Community Health Centers Services Research Articles

Pemberdayaan Puskesmas Sebagai Sarana Peningkatan Derajat Kesehatan Masyarakat Di Gampong Sungai Pauh Tanjung Kota Langsa

Puskesmas is a health service facility that organizes public health efforts and first-level individual health efforts. Community Health Centers known as Puskesmas are First Level Health Facilities (FKTP) which are responsible for public health in their working areas in one or part of the sub-district area. In the Regulation of the Minister of Health Number 75 of 2014 concerning Community Health Centers it is stated that the Puskesmas has the function of organizing the first level of Community Health Efforts (UKM) and Individual Health Efforts (UKP). The lack of public understanding of the role of the puskesmas causes a conflict on the status of the community's health status. the inhibiting factor for community health center services is the lack of education and health information for the community on healthy lifestyles, the results of mini workshops that are not published to the surrounding community. public health. The method used is a lecture by providing counseling about the role of Puskesmas for the community to improve health status and be free from various health problems that often occur in the community. The target achieved in community service is to increase public knowledge about the function of the puskesmas which will later change people's attitudes in making changes in health status.

Analysis of the Implementation of the Generic Regional Health Information System (SIKDA) at Simpang Tiga Health Center Pekanbaru City

The application of the Generic Regional Health Information System at the Community Health Center as a user aims to provide convenience for officers in carrying out reporting activities between sections and also for activities in reporting to the Health Office by using the Generic Regional Health Information System for online patient management. It is hoped that the results of the application of the Generic Regional Health Information System will be input for the benefit of management in preparing a health program planning and is expected to be used as a monitoring system for Community Health Center services by the Head of the Community Health Center and the Health Office to be more effective. This research is a qualitative research with a case study approach. The types of data used are primary data and secondary data. Primary data were obtained from direct observation, in-depth interviews, and document review. The informants of this study consisted of the Head of the Public Health Center, the Person in Charge of the Generic Regional Health Information System, the Operator of the Generic Regional Health Information System, the Police Officer, the Drug Warehouse & Pharmacy Officer and the Cashier of the Simpang Tiga Health Center. The results showed that the implementation of the Generic Regional Health Information System at the Simpang Tiga Health Center was still running up to the registration flow, so it was not interrelated between programs in accordance with the regulations set by the Government. Human resources who operate the Regional Health Information System still have adequate and not in accordance with the minimum educational standards, besides that the operators who run the Regional Health Information System have never received. Existing facilities and infrastructure still do not support the operation of the Generic Regional Health Information System, ranging from network and computer disturbances, which are still insufficient for the implementation of a complete Regional Health Information System flow. Therefore, it is hoped that the puskesmas can pay attention to the existing constraints, so that the operation of the Generic Regional Health Information System runs optimally.

Embedding general neurology and tertiary care headache services in community health centers (CHCs) in Boston, MA: establishment and early experiences (S28.010)

Embedding general neurology and tertiary care headache services in community health centers (CHCs) in Boston, MA: establishment and early experiences (S28.010)

The Effect of National Health Service Corps Clinician Staffing on Medical and Behavioral Health Care Costs in Community Health Centers.

Prior studies of community health centers (CHCs) have found that clinicians supported by the National Health Service Corps (NHSC) provide a comparable number of primary care visits per full-time clinician as non-NHSC clinicians and provide more behavioral health care visits per clinician than non-NHSC clinicians. This present study extends prior research by examining the contribution of NHSC and non-NHSC clinicians to medical and behavioral health costs per visit. Using 2013-2017 data from 1022 federally qualified health centers merged with the NHSC participant data, we constructed multivariate linear regression models with health center and year fixed effects to examine the marginal effect of each additional NHSC and non-NHSC staff full-time equivalent (FTE) on medical and behavioral health care costs per visit in CHCs. On average, each additional NHSC behavioral health staff FTE was associated with a significant reduction of 3.55 dollars of behavioral health care costs per visit in CHCs and was associated with a larger reduction of 7.95 dollars in rural CHCs specifically. In contrast, each additional non-NHSC behavioral health staff FTE did not significantly affect changes in behavioral health care costs per visit. Each additional NHSC primary care staff FTE was not significantly associated with higher medical care costs per visit, while each additional non-NHSC clinician contributed to a slight increase of $0.66 in medical care costs per visit. Combined with previous findings on productivity, the present findings suggest that the use of NHSC clinicians is an effective approach to improving the capacity of CHCs by increasing medical and behavioral health care visits without increasing costs of services in CHCs, including rural health centers.

