Community health centers: unrecognized partners in health professions education

Beyond the First Trimester: Social Determinants of Delayed Prenatal Care at a Community Health Center Using the PRAPARE Tool

Social determinants of health have been used to explore associations with pregnancy outcomes and the birth weight of infants; however, research employing individually based social risk measures has not examined associations among underserved populations, including pregnant persons at community health centers. Data were collected from a sample (n = 345) of pregnant persons who sought care at a community health center between January 2019 and December 2020. Social risks of pregnant patients were measured using the PRAPARE tool. First, associations between patients' social risks and trimester in which they initiated care were assessed using ANOVAs, grouping social risk by PRAPARE social determinant domains (persona characteristics, family and home, money and resources, and social and emotional health). ANOVAs were stratified by ethnicity. Next, a multivariate logistic regression examined associations between social measures and seeking care after the first trimester. Patients who sought care in the first trimester reported more financial needs than those who sought care in the second (p = .02) or the third (p = .049). Hispanic patients who sought care in the first trimester reported more monetary needs than those who sought care in the second trimester (p = .048), and non-Hispanic patients who sought care in the first trimester reported greater family and home needs than those who sought care in the second trimester (p = .47). Those who experienced stress were 3.07 times as likely to seek care after the first trimester as those who reported no stress. CHC may reduce social risk among poor and underserved communities by reducing barriers to access to care.

Examining the pedagogical practices that support cultural proficiency development in graduate health science students

BACKGROUND

Health disparities are often a function of systemic discrimination and healthcare providers' biases. In recognition of this, health science programs have begun to offer training to foster cultural proficiency (CP) in future professionals. However, there is not yet consensus about the best ways to integrate CP into didactic and clinical education, and little is known about the role of clinical rotations in fostering CP.

METHODS

Here, a mixed-methods approach was used to survey students (n = 131) from a private all-graduate level osteopathic health sciences university to gain insight into the training approaches students encountered related to CP and how these may vary as a function of academic progression. The research survey included instruments designed to quantify students' implicit associations, beliefs, and experiences related to the CP training they encountered through the use of validated instruments, including Implicit Association Tests and the Ethnocultural Empathy Inventory, and custom-designed questions.

RESULTS

The data revealed that most students (73%) had received CP training during graduate school which primarily occurred via discussions, lectures, and readings; however, the duration and students' perception of the training varied substantially (e.g., training range = 1-100 hours). In addition, while students largely indicated that they valued CP and sought to provide empathetic care to their patients, they also expressed personal understandings of CP that often fell short of advocacy and addressing personal and societal biases. The results further suggested that clinical rotations may help students attenuate implicit biases but did not appear to be synergistic with pre-clinical courses in fostering other CP knowledge, skills, and attitudes.

CONCLUSIONS

These findings highlight the need to utilize evidence-based pedagogical practices to design intentional, integrated, and holistic CP training throughout health science programs that employ an intersectional lens and empowers learners to serve as advocates for their patients and address systemic challenges.

Family medicine residency training in community health centers: a national survey

PURPOSE

For more than 25 years, family medicine residencies (FMRs) have worked with community health centers (CHCs) to train family physicians. In light of the long history and current policy focus on this training model, the authors sought to evaluate comprehensively the scope and extent of family physician training occurring in CHCs.

METHOD

The authors conducted a cross-sectional survey of 439 U.S. FMR directors in 2007. FMR directors were asked to provide information regarding the number, type, location, and length of any CHC training affiliations and to rate their satisfaction with such affiliations.

RESULTS

Of 354 respondents (80% response rate), 83 FMRs (23.4%) provided some type of CHC training experience; 32 (9%) had their main residency continuity training site in a CHC. Respondents reported that 10.5% (788) of family medicine residents were trained in a CHC continuity clinic. The average length of affiliation was 10.2 years. Residency directors reported high satisfaction with CHC training affiliations.

CONCLUSIONS

Almost one-quarter of FMRs in 2007 provided some training in CHCs. However, the proportion of residencies providing continuity training in CHCs--the type of training associated with enhanced recruitment and retention of family medicine graduates in underserved areas--was limited and relatively unchanged since 1992.

Training residents in community health centers: facilitators and barriers

PURPOSE

Training family medicine residents in underserved settings, such as community health centers (CHCs), may provide a solution to the primary care workforce shortage. We sought to describe the facilitators and barriers to creating partnerships between CHCs and family medicine residencies (FMRs).

