Community Health Center Study
Community health centers for poor people will be a fine substitute for doctors, says study
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Randall Stafford, MD, PhD, professor of medicine at the Stanford Prevention Research Center, and colleagues at University of California, San Francisco looked at the actions physicians took when patients visited private practices versus the actions that were taken at community health centers, also referred to as Federally Qualified Health Centers and FQHC Look-Alikes, both of which receive government support.Their study is in the American Journal of Preventive Medicine.
The results of the study are encouraging given that the Affordable Care Act, upheld by the U.S. Supreme Court June 28th, depends on community health centers to provide services to poorer people who will not be able to afford general physicians.
"If community health centers are going to be taking up some of the new demand, we can be confident that they're giving relatively good care," Stafford said.
They analyzed records of 73,074 visits to private practices, FQHCs and FQHC Look-Alikes. Both FQHCs and Look-Alikes receive enhanced Medicare and Medicaid reimbursement; FQHCs also receive government grants. The researchers acquired the records from the National Ambulatory Medical Care Survey, which the National Center for Health Statistics gathered between 2006 and 2008.
They evaluated the physicians' adherence to professional and federal guidelines for 18 measures, which included treatments for specific diseases, screening for certain conditions, and diet and lifestyle counseling. "We looked at fairly common conditions that are seen in primary care," said lead author L. Elizabeth Goldman, MD, of the UC San Francisco.
The researchers found that community health center physicians performed as well as their private practice colleagues in 13 of the 18 measures. For the remaining five measures — use of ACE inhibitors for congestive heart failure, use of beta blockers, use of inhaled corticosteroids for adult asthmatics, blood pressure screening and avoidance of electrocardiograms in low-risk patients — the community physicians followed recommendations a higher percent of the time.
Given that patients at community health centers have more health and socioeconomic challenges and therefore take up more physician time, said Stafford, "The fact that community health centers look better is perhaps surprising."
"On the other hand, having worked in community health centers, I can see how it makes sense," he added. "These are centers where physicians are not as profit-driven and many have incentives more in line with providing quality care."
Stafford added that the government has provided the centers with technology that helps manage patient care, which may explain their superior performance. And they are generally larger than private practices: "Having a number of colleagues helps you develop better practices. In a solo practice, you have rare opportunities to debate the best way to practice medicine."
When the researchers adjusted the data so that the patients' characteristics were statistically equal, the community health center physicians performed better on three additional measures: aspirin for congestive heart failure, statins for congestive heart failure, and avoidance of benzodiazepine, which has serious long-term side effects, for depression. (The statistical adjustment did not alter the balance in the other previous measures, and if anything, the magnitude of the difference increased in favor of the community physicians.)