Factor Analysis Affecting Quality of Life of PLWHA at the Community Health Center Service

Until now, HIV infection is still a global health problem. Handling of HIV infection cases still faces many problems due to various factors. As a result of these factors can also affect the quality of life of PLWHA. The purpose of this study was to analyze the influence of factors from knowledge, attitudes, stigma and family support on the quality of life of PLWHA at the Community health center Service of Teladan in 2020. This study used an analytic survey design with a cross-sectional approach. The sample size in the study was 93 people. The measuring instrument used is a questionnaire. The bivariate analysis used was the Chi-square test and the multivariate with the multivariable logistic regression test. A total of 72 respondents (77.4%) were male and 63 respondents (67.4%) were adults. From the results of the multivariate analysis, the sig values of knowledge (p = 0.013), attitudes (p = 0.045), stigma (p = 0.045) and family support (p = 0.001) were obtained. It was found that there was an influence of knowledge, attitudes, stigma and family support factors on the quality of life of PLWHA. From the results of this study, it is hoped that it can improve services to PLWHA and provide understanding about HIV-AIDS to patients, families and also the community in order to reduce stigma and discrimination against PLWHA

Impacts of the Affordable Care Act on Receipt of Women’s Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States

(Abstracted from Womens Health Issues 2021;31:9–16) After implementation of insurance expansion provisions under the Affordable Care Act (ACA), rates of health insurance coverage increased dramatically throughout the United States in 2014 and improved care delivery for some services. Despite the availability of federally funded Medicaid expansion to all states, many did not accept ACA-sponsored expansion and opted to maintain current eligibility criteria in their states.

Impacts of the Affordable Care Act on Receipt of Women's Preventive Services in Community Health Centers in Medicaid Expansion and Nonexpansion States.

Background:The Affordable Care Act (ACA) increased health insurance coverage throughout the United States and improved care delivery for some services. We assess whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers.Methods:Using electronic health record data from 354 community health centers in 14 states (10 expansion, 4 non-expansion), we used generalized estimating equations and difference-in-difference methods to compare receipt of six recommended preventive services (cervical cancer screening, human papilloma virus vaccination, chlamydia screening, influenza vaccination, human immunodeficiency virus screening, and blood pressure screening) among active female patients ages 11 to 65 (N = 711,121) before and after ACA implementation and between states that expanded versus did not expand Medicaid.Results:Except for blood pressure screening, receipt of all examined preventive services increased after ACA implementation in both Medicaid expansion and nonexpansion states. Influenza vaccination and blood pressure screening increased more in expansion states (adjusted absolute prevalence difference-in-difference, 1.55; 95% confidence interval, 0.51–2.60; and 1.98; 95% confidence interval, 0.91–3.05, respectively). Chlamydia screening increased more in nonexpansion states (adjusted absolute prevalence difference-in-difference: −4.21; 95% confidence interval, −6.98 to −1.45). Increases in cervical cancer screening, human immunodeficiency virus screening, and human papilloma virus vaccination did not differ significantly between expansion and nonexpansion states.Conclusions:Among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and nonexpansion states, although the overall rates remained low. Continued support is needed to overcome barriers to preventive care in this population.

ACA Funding Increases for Federally Qualified Health Centers and Changes in Health Center Use for Children in Massachusetts

Federally qualified health centers (FQHCs) provide care in underserved areas, regardless of an individual’s ability to pay, and can be a critical source of care for children with public or no insurance who have greater difficulty getting care from providers in the community. In 2013, about one‐third of FQHC patients nationally were children. The Affordable Care Act (ACA) increased federal funding for FQHCs by $11 billion between 2011 and 2015, with the policy goal of increasing access to care for underserved populations. We examined the effects of the increased funding for FQHCs on children and adults in Massachusetts.We used 2010‐2013 claims data from the Massachusetts All Payer Claims Database (APCD) to examine changes in visits to FQHCs among enrollees included in the APCD (Medicaid, commercial insurance, and visits by uninsured residents covered by the Health Safety Net).We obtained FQHC funding information from the Uniform Data Set. To assess the impact of changes in funding (federal and state) on FQHC visits, we used a shift‐share instrument to measure local exposure (5‐digit ZIP code‐level) to changes in funding: we weighted the year‐to‐year percentage change in FQHC funding by the local share of each FQHC’s patient population in 2009 and summed across FQHCs in the ZIP. We used a multivariate linear regression model to assess the association between the year‐to‐year percentage change in local exposure to FQHC funding and the percentage change in the total number of FQHC visits or number of residents with FQHC visits in 2010‐13, adjusting for each ZIP codes’ demographic and health characteristics (eg, age, median comorbidity scores). We used similar models to examine changes in ED visits and stratified models for children vs. adults. Models were weighted by the ZIP code population, and standard errors were clustered by ZIP.Children (N = 1 145 205 in 2010) and adults (N = 5 038 277 in 2010) included in the Massachusetts APCD and 31 FQHCs that received funding from the Community Health Center Fund between 2010 and 13.Annual pediatric visits at MA FQHCs increased by 10% and adult FQHC visits by 14% from 2010 to 2013. Those with vs. without FQHC visits were more likely to have Medicaid insurance (67% vs. 17%) and live in low‐income neighborhoods (37% vs. 22%). Increased visits to FQHCs by children were associated with increases in FQHC funding, for example, +6.8 percentage point (95% CI [1.7, 11.8]) with +1SD change in prior year funding. ED visits by children also decreased with greater local exposure to FQHC funding, for example, −1.3pp ([−2.4, −0.2]) with +1SD change in prior year funding. FQHC visits for adults did not vary significantly with FQHC funding, but ED visits decreased by a similar magnitude as children.Increases in FQHC funding resulted in significant increases in use of FQHC services, especially for children. ED visits for children and adults also decreased with greater FQHC funding.The ACA funding increases for FQHCs appeared to increase access to community health center services for low‐income children and reduced costly emergency department care for underserved communities.Agency for Healthcare Research and Quality.

