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Community Health Centers (community + health_center)

Distribution by Scientific Domains

Medical Sciences	88%

Selected Abstracts

Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties

THE JOURNAL OF RURAL HEALTH, Issue 1 2009
FAAFP, FACPM, George Rust MD
ABSTRACT:,Context: Community health centers (CHCs) provide essential access to a primary care medical home for the uninsured, especially in rural communities with no other primary care safety net. CHCs could potentially reduce uninsured emergency department (ED) visits in rural communities. Purpose: We compared uninsured ED visit rates between rural counties in Georgia that have a CHC clinic site and counties without a CHC presence. Methods: We analyzed data from 100% of ED visits occurring in 117 rural (non-metropolitan statistical area [MSA]) counties in Georgia from 2003 to 2005. The counties were classified as having a CHC presence if a federally funded (Section 330) CHC had a primary care delivery site in that county throughout the study period. The main outcome measure was uninsured ED visit rates among the uninsured (all-cause ED visits and visits for ambulatory care sensitive conditions). Poisson regression models were used to examine the relationship between ED rates and the presence of a CHC. To ensure that the effects were unique to the uninsured population, we ran similar analyses on insured ED visits. Findings: Counties without a CHC primary care clinic site had 33% higher rates of uninsured all-cause ED visits per 10,000 uninsured population compared with non-CHC counties (rate ratio [RR] 1.33, 95% confidence interval [CI] 1.11-1.59). Higher ED visit rates remained significant (RR 1.21, 95% CI 1.02-1.42) after adjustment for percentage of population below poverty level, percentage of black population, and number of hospitals. Uninsured ED visit rates were also higher for various categories of diagnoses, but remained statistically significant on multivariate analysis only for ambulatory care sensitive conditions (adjusted RR = 1.22, 95% CI 1.01-1.47). No such relationship was found for ED visit rates of insured patients (RR 1.06, 95% CI 0.92-1.22). Conclusions: The absence of a CHC is associated with a substantial excess in uninsured ED visits in rural counties, an excess not seen for ED visit rates among the insured. [source]

Use of herbal remedies by diabetic Hispanic women in The southwestern United States

PHYTOTHERAPY RESEARCH, Issue 4 2006
Lane Johnson
Abstract Objective: The primary purpose of this study was to examine the use and documentation of herbal remedies used by Hispanic women with Type II diabetes enrolled in two Community Health Centers in the Southwest USA. A secondary purpose was to review the literature on identified herbs to assess their likely effects on diabetes. Design: Open-ended structured interviews were conducted on a convenience sample (n = 23) of participants. Medical and medication charts were reviewed for the interviewed participants, and for a random sample of enrolled Hispanic diabetic patients (n = 81) who were not interviewed. Setting: Two Community Health Centers in the Southwest USA. Participants: Enrolled patient, Hispanic females with Type II diabetes. Intervention: Subjects were interviewed about their use of herbal therapies and supplements. Information collected from medical and pharmaceutical charts included documented use of herbal remedies; standard therapies prescribed and diabetes control (hemoglobin A1C values). For those herbal remedies reported, literature reviews were conducted to determine if there was supporting evidence of harm or efficacy for the stated condition. Main Outcome Measures: Reports of herbal use, and types of remedies used. Results: Among the interviewed participants, 21 of 23 (91%) reported using one or more herbal remedies. Among a random sample of patient medical charts, seven (6.7%) contained documentation of diabetes-specific herbs, and 16 (15.4%) had documented general herb use. A total of 77 different herbal remedies were identified, most of which were contained as part of commercial preparations, and appeared to supplement, rather than replace standard medical therapy for diabetes. Conclusion: Use of herbal therapies is not uncommon among diabetic patients. Many of the herbs reported have potential efficacy in treating diabetes or may result in adverse effects or interactions. In practical use, however, the herbs reported in this study are unlikely to have a significant effect on clinical outcomes in diabetes, either positively or negatively. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Presence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural Counties

Quality improvement and its impact on the use and equality of outpatient health services in India

HEALTH ECONOMICS, Issue 8 2007
Krishna Dipankar Rao
Abstract This paper examines the impact of quality improvements in conjunction with user fees on the utilization and equality of outpatient services at a range of public sector health facilities in India. Project impact on outpatient visits was estimated via the difference-in-difference method using pooled time series visit data from project and control facilities. The results indicate that the quality improvements significantly increased visits at all facility types. The project effect was largest at primary health center (PHC) and community health center (CHC), followed by district hospital (DH) and female district hospital (FDH). Pro-rich inequalities in outpatient visits increased at DHs and FDHs while at CHCs and PHCs the distribution remained equitable. This suggests that quality improvements at public sector health facilities can increase utilization of outpatient services in the presence of nominal user fees, but can also promote greater inequality favoring the better-off. At the referral hospital level, quality improvements should be made in conjuction with programs which encourage utilization by the poor. In contrast, the benefit of quality improvements at PHCs and CHCs is equitably distributed. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Availability of Safety Net Providers and Access to Care of Uninsured Persons

