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Community Health Centers Responding to Disparities in Eye Care Roger Wilson, OD, FAAO December 7, 2006 What Are Health Centers?

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slide1
Community Health Centers

Responding to Disparities in Eye Care

Roger Wilson, OD, FAAO

December 7, 2006

what are health centers
What Are Health Centers?
  • Health Centers are local, non-profit, community-governed health care facilities that provide a vast array of health services to low income and medically underserved communities
  • Historically a Federal strategy to providing comprehensive primary care to underserved
  • First CHC demonstration project in 1965 at Columbia Point, Boston MA
  • Congress authorized health centers in 1975
  • For 40 years, health centers have provided primary care and preventive health services to the nation’s most vulnerable populations
how many chcs in us
How Many CHCs in US?

1000 Community Health Centers

5500 Unique service locations

  • In every State, Commonwealth, Territory and District of Columbia
  • Located where economic, geographic, or cultural barriers would otherwise limit access to primary health care
slide4

What Types of CHCs Exist?

http://bphc.hrsa.gov/chc/default.htm

Community Based - located in a high need community (medically underserved areas) and receive federal funding under section 330 of the Public Health Service (PHS) Act

Rural – a broad strategy for delivering services to rural underserved including clinics, hospitals, health departments and private providers

Migrant Care – health services at over 400 migrant and seasonal farm worker clinical sites throughout the US and Puerto Rico

Health Care for the Homeless (HCH)-through local coalitions provides for primary/emergency/substance abuse care and outreach assistance and services (housing and entitlements)

Public Housing Primary Care (PHPC) Program - provides residents with on site or nearby access to comprehensive primary health care services through the direct provision of health promotion, disease prevention, and primary health care services.

chc patients in 2004
CHC Patients in 2004

14 Million unique patients which accounted for 52 million visits:

59% = Female; 41% = Male

Medical visits = 38 million

Dental visits = 5 million

Source: NACHC, 2005.  Based on 2004 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

health center users by race ethnicity in 2004

Note: Percents may not total 100% due to rounding.

Source: NACHC, 2005.  Based on 2004 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Health Center Users By Race/Ethnicity in 2004
chc patients by age 2004

Under 5

Ages 65+

12.2%

7.1%

Ages 5-12

Ages 45-64

13.2%

19.4%

Ages 13-19

11.7%

Ages 25-44

Ages 20-24

28.0%

8.4%

Note: Percents may not total 100% due to rounding.

Source: NACHC, 2005.  Based on 2004 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

CHC Patients By Age, 2004
health center patients by insurance status 2004

Note: Percents may not total 100% due to rounding.

Source: NACHC, 2005.  Based on 2004 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

Health Center Patients By Insurance Status, 2004

Private Insurance

14.7%

Other Public

2.1%

Medicare

7.5%

Ages 20+

40.7%

Medicaid

35.7%

Under

Age 20

59.3%

Uninsured

40.1%

how chcs address disparities source nachc sept 2005 fact sheet 0405
How CHCs Address Disparities(Source: NACHC Sept 2005 Fact Sheet #0405)
  • Located in federally designated high-need underserved areas
  • Governed by community boards, majority of whom are patients at center - unique structure
  • Open to all residents, regardless of income or insurance status, sliding fees
  • Provide comprehensive health and enabling services (e.g. translation, advocacy, travel)
  • Tailor services to community, culturally and linguistically competent (care management)
  • Follow rigorous performance and accountability requirements clinically, operationally and financially
research has shown that chcs are effective in improving health 0405
Research has shown that CHCs are effective in improving health (#0405)
  • Disparities in health status do not exist among health center patients (Shi et al)
  • Effective preventive services – timely screenings for mammograms & pap smears compared to nation
  • Fewer low birth weight babies – compared to national counterparts
  • Effective management of chronic disease – diabetes, cardiovascular disease, asthma, depression, cancer, HIV disease, hypertension
however there remains significant visual health disparities at chcs
However, there remains significant Visual Health Disparities at CHCs

Percentage of CHCs which offer the following clinical services:

Primary Medical 100%

Dental 75%

Behavioral Health 70%

Substance Abuse 50%

Pharmacy 33%

Optometry 18%

Source: NACHC, 2005.  Based on 2004 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

slide13

CHC Staffing in 2004

  • Primary Care Clinicians = 18,000
  • Dental/Oral Health Staff = 2,100
  • Pharmacy = 1,600
  • Other clinicians = 18,200
  • Optometry (estimate) = 100

TOTAL Clinical STAFF = 40,000

Note: Numbers rounded.

Source: NACHC, 2005.  Based on 2004 Uniform Data System, Bureau of Primary Health Care, HRSA, DHHS.

slide14
UNMET NEED: Vitale S, et al. Prevalence of visual impairment in the United States. JAMA 2006; 295:2158-2163

“Rates of visual impairment were highest among Hispanic…or other ethnicity, were poor, had diabetes…, lacked private health insurance or had fewer years of education.”

asco what is the role of schools and colleges of optometry with chcs
ASCO: What is the role of schools and colleges of optometry with CHCs?
  • 2006 AOA Survey: ASCO and CHCs

(AAO POSTER SESSION)

  • Opportunity for Schools and Colleges
    • Form affiliations with state & local PCAs
    • Partner with CHCs to open comprehensive eye care programs
    • Develop clinical Rotations & Residencies
    • Teach community health principles via front line clinical service/education
    • Contribute to workforce development

(ASCO approval in November, 2006 of “Community Health Optometry” residency)

asco what is the role of schools and colleges of optometry with chcs16
ASCO: What is the role of schools and colleges of optometry with CHCs?

Coleman DL. The impact of the lack of health insurance: how should academic medical centers and medical schools respond? Acad Med 2006; 81:728-731

“Exposing trainees to community-based clinics that provide care for the underserved will provide important experience in addressing the health care needs of this patient population and will expose trainees to inspirational role models.”

aoa what if eye care were a priority must have service in the next decade
AOA: What if Eye Care Were a Priority “Must Have” Service in the Next Decade?

By 2016 with appropriate funding and incentives for ODs to work at CHCs:

  • Open a new Eye Service in 1000 CHCs

(That’s roughly 100 new programs/year!)

  • Hire 2000 optometrists to work at CHCs (That’s approximately 15-20% of all new graduates over the next 10 years)
  • We could provide over 4 million eye visits annually – the beginning of improved visual health status for the underserved
chcs are a major part of the solution further information
CHCs are a Major Part of the Solution: Further Information

Roger Wilson, OD

Chair, American Optometric Association Community Health Center Committee

c/o New England Eye Institute

1255 Boylston Street

Boston MA 02215

617.236.6229

www.aoa.org

wilsonr@neco.edu