Integrating tb-hiv services in community health centers in Kulon Progo District

Background: Indonesia is a country with a high burden of tuberculosis and the human immunodeficiency virus. In response, countries adopted WHO recommendations on integrated services, including diagnostic screening and care for TB-HIV patients. Kulon Progo seeks to improve services under existing health system resources, and it is very important to understand its capacity to provide integrated TB-HIV services. Objective: This study aims to assess the readiness of TB-HIV integrated services in Puskesmas for the health system in the Kulon Progo Regency. Method: The research method uses mixed methods explanatory sequential design. The unit of analysis is the Puskesmas. Observation of the availability and readiness of TB services and cross-sectional HIV services using SARA modified questionnaires, followed by in-depth interviews exploring barriers and opportunities for integration of TB-HIV services at the Puskesmas. Results: Puskesmas service readiness, 93.3% (95% CI; 92.7% -93.9). Puskesmas had the readiness to provide basic health services, 63.8% (95% CI, 60.7-66.8). Puskesmas TB service readiness, 80.9% (95% CI: 73.6–88.2) HIV test counseling service readiness, only 1 Puskesmas (4.7%) has readiness for both services. Based on the domain assessment, 40.4% of the Puskesmas had trained TB diagnosis and treatment officers, 61.9% had trained officers and HIV testing counseling guidelines. The dominant themes include non-supportive staffing, not optimal human resource capacity, the lack of coordination and teamwork, and lack of monitoring and supervision system. With the support of leaders and good policies to mobilize funding, the availability of facilities becomes an opportunity for integrated TB-HIV services to run. Conclusion: Towards readiness to integrate TB-HIV services under the TB-HIV collaboration recommendation, efforts to address the needs of the number of health workers and equip staff with knowledge and skills as capacity building to manage integrated care. The involvement and support of the leadership of the determinants of readiness to ensure the availability of facilities, diagnostic supplies, and medicines as a continuous implementation.

THE RELATIONSHIP BETWEEN THE QUALITY OF HEALTH SERVICES REGARDING THE LEVEL OF PATIENTS SATISFACTION PATIENTS IN THE PUSKESMAS SINDANG BARANG BOGOR

Based on the results of a preliminary study conducted on January 15, 2018 regarding the level of patient satisfaction with the quality of care at Sindang Barang Community Health Center in January 2018 out of 10 patients interviewed, 7 patients expressed dissatisfaction with the realible and responsive service quality at Sindang Barang Health Center and 3 other patients stated satisfied with the realible and responsive services available at the Sindang Barang Health Center. Of the 7 patients who expressed dissatisfaction with the Sindang Barang Community Health Center services 6 of them stated that the quality service of Sindang Barang Public Health Center was less than the five service quality (tangible, realible, responsive, assurance, empathetic) and 1 patient said from the five good quality services (tangible, realible) , responsive, assurance, empathy).This research was conducted at the Sindang Barang Health Center in Bogor Regency. The purpose of this study was to determine the relationship between the quality of health services and the level of outpatient satisfaction at the Sindang Barang health center in Bogor regency in 2018. The type of research the researchers conducted was analytic research with a quantitative analysis method with a cross sectional design. The results in this study are known as kendall’s tau results, namely p value = 0,000 which means that the p value ≤ 0.05 Ho is rejected, Ha is accepted so there is a relationship between service quality and outpatient satisfaction in Sindang Barang Health Center in 2018.