HEALTH SERVICES RESEARCH, Issue 5 2004
Jack Hadley
Objective. To understand how proximity to safety net clinics and hospitals affects a variety of measures of access to care and service use by uninsured persons. Data Sources. The 1998,1999 Community Tracking Study household survey, administered primarily by telephone survey to households in 60 randomly selected communities, linked to data on community health centers, other free clinics, and safety net hospitals. Study Design. Instrumental variable estimation of multivariate regression models of several measures of access to care (having a usual source of care, unmet or delayed medical care needs, ambulatory service use, and overnight hospital stays) against endogenous measures of distances to the nearest community health center and safety net hospital, controlling for characteristics of uninsured persons and other area characteristics that are related to access to care. The models are estimated with data from a nationally representative sample of uninsured people. Principal Findings. Shorter distances to the nearest safety net providers increase access to care for uninsured persons. Failure to account for the endogeneity of distance to safety net providers on access to care generally leads to finding little or no safety net effects on access. Conclusions. Closer proximity to the safety net increases access to care for uninsured persons. However, the improvements in access to care are relatively small compared with similar measures of access to care for insured persons. Modest expansion of the safety net is unlikely to provide a full substitute for insurance coverage expansions. [source]

Help seeking and satisfaction among Latinas: The roles of setting, ethnic identity, and therapeutic alliance

JOURNAL OF COMMUNITY PSYCHOLOGY, Issue 3 2005
Manuel Paris Jr.
This study explored help seeking among primary Spanish speaking women of Hispanic origin who had behavioral health needs. We evaluated relational and cultural aspects of care and service utilization by using qualitative and quantitative measures of perceived behavioral health needs, therapeutic relationships, ethnic identity and degree of acculturation, and satisfaction with services among 103 women. We explored the nature of the therapeutic relationship and satisfaction with services among Latinas who received behavioral health services at: (1) a community behavioral health center, (2) a community health center, and (3) a faith-based agency. Overall, results demonstrated that participants had strong therapeutic alliances and were satisfied with services at the three different treatment sites. Differences noted, including clinical and research implications, are also described. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 299,312, 2005. [source]

The Politics of Recognition in Culturally Appropriate Care

MEDICAL ANTHROPOLOGY QUARTERLY, Issue 3 2005
SUSAN J. SHAW
Over the last 20 years, the concept of culturally appropriate health care has been gradually gaining popularity in medicine and public health. In calling for health care that is culturally appropriate, minority groups seek political recognition of often racialized constructions of cultural difference as they intervene in health care planning and organization. Based on interview narratives from people involved in community organizing to establish a federally funded community health center in a mid-size New England city, I chart the emergence of a language of "culturally appropriate health care" in language used to justify the need for a health center. An identity model of recognition underlies the call for ethnic resemblance between patient and provider seen in many culturally appropriate care programs. I contrast this model of health care with earlier calls for community access and control by activists in the 1970s and explore the practical and theoretical implications of each approach. [source]

Infrequency of Sexually Transmitted Disease Screening Among Sexually Experienced U.S. Female Adolescents

PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 6 2004
Lynne C. Fiscus
CONTEXT: Since 1993, the Centers for Disease Control and Prevention and professional medical organizations have recommended that all sexually experienced female adolescents receive annual screening for Chlamydia trachomatis. Whether adolescents receive this care is largely unknown. METHODS: Reports of receipt of testing or treatment for a sexually transmitted disease (STD) in the past year, as well as sites of care, were obtained from 3,987 sexually experienced females in grades 7,12 who participated in Wave 1 of the National Longitudinal Study of Adolescent Health, conducted in 1995. Logistic regression was used to determine predictors of reporting care. RESULTS: Eighteen percent of all participants reported having received STD services in the past year. Of those who reported having had a routine physical examination in the past year, 22% reported receipt of STD services. The proportion reporting STD care increased linearly with age from 9% of 12,13-year-olds to 25% of those 19 or older. In adjusted analyses, the odds of reporting testing or treatment were elevated among participants who had had a physical examination in the past year (odds ratio, 2.1), those with Medicaid or Medicare insurance (1.9), black women (1.5) and older adolescents (1.2). Adolescents most often reported having received STD care at a community health center (44%) or a private physician's office (31%). CONCLUSIONS: Continued inadequate screening may contribute to persisting high prevalence of chlamydia infection among adolescents. Future research is needed to determine whether the proportions of adolescents receiving recommended STD screening have increased over time. [source]

