treatment, health education, patient satisfaction, self-reported health, provider skills and internal policies on quality is upheld even when serving underserved populations

3. Social Work Relevance • There are needs in providing better quality of care among gender, race and socioeconomic status that are not present in our healthcare system. • It is important for CHCs to be better known about and better funded allowing a safety net to further remain in place for millions of people until something on a national scale is potentially implemented • CHCs are an excellent platform for social workers to use as an example of how healthcare availability for everyone could be beneficial to us as a nation

4. Cross-Cultural Relevance • CHCs place emphasis on eliminating disparities in healthcare by the incorporation of culturally competent practices including hiring bilingual staff, making community residents a part of their board and being located within specific cultural communities. • Medical social workers can use the multicultural services implemented by CHCs to provide better care for patients. • The findings from CHCs that demonstrated the benefits of culturally sensitive services can further encourage social workers about the benefits of the services they provide and the true need for multicultural practices.

5. Literature • CHC federal requirements for funding and operation also make up their core framework. These requirements include: • Being located where there are impoverished areas or people • Integration and coordination of high quality patient care in-house and off-site • Solicitation of community involvement by requiring residents on the board of directors • Delivery of healthcare services regardless of ability to pay (Deye & Duncan, 2006; NHPF, 2004; USDHHS, HRSA, BPHC, 2011b) • The majority age range for CHC clients is between the ages of 19 to 64, making up 65% of its clients (NHFP, 2004; USDHHS, HRSA, BPHC, 2011a) • In 2007, CHCs serviced 1 in 7 of every uninsured person in the United States and 1 in 5 of the low-income uninsured (NACHC, 2009). Also, in 2007, 1 in 3 of the clients they served live in poverty and 1 in 4 was a minority living in poverty (NACHC, 2009) • The most recent data shows that nationally CHCs serviced approximately 35% White non-Hispanics, 35% White Hispanics, 25% African American and 10% Asian/Pacific Islander/Native American/multiracial (USDHHS, HRSA, BPHC, 2011a) • CHCs predominantly service the low-income and uninsured within a specific neighborhood but they also service Medicare and Medicaid recipients along with some privately insured persons (NHPF, 2004).

6. Methods • A total of 34 articles related to community health centers were found by using numerous library databases at California State University, Long Beach. • These articles were reviewed and selected based on their relevancy to the focus of community health centers contained in this proposal. • The articles were systematically analyzed based on author and year of publication, purpose statement, research design, sampling method, data collection method, sample size, source of sample, setting of study, demographics of community health center clients, enrollment correlation with disease management, effect of enrollment to access to medical care, results on the community with community health center presence, quality of care measurements and affects and impact of community health center on disparities in healthcare. • These results were then presented in narratives and in four tables.

7. Findings • CHC impact on access to healthcare: • CHCs more likely to accept new patients, take publicly insured patients, have evening and weekend hours, and allow same-day appointments when compared to office-based doctors • Low-income populations were found have better access to primary care needs when there is the presence of a CHC • Obtaining preventative services, such as cervical and breast cancer screenings, were found to be closely associated with access to a CHC and to decrease the prevalence of their associated cancers among CHC patients Presence and availability of CHCs were found by studies to decrease patient visits to emergency rooms and admission to hospitals

8. Findings • Factors associated with high quality care deliver at CHCs: • CHC met or exceeded rates of quality care when compared to similar settings—such as hospital outpatient centers and physician offices • Through ingrained quality care policies, CHCs allowed clients to increase check-up visit and immunizations rates • CHC users had an increase in levels of delivery and comprehension related to information—such as, smoking, exercise, sexually transmitted diseases and drug use—than similar patients nationally • CHC patients reported more positive primary care experiences than those nationally • CHC role in reducing healthcare disparities: • CHCs had significantly higher rates of minorities accessing their clinics than in other, similar outpatient settings • Studies identified increases in women’s health to female CHC patrons for PAP smears, mammograms, other preventative cancer screenings and obstetrician and gynecological visits in general than national averages, especially among the uninsured • CHCs have few differences among its patient income brackets indicating greater socioeconomic equality

9. References National Association of Community Health Centers. (2009). Chartbook: A sketch of community health centers. Retrieved from http://www.nachc.com/client/ documents/Chartbook_Update_20091.pdf National Health Policy Forum (NHPF). (2004, August 31). The fundamentals of community health centers. Retrieved from http://www.nhpf.org/library/ background-papers/BP_CHC_08-31- 04.pdf U.S. Department of Health and Human Services (USDHHS), Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC). (2011a). Uniform data system manual 2010. Retrieved August 13, 2011, from http://bphc.hrsa.gov/healthcenterdatastatistics/index.html