Will Community Health Centers Survive COVID‐19?

Will Community Health Centers Survive COVID‐19?

Relative validity of a food frequency questionnaire for pregnancy in a low-income urban community in the Philippines

ObjectiveThe aim of this study was to develop and validate a food frequency questionnaire (FFQ) for pregnant women to identify those who are at risk for possible deficiencies in the key nutrients for pregnancy. MethodsPregnant women 18 to 39 y of age who availed themselves of perinatal services in community health centers in Makati City, Philippines were screened for the study. Five hundred eligible participants were asked to complete three 24-h food recalls for the development of the FFQ. A different set of participants with a total number of 100 were recruited for the validation of the questionnaire, which involved the use of the 3-d food record as the reference tool. The validity of the nutrient intakes obtained from the FFQ were measured against the values from the 3-d food record using Pearson's correlation coefficients and Bland–Altman plots. ResultsSignificant correlations at P ≤ 0.05 were seen for energy, fat, riboflavin, cobalamin, and calcium. Pearson's correlation coefficients ranged from 0.016 to 0.32 for energy and nutrients. ConclusionsAcceptable agreements were seen for most of the nutrients. Possible deficiencies for key nutrients during pregnancy can be detected by the developed FFQ for Filipino pregnant women living in low-income urban communities with similar profiles.

Structural Analysis on Quality of Life for Terminal Cancer Patients provided Hospice and Palliative Care Services in Community Health Centers

Structural Analysis on Quality of Life for Terminal Cancer Patients provided Hospice and Palliative Care Services in Community Health Centers

The Web-Based Outpatient Information System at Community Health Center

Community Health Center is one of the agencies engaged in public health services. As technology advances in the health sector, an application is needed to accelerate and facilitate the Community Health Center in delivering information about Community Health Center and can be accessed by the public without limited space and time. Therefore this final project aims to provide information by improving the quality of Community Health Center by facilitating websites so that they can support the development of Community Health Center services. With the establishment of a Web-Based Outpatient Patient Information System at Talangpadang Community Health Center, it is hoped that it can facilitate the community to get the information needed, related to the Talangpadang Community Health Center. This application is Web-based, using the Web programming language, PHP, MySQL.

Fasilitas dan Lingkungan Kerja Layanan Kesehatan Terhadap Kepuasan pelanggan

Service organizations are required to always optimize the resources to be managed in order to increase customer satisfaction, this study intends to analyze the effect of facilities (direct facilities and supporting facilities) health services and work environment (direct work environment and working environment conditions or weather) health services on customer satisfaction. Retrieval of data with a survey method of 500 respondents of health service users at the Community Health Center in Probolinggo District, with quantitative data methods were analyzed by t test in regression. The results of the study have shown that direct work facilities and supporting facilities as well as the direct work environment of health services have made a positive contribution to customer satisfaction, while the work environment related to environmental conditions or weather as measured by indicators of noise, air pollution, and lighting at the service has not yet fully contributed to customer satisfaction, so the work environment related to weather conditions needs to get attention or solutions to improve services to meet customer satisfaction, and this needs to pay attention to the location of the Community Health Center services in Probolinggo Regency, which is close to the highway.

Psychiatric Emergency Department Visits After Regional Expansion of Community Health Centers

Regional primary health care system capacity may affect the demand for psychiatric visits to the emergency department (ED). In the United States, community health centers (CHCs), which serve low-income regions regardless of individuals' ability to pay, expanded primary care services by over 70% in the past decade. No research, however, evaluates whether this expansion affects overall psychiatric ED visits. This hypothesis is tested in 143 U.S. counties that expanded CHC services. For the years 2006 through 2011, 18.84 million psychiatric outpatient ED visits were aggregated by county-year for the 143 U.S. counties with a participating CHC. The rate of psychiatric ED cases in a county-year is the dependent variable. Two independent variables were examined: total patients seen at CHCs and total patients receiving mental health services at CHCs. Fixed-effects regression methods controlled for county effects, year effects, and other health care and sociodemographic factors. Psychiatric ED visits fell below expected levels in county-years where the volume of overall CHC patients rose (coefficient=-0.059; standard error=0.027, p=0.03). Findings indicate no relation between the volume of mental health patients seen at CHCs and psychiatric ED visits. An increase in general primary health care to an underserved population, in the form of CHCs, corresponds with a decline in psychiatric ED visits. This result coheres with a recent Medicaid expansion experiment in which increased access to general primary care reduced the prevalence of undiagnosed and untreated depression. Findings, if replicated, may hold policy implications for regional health systems.