Geographic Information Systems: A New Tool for Environmental Health Assessments

PUBLIC HEALTH NURSING, Issue 5 2006
Mona Choi
ABSTRACT Objectives: (1) To develop tools for health care professionals and communities to assess environmental exposures and (2) to evaluate the utility of integrating patient-reported environmental health information with geographic information systems (GIS) mapping of environmental data in a pilot study. Methods: A survey was used to collect self-reported environmental exposure and health data from a convenience sample of people at an urban community health center (N=101). Environmental exposure and census information were obtained from federal agencies. Analysis was performed using descriptive statistics and GIS. Results: Frequent environmental health risk factors were reported, such as older housing (93%) and household smoking (78%). Health problems including asthma (54%) and lead poisoning (14%) were reported. Odds ratios indicated a statistically significant relationship between mold/mildew and reporting asthma. GIS was found to be a useful tool in displaying environmental risk factors and potentially associated health effects. Conclusions: Given the important role that environmental health risks can play in public health, it is critical that community/public health nurses begin to integrate environmental health assessment skills into their professional practices. Simple community surveys can be an effective means to raise awareness about environmental health risk factors and utilizing GIS can further enhance the accessibility of the combined exposure and health information. [source]

Availability of Safety Net Providers and Access to Care of Uninsured Persons

What Predicts Influenza Vaccination Status in Older Americans over Several Years?

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2005
Melissa Tabbarah PhD
Objectives: To examine the correlates of repeat influenza vaccination and determine whether there are age-group (50,64, ,65) differences in decision-making behavior. Design: Longitudinal survey study. Setting: Two community health centers in Pittsburgh, Pennsylvania. Participants: Two hundred fifty-three patients aged 50 and older in 2001 who visited one of the health centers and completed telephone surveys in 2002 and 2003 after the respective influenza seasons. Measurements: Influenza vaccination status, demographic characteristics, and decision-making behavior were self-reported. Vaccination status was identified for three seasons: 2000,2001, 2001,2002, and 2002,2003. A three-level outcome was defined as unvaccinated all 3 years, vaccinated one to two times over 3 years, and vaccinated all 3 years. Factor analysis identified three decision-making behaviors. Results: Predictors of being vaccinated across 3 years included being older, the belief that social forces influence vaccination behavior, and disagreement with the view that vaccine is detrimental. Conclusion: National educational efforts should be intensified to dispel the myths about alleged adverse events, including contracting influenza from inactivated influenza vaccine. Physicians should continue to share their personal experiences of treating patients with influenza, including the incidence of hospitalization and death. [source]

The Identification of Seniors At Risk Screening Tool: Further Evidence of Concurrent and Predictive Validity

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2004
Nandini Dendukuri PhD
Objectives: To evaluate the validity of the Identification of Seniors at Risk (ISAR) screening tool for detecting severe functional impairment and depression and predicting increased depressive symptoms and increased utilization of health services. Setting: Four university-affiliated hospitals in Montreal. Design: Data from two previous studies were available: Study 1, in which the ISAR scale was developed (n=1,122), and Study 2, in which it was used to identify patients for a randomized trial of a nursing intervention (n=1,889 with administrative data, of which 520 also had clinical data). Participants: Patients aged 65 and older who were to be released from an emergency department (ED). Measurements: Baseline validation criteria included premorbid functional status in both studies and depression in Study 2 only. Increase in depressive symptoms at 4-month follow-up was assessed in Study 2. Information on health services utilization during the 5 months after the ED visit (repeat ED visits and hospitalization in both studies, visits to community health centers in Study 2) was available by linkage with administrative databases. Results: Estimates of the area under the receiver operating characteristic curve (AUC) for concurrent validity of the ISAR scale for severe functional impairment and depression ranged from 0.65 to 0.86. Estimates of the AUC for predictive validity for increased depressive symptoms and high utilization of health services ranged from 0.61 to 0.71. Conclusion: The ISAR scale has acceptable to excellent concurrent and predictive validity for a variety of outcomes, including clinical measures and utilization of health services. [source]

Relationship Between Personality Traits, Job Satisfaction, and Job Involvement Among Taiwanese Community Health Volunteers