METHODS

We conducted 19 key informant interviews and 3 focus groups to identify the key factors in the CHC-FMR relationship. Audiotapes and transcripts were analyzed to identify major themes. Key informant results were validated and expanded in the focus group discussions.

RESULTS

Four major themes describe the CHC-FMR training partnership: mission, money, quality, and administrative/governance complexity. The CHC-FMR training affiliation is a complex relationship drawn together by a shared mission of service to the underserved, enhanced financial stability, workforce improvement, and greater educational and clinical quality. The relationship is hindered by competing primary missions, chronic underfunding, complex governing institutional regulations, and administrative challenges. In addition, the focus groups offered several policy solutions to address the barriers to CHC-FMR affiliation.

CONCLUSIONS

A successful CHC-FMR training partnership relies upon the development of a shared mission of education and service, as well as innovation and flexibility by the organizations that govern them.

History of community health center affiliations with The New England College of Optometry

BACKGROUND

Since the 1970s, The New England College of Optometry (NECO) has been a leader in community-based educational programming. This was accomplished through the development of affiliation agreements with health care facilities that care for the underserved, notably community health centers (CHCs). The college's clinical system, the New England Eye Institute (NEEI), develops CHC programs, manages professional services agreements, initiates teaching affiliation agreements, and leads staff recruitment and retention efforts.

OVERVIEW

CHC collaborations, which effectively address disparities in access to health care and visual health status, represent a significant component of the college's primary care clinical training venues. Since their inception in 1972, these CHC academic-community partnerships have provided more than 650,000 eye examinations to the underserved and have trained more than 3,200 graduates in community-based eye care, interdisciplinary care management environment, clinical prevention strategies, and population health.

CONCLUSIONS

This report describes NECO's longstanding success with CHCs, explains the scope of practice at CHCs, explains how students are involved in the CHCs' eye care services, and discusses the various management and business arrangements. The benefits and challenges of CHC affiliations with optometry schools and colleges are also discussed.

Affiliations of community health centers with the accredited schools and colleges of optometry in the states and territories of the United States

BACKGROUND

In 2006, the American Optometric Association Community Health Center Committee surveyed schools/colleges of optometry in the United States and its territories to assess collaborations between community health centers and optometric institutions.

METHODS

The survey investigated the number and structure of affiliations that existed between Federally Qualified Health Centers and schools/colleges of optometry in the United States. The survey reached the schools through the American Optometric Association Faculty Relations Committee or personal contact (Inter-American University of Puerto Rico).

RESULTS

The survey showed wide variation in affiliations of community health centers with optometry programs. Six schools had no affiliations, whereas the remaining 11 ranged from 1 to 14. Information relating to 37 community health centers was reported. Results showed that schools utilized community health centers for fourth-year students in 5 schools, and both third- and fourth-year students in the remaining 6 schools. Schools vary regarding how precepting is managed with either full-time faculty (64.9%) or adjunct faculty. Business models also vary between schools.

CONCLUSION

Affiliations between school/colleges of optometry and community health centers differ considerably. Optometric affiliations with community health centers can result in increased access to eye care for underserved populations and increased clinical experience for optometry students and residents. Opportunities exist to establish additional affiliations. Educational benefits and costs associated with affiliations should be explored before entering into a collaborative model of eye care delivery.

Shaping the future of academic health centers: the potential contributions of departments of family medicine

Academic health centers (AHCs) must change dramatically to meet the changing needs of patients and society, but how to do this remains unclear. The purpose of this supplement is to describe ways in which departments of family medicine can play leadership roles in helping AHCs evolve. This overview provides background for case studies and commentaries about the contribution of departments of family medicine in 5 areas: (1) ambulatory and primary care, (2) indigent care, (3) education in community and international settings, (4) workforce policy and practice, and (5) translational research. The common theme is a revitalization of the relationship between AHCs and the communities they serve across all missions. Family medicine leadership can provide dramatic organizational improvement in primary and ambulatory care networks and foster opportunities for leadership by AHCs in improving the health of the population. Departments of family medicine can also play a leading role in developing new partnerships with community-based organizations, managing the care of the indigent, and developing new curricula in community and international settings. Finally, family medicine departments and their faculty have a central role in helping AHCs respond to workforce needs and in developing translational research that emphasizes the health of the population and effectiveness of care. AHCs are a public good that must now evolve substantially to meet the needs of patients and society. By pushing for substantial change, by helping to reinvigorate the relationship between AHCs and the communities they serve, and by emphasizing fundamental innovation in clinical care, teaching, and research, family medicine can help lead the renewal of the AHC.