Delivery of Preventive Services for Low-Income Persons Over Age 50: A Comparison of Community Health Clinics to Private Doctors' Offices
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This study focused on the use of 14 evidence-based preventive services for the low-income population over age 50: colorectal, breast and cervical cancer screening, cholesterol screening, counseling around diet, exercise, tobacco, alcohol and illicit drugs, and immunizations for influenza, tetanus and pneumonia. Population characteristics and rates of delivery of these preventive services are compared for low-income users of community health clinics vs private doctors' offices/HMOs. Three nationally representative data-files from the National Health Interview Survey—the Person-Level File, Sample Adult File, and Sample Adult Prevention File—were linked to obtain the necessary data on preventive services use in the 12,024 persons over age 50. Among the population of persons over age 50 living below 200% of the poverty threshold, those using community clinics were more likely to be younger, a racial or ethnic minority, less formally educated, in poorer health, uninsured, and more likely to face time, transportation or cost barriers to obtaining health care (p < .01 for all comparisons), than their counterparts using private doctors' offices/HMOs. Community health clinics performed as well as private doctors/HMOs in the delivery of cancer screening, cholesterol screening and immunizations to lower income persons over 50 years. Rates of counseling about diet and exercise were higher among users of private doctor's offices than among users of community health clinics users (40% vs. 31% respectively, p = .02). Despite the severe resource constraints under which they operate, and the greater vulnerability of the population they serve, community clinics deliver preventive services at rates comparable to private doctors' offices and HMOs.
- U.S. Department of Health and Human Services. Healthy People 2010 (Conference Edition, in Two Volumes). Washington, DC: January 2000.
- Forrest CB, Whelan EM. Primary Care Safety-Net Delivery Sites in the United States. JAMA. 2000;284:2077–83.
- U.S. Preventive Services Task Force, 1996. Baltimore, MD: Williams and Wilkins, 2nd ed.
- Institute of Medicine. America's Health Care SAFETY NET: Intact but Endangered. National Academy Press, Washington DC. 2000.
- McAlearney JS. The Financial Performance of Community Health Centers, 1996–1999. Health Affairs 2002;21:219–225.
- Harrington M, Frazer H, Aizer A. Medicaid Managed Care and FQHCs: Experience of Plans, Networks, and Individual Health Centers.1998. Washington, DC: Mathematica Policy Research Inc.
- Bovbjerg R, Marsteller J. Health Care Market Competition in Six States: Implications for the Poor. 1998. Paper No. 17. Washington D.C. Urban Institute.
- West D. Medicaid Managed Care: Linking Success to Safety-Net Provider Recruitment and Retention. J Ambul Care Management 1999;22:28–32.
- Lane DS, Polednak AP, Burg MA. Breast Cancer Screening Practices among Users of County-Funded Health Centers vs. Women in the Entire Community. Am J Pub Health 1992;82:199–203.
- Bloom JR, Stewart SL, Koo J, Hiatt RA. Cancer screening in public health clinics: the importance of clinic utilization. Med Care 2001;39:1345–51.
- Regan J, Lefkowitz B, Gaston MH. Cancer screening among community health center women: eliminating the gaps. J Ambulatory Care Manage 1999;22:45–52.
- Rimer BK, Conaway MR, Lyna PR, Rakowski W, Woods-Powell CT, Tessaro I, Yarnall KS, Barber LT. Cancer screening practices among women in a community health center population. Am J Prev Med 1996;12:351–7.
- Wright PJ, Fortinsky RH, Covinsky KE, Anderson PA, Landefeld CS. Delivery of preventive services to older black patients using neighborhood health centers. J Am Geriatr Soc 2000;48: 124–30.
- Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997;112:594–642.
- National Cholesterol Education Program. Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Bethesda: National Health, Lung and Blood Institute, National Institutes of Health, 1993, Publication No. 93-3095.)
- National Center for Health Statistics (2000). Data File Documentation, National Health Interview Survey, 1998 (machine readable data file and documentation, CD-ROM Series 10, No. 13A), National Center for Health Statistics, Hyattsville, Maryland.
- Shah BV, Barnwell BG, Bieler GS. (1997) SUDAAN User's Manual; Release 7.5, Research Triangle Institute, Research Triangle Park, NC.
- Breen N, Wagener DK, Brown ML, Davis WW, Ballard-Barbash R. Progress in cancer screening Ann S. O'Malley and Jeanne Mandelblatt 197 over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst 2001 Nov 21;93(22):1704–13.
- Frick KD, Regan J. Whether and Where Community Health Center Users Obtain Screening Services. J Health Care Poor Underserved 2001;12:429–445.
- Davis K, Shoen C. Health and the War on Poverty: A Ten-Year Appraisal. Washington DC: The Brookings Institution. 1977
- Dievler A, Giovannini T. Community Health Centers: Promise and Performance. Medical Care Research and Review 1998;55:405–431.
- Hawkins D, Rosenbaum S. The Challenges Facing Health Centers in a Changing Healthcare System. In: Who Will Take Care of the Poor and Uninsured? Altman S, Reinhardt U, Shields A. (eds.) Chicago IL: Health Administration Press.1998
- Okada L, Wan T. Impact of Community Health Centers and Medicaid on the Use of Health Services. Public Health Rep 1980;95:520–534.
- Bureau of Primary Health Care. 1998. Uniform Data System. Bethesda, MD: Bureau of Primary Health Care/Health Resources and Services Administration, U.S. Department of Health and Human Services. As cited by IOM, America's Health Care Safety Net, 2000.
- Delivery of Preventive Services for Low-Income Persons Over Age 50: A Comparison of Community Health Clinics to Private Doctors' Offices
Journal of Community Health
Volume 28, Issue 3 , pp 185-197
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- primary health care
- preventive services
- community health clinics
- Author Affiliations
- 1. Departments of Oncology and Internal Medicine, Georgetown University Medical Center, Lombardi Cancer Center, Cancer Control Program, Washington DC
- 2. Georgetown University Medical Center, Lombardi Cancer Center, Cancer Control Program, Washington DC, USA