Impact of dermatology eConsults on access to care and skin cancer screening in underserved populations: A model for teledermatology services in community health centers

The clinical outcome of teledermatology with dermoscopy in large-scale primary care networks remains unclear. We evaluate the impact of implementing a teledermatology consultation program with dermoscopy on a statewide scale, focusing on access to care and skin cancer screening for medically underserved populations. Descriptive retrospective cohort study of 2385 dermatology referrals from primary care from June 2014 through November 2015. Before implementation of electronic consultations (eConsults), access to dermatology was limited; only 139 (11%) of 1258 referrals resulted in a confirmed appointment with a median wait time of 77days. Post implementation, 499 of 1127 consults (44%) were sent electronically, and of those, 16% required a face-to-face visit with a median wait time of 28days. Ten malignancies were identified via eConsults. Overall consult volume remained stable pre- and post-eConsult implementation. We evaluated eConsults in medically underserved populations seeking care at community health centers. Results might not be generalizable to other populations or in other settings. eConsults increase access to dermatologic care and reduce wait times for patients receiving medical care at community health centers. Implementing dermoscopy into teledermatology could increase access to skin cancer screening and treatment for medically disadvantaged populations.

The availability of community health center services and access to medical care

BackgroundCommunity Health Centers (CHCs) funded by Section 330 of the Public Health Service Act are an essential part of the health care safety net in the US. The Patient Protection and Affordable Care Act expanded the program significantly, but the extent to which the availability of CHCs improve access to care in general is not clear. In this paper, we examine the associations between the availability of CHC services in communities and two key measures of ambulatory care access – having a usual source of care and having any office-based medical visits over a one year period. MethodsWe pooled six years of data from the Medical Expenditure Panel Survey (2008–2013) and linked it to geographic data on CHCs from Health Resources and Services Administration's Health Center Program Uniform Data System. We also link other community characteristics from the Area Health Resource File and the Dartmouth Institute's data files. The associations between CHC availability and our access measures are estimated with logistic regression models stratified by insurance status. ResultsThe availability of CHC services was positively associated with both measures of access among those with no insurance coverage. Additionally, it was positively associated with having a usual source of care among those with Medicaid and private insurance. These findings persist after controlling for key individual- and community-level characteristics. ConclusionsOur findings suggest that an enhanced CHC program could be an important resource for supporting the efficacy of expanded Medicaid coverage under the Affordable Care Act and, ultimately, improving access to quality primary care for underserved Americans.

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN PEMANFAATAN PELAYANAN KESEHATAN DI WILAYAH KERJA PUSKESMAS TAMBARANA KECAMATAN POSO PESISIR UTARA KABUPATEN POSO

<p>Community Health Center is a health service facility that organizes public health efforts and the efforts of individual health at the first level, with more prioritizes promotive and preventive efforts, to achieve the highest public health status in its working area. Utilization of Community Health Center service is influenced by several factors like the public perception of health, public perception of the quality of service, family income and level of education. This study aimed to determine the relationship of the public perception of health, public perception of the quality of service, family income and education level with Health Service Utilization in the working area of Community Health Center Tambarana North Coastal of Poso sub-district, Poso district. This type of research was analytical survey research with cross sectional approach. The total of the sample were 69 respondents which was drawn by using Standley Lameshow formula which the population was known. Data was analyzed descriptively which was known as univariate and bivariate analysis, on the credibility degree of 95% (p <0.05). Chi Square test results showed that the public perception of health related to health service utilization (ρ = 0.000), public perception of the quality of service was not related to health service utilization (ρ = 0.213), family income relatedto health service utilization (ρ = 0.004), and there was a relationship between the education level with health service utilization (ρ = 0.000). The relation absence of public perception of service quality with health service utilizationmay be affected by physical evidence, reliability, responsiveness, assurance and empathy.</p>

Mobile Technology and Promoting Health Equity for Low-Income Patients

Background/Aims: Mobile health promotion (mHealth) is health practices supported by mobile devices like smartphones and wireless technology. mHealth delivers health information to increase awareness, provides guided instructions about healthy behaviors and offers self-monitoring of health status. Approximately 58% of adults and 43% of individuals earning less than $20,000/year own smartphones; pervasiveness of mobile devices provides opportunity for patient self-care management. A majority of low-income patients access services in community health centers (CHCs), thus an opportunity exists to evaluate how mobile devices can promote continuity of care in CHCs. The objectives are as follows: 1) Assess attitudes and practices concerning mobile technology; and 2) Evaluate how mobile devices can promote equity in health care access for low-income populations.