RESUMO
OBJECTIVE: We examined trends in delivery of mental health and substance abuse services at the nation's community health centers. METHODS: Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care's (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data. RESULTS: Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210,000 to 800,000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals. CONCLUSIONS: Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve.
RESUMO
OBJECTIVE: We examined trends in delivery of mental health and substance abuse services at the nation's community health centers. METHODS: Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care's (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data. RESULTS: Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210,000 to 800,000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals. CONCLUSIONS: Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve.
Assuntos
Centros Comunitários de Saúde Mental/tendências , Serviços Comunitários de Saúde Mental/tendências , Serviços de Saúde Mental/tendências , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Adulto , Idoso , Criança , Centros Comunitários de Saúde Mental/estatística & dados numéricos , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Demografia , Etnicidade , Feminino , Humanos , Masculino , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Grupos Raciais , Estados UnidosRESUMO
The Federal Health Center Growth Initiative aims to increase community health centers' (CHCs') capacity by 60 percent from 2002 to 2006. This study investigates how primary care delivery changed and sustained its growth during 1994-2001. Findings reveal a rise in the number of patients and maintenance of their visit rate. People ages 41-64 accounted for the highest percentage of visits in 2001, and continuity of care improved. There were no disparities in visit-based preventive services delivery by race/ethnicity or insurance status. Continued growth under the initiative is likely to help reduce health disparities and improve care for the underserved.
Assuntos
Centros Comunitários de Saúde/tendências , Governo Federal , Justiça Social , Continuidade da Assistência ao Paciente , Etnicidade , Humanos , Cobertura do Seguro , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/normas , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Grupos Raciais , Estados UnidosRESUMO
In 2001, the United States federal government began a 5-year initiative to expand services offered by health centers to people who live in area designated "underserved" because there are insufficient primary care medical practitioners. There were national targets for expansion. How the Health Resources and Services Administration (HRSA) reviewed and monitored State plans to expand health centers is presented. These early results suggest that collectively the States would meet the target. Several States would require major efforts to move toward the national average and they were examined more closely.
Assuntos
Centros Comunitários de Saúde/provisão & distribuição , Política de Saúde , Acessibilidade aos Serviços de Saúde , Área Carente de Assistência Médica , Programas Nacionais de Saúde , Atenção Primária à Saúde/organização & administração , United States Health Resources and Services Administration , Governo Federal , Organização do Financiamento , Humanos , Desenvolvimento de Programas , Estados UnidosRESUMO
Serving a predominantly poor and minority population, health centers are positioned to address national immunization disparities in the context of comprehensive primary care. Having demonstrated success in eliminating disparities for other preventive services, this study evaluates health center effectiveness in mitigating immunization disparities. Up-to-date health center and national immunization rates were obtained from the 1995 User and the 1995 National Health Interview Surveys. For the most part, national immunization disparities were not found among health center children. However, black children served at health centers were still significantly less likely to be vaccinated for polio and Medicaid children significantly less likely for measles. Health center outreach and enabling services are hypothesized to facilitate regular access to care and thus timely immunization. Additional health center analysis is necessary to establish factors responsible for the relative absence of disparties, uncover persistent barriers to immunization, and identify structural attributes that may further raise immunization coverage.
Assuntos
Serviços de Saúde da Criança/provisão & distribuição , Centros Comunitários de Saúde/organização & administração , Etnicidade/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/organização & administração , Programas de Imunização/organização & administração , Imunização/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Vacinas/administração & dosagem , Pré-Escolar , Centros Comunitários de Saúde/estatística & dados numéricos , Humanos , Programas de Imunização/estatística & dados numéricos , Lactente , Pobreza/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos , Vacinas/classificação , Populações VulneráveisRESUMO
OBJECTIVE: To examine whether community health centers (CHCs) reduce racial/ethnic disparities in perinatal care and birth outcomes, and to identify CHC characteristics associated with better outcomes. BACKGROUND: Despite great national wealth, the U.S. continues to rank poorly relative to other industrialized nations on infant mortality and other birth outcomes, and with wide inequities by race/ethnicity. Disparities in primary care (including perinatal care) may contribute to disparities in birth outcomes, which may be addressed by CHCs that provide safety-net medical services to vulnerable populations. METHODS: Data are from annual Uniform Data System reports submitted to the Bureau of Primary Health Care over six years (1996-2001) by about 700 CHCs each year. RESULTS: Across all years, about 60% of CHC mothers received first-trimester prenatal care and more than 70% received postpartum and newborn care. In 2001, Asian mothers were the most likely to receive both postpartum and newborn care (81.7% and 80.3%), followed by Hispanics (75.0% and 76.3%), blacks (70.8% and 69.9%), and whites (70.7% and 66.7%). In 2001, blacks had higher rates of low birth weight (LBW) babies (10.4%), but the disparity in rates for blacks and whites was smaller in CHCs (3.3 percentage points) compared to national disparities for low-socioeconomic status mothers (5.8 percentage points) and the total population (6.2 percentage points). In CHCs, greater perinatal care capacity was associated with higher rates of first-trimester prenatal care, which was associated with a lower LBW rate. CONCLUSION: Racial/ethnic disparities in certain prenatal services and birth outcomes may be lower in CHCs compared to the general population, despite serving higher-risk groups. Within CHCs, increasing first-trimester prenatal care use through perinatal care capacity may lead to further improvement in birth outcomes for the underserved.