PUBLIC HEALTH NURSING, Issue 3 2007
I-chuan Li
ABSTRACT Objective: To understand the relationship between job involvement, job satisfaction, and personality traits among health volunteers in one Taiwan community. It is not easy to retain voluntary workers as part of health programs even though they have been trained. Previous research has shown that in order to increase job involvement, volunteers must effectively fulfill their needs to achieve and obtain job satisfaction. Design and sample: Cross-sectional design. Surveys were mailed to 317 health volunteers at community health centers in I-lan County, northern Taiwan; 213 complete responses (67%) were received. Methods: The survey instrument included sociodemographic items and scales measuring locus of control, achievement orientation, job involvement, and job satisfaction. Results: Most respondents (94.8%) were female and their average age was 49.6 years. In terms of personality traits, most volunteers showed internal control orientation. Explainable variance for the prediction of job involvement from a combination of participation frequency, on-job training, achievement orientation, and job satisfaction was 33.6%. Conclusions: The results suggest that there is a need to strengthen cooperative relationships among volunteers by initiating well-planned volunteer training programs and growth groups. These should involve the empowerment concept with the aim of enhancing the volunteers' interpersonal relationships and job satisfaction. [source]

Child-rearing Anxiety and Its Correlates Among Japanese Mothers Screened at 18-Month Infant Health Checkups

PUBLIC HEALTH NURSING, Issue 2 2007
Azusa Arimoto
ABSTRACT Objective: To examine the level of child-rearing anxiety and to explore the variables correlated with child-rearing anxiety in a city in Japan. Design: Cross-sectional study. Sample: From July to September 2003, 371 mothers who visited community health centers in a city in Tokyo Metropolis for their child's 18-month health checkups. Measurements: Child-rearing anxiety was measured by the child-rearing anxiety scale. Questions in a self-reported questionnaire were on maternal variables, including maternal background information, child variables, and family system variables such as the presence of social support, and utilization of parenting support services. Also included within the questionnaire was the General Health Questionnaire-12. Results: Hierarchical multiple linear regression analysis revealed that mothers with higher child-rearing anxiety had less childcare satisfaction, more depressive symptoms, more worries about the child, less support from the husband, and less social support. Conclusion: To identify mothers with high child-rearing anxiety in Japan, the infant health checkups should be utilized as an opportunity for screening, focusing on variables regarding mothers. Public health nurses can provide the necessary support after gaining an understanding of issues confronting mothers to prevent child-rearing anxiety and child abuse. [source]

Public Health Rural Health Priorities in America: Where You Stand Depends on Where You Sit

THE JOURNAL OF RURAL HEALTH, Issue 3 2003
Larry Gamm PhD
Methods: Analysis of responses to a mail survey sent to 999 rural health leaders, with 501 responses. Respondents were asked to rank importance to rural health of focus areas named in Healthy People 2010 Findings: There was substantial agreement on top rural health priorities among state and local rural health leaders across the 50 states. "Access to quality health services" was the top priority among leaders of state-level rural agencies and health associations, local rural public health agencies, rural health clinics and community health centers, and rural hospitals. It was the top priority across all 4 major census regions of the nation as well. The next 4 top-ranking rural priorities,"heart disease and stroke,""diabetes,""mental health and mental disorders," and "oral health",were selected as 1 of the top 5 rural priorities by one third or more of respondents across most groups and regions. At the same time, some observed differences in rural health priorities suggest opportunities for community partnership strategies or for regional multistate policy initiatives by states sharing similar rural health priorities. [source]

How Much Do Rural Hispanics Know About the Adverse Health Risks of Smoking?

THE JOURNAL OF RURAL HEALTH, Issue 3 2001
Tania Butkovic B.S.
ABSTRACT: The object of this study was to measure knowledge in a rural Hispanic community about the adverse health effects of smoking and to compare knowledge between current smokers and nonsmokers. A survey was administered to waiting room patients (n=137) over 16 years old at three predominantly Hispanic rural community health centers in the central San Joaquin Valley of California. Proportions of respondents who believed that smoking caused a specific consequence were calculated and compared between smokers and nonsmokers by chi-square tests. Likelihood of attributing negative health consequences to smoking was determined and compared between smokers and nonsmokers. A majority of all participants (smokers and nonsmokers) knew that smoking causes lung cancer (93 percent) and emphysema (91 percent). Many fewer participants knew that smoking contributes to problems such as osteoporosis (39 percent) or sexual dysfunction (33 percent). Current smokers were less likely than nonsmokers (P=0.01) to say that smoking causes any adverse health outcome, including those not known to be related to smoking. Although this is a culturally, ethnically and geographically unique group, knowledge of smoking risks among smoking and nonsmoking rural Hispanics is similar to that found in the general population. When compared with nonsmokers, current smokers underestimate the risk that smoking poses to health. [source]