Eye Care in Federally Qualified Health Centers

Abstract

PurposeTo understand the availability of vision care provided within Federally Qualified Health Centers (FQHCs) in 2017 versus 2021, and to assess whether differences exist in neighborhood-level demographic factors and social risk factors (SRFs) between FQHCs based on the availability of eye care services. DesignSecondary data analysis of the Health Resources and Services Administration (HRSA) FQHC data and 2017-2021 American Community Survey neighborhood SRFs. ParticipantsFQHCs in 2017 and 2021. MethodsPatient and neighborhood characteristics for each SRF were summarized. Differences in FQHCs providing and not providing vision care were compared via Wilcoxon Mann–Whitney tests for continuous measures and chi-square tests for categorical measures. Logistic regression models were used to test the associations between neighborhood measures and FQHCs providing vision care, adjusted for patient characteristics. Main Outcome MeasuresOdds ratios (ORs) with 95% confidence intervals for neighborhood-level predictors of FQHCs providing vision care services. ResultsOverall, 28.5% of FQHCs (n=375/1318) provided vision care in 2017 vs. 32% (n=435/1362) in 2021 with some increases and decreases in both the number of FQHCs and those with and without vision services. Only 2.6% of people who accessed FQHC services received eye care in 2021. Among the 435 FQHCs that provided vision care in 2021, 27.1% (n=118) had added vision services between 2017 and 2021, 71.5% (n=311) had been offering vision services since at least 2017, and 1.4% were newly established. Logistic regression models demonstrated FQHCs providing vision care in 2021 were more likely to be in neighborhoods with higher percentage of Hispanic/Latino individuals (OR=1.08, 95% CI=1.02-1.14, p=0.0094), Medicaid-insured individuals (OR=1.08, 95% CI=1.02-1.14, p=0.0120), and no car households (OR=1.07, 95% CI=1.01-1.13, p=0.0142). However, FQHCs with vision care, compared to FQHCs without vision care, served a lower percentage of Hispanic/Latino individuals (27.2% vs. 33.9%, p=0.0007), Medicaid-insured patients (42.8% vs. 46.8%, p<0.0001), and patients living at/below 100% of the federal poverty line (61.3% vs. 66.3%, p<0.0001). ConclusionsVision care services are available at few FQHCs, localized to a few states. Expanding access to eye care at FQHCs would meet patients where they seek care to mitigate vision loss to underserved communities.