Assuntos
Centros Comunitários de Saúde/organização & administração , Etnicidade , Resultado da Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Grupos Raciais , Justiça Social , Adulto , Feminino , Humanos , Gravidez , Classe Social , Estados UnidosRESUMO
International health rankings for the US are heavily influenced by striking racial and socioeconomic health status disparities. Current discussions of health determinants frequently relegate or entirely dismiss health care contributions despite increasing evidence of the importance of access to primary care. Health centers deliver community-based primary care to a considerable and growing proportion of the nation's most vulnerable and have produced significant health improvements, especially for women and children. Policies that disproportionately benefit those in greatest need are likely to produce the largest gains in national health. Continued expansion of the health center network to ensure primary care for those who remain underserved is both an effective and politically acceptable strategy to improve national health.
Assuntos
Centros Comunitários de Saúde/organização & administração , Promoção da Saúde/organização & administração , Indicadores Básicos de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Área Carente de Assistência Médica , Pobreza , Atenção Primária à Saúde/organização & administração , Saúde Pública , Justiça Social , Estados Unidos/epidemiologiaRESUMO
CONTEXT: Federally funded health centers attempt to improve rural health by reducing and eliminating access barriers to primary care services. PURPOSE: This study compares rural health center patients with people in the general rural population for indicators of access to preventive services and health outcomes. METHODS: Data from the annual reporting system for federally funded health centers, the 1999 Uniform Data System, and published national census data were used to provide sociodemographic comparisons. Selected health status indicators, preventive services utilization, and health outcomes were obtained from a survey of health center patients, and the results were compared with the National Health Interview Survey and National Vital Statistics. FINDINGS: Unlike the nation's rural population, the majority of rural health center patients are of minority race/ethnicity, live at or below poverty, and are either uninsured or on Medicaid. Despite having higher prevalence of traditional access barriers than the general rural population, rural health center patients are significantly more likely to receive certain preventive services and also to experience lower rates of low birthweight, particularly for African American infants. However, rural health center patients are not more likely to have received influenza vaccination or up-to-date mammogram screening. CONCLUSIONS: Health centers provide access to essential preventive care for many of the most vulnerable rural residents. A national strategy to expand the rural health center network will likely help to ensure improved health for the considerable proportion of rural residents who still lack access to appropriate services.
Assuntos
Centros Comunitários de Saúde/economia , Governo Federal , Financiamento Governamental , Acessibilidade aos Serviços de Saúde/economia , Serviços de Saúde Rural/economia , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Criança , Pré-Escolar , Centros Comunitários de Saúde/estatística & dados numéricos , Demografia , Feminino , Pesquisa sobre Serviços de Saúde , Indicadores Básicos de Saúde , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/prevenção & controle , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/estatística & dados numéricos , Fatores de Risco , Serviços de Saúde Rural/estatística & dados numéricos , Fumar/epidemiologia , Prevenção do Hábito de Fumar , Fatores Socioeconômicos , Estados Unidos/epidemiologiaRESUMO
This study examined access to care for uninsured and Medicaid-insured community health center patients in comparison to nonhealth center patients nationally. Using nationally representative data from 2 major surveys in 2002, there was a positive association between seeking care in community health centers and self-reported access to care for both uninsured and Medicaid patients. This suggests that health centers may fill a critical gap in access to care for patients who use their services. Given recent budget cuts to the Medicaid program, health centers remain an important policy option to assure access to care for vulnerable populations.