Despite technological advances, modern medical interventions, and one of the world’s highest rates of health care spending per person, the overall health and quality of life for Americans remain shockingly low. The United States ranked 23rd in the world in life expectancy for both men and women in 2000, 50th for maternal mortality and 28th for infant mortality. The predominance and emphasis on specialist care over primary care has been identified as a major contributing factor to this problem.
|Jeannette South-Paul, MD
As health care reform takes shapes and demand for primary care increases, community health centers (CHCs) will become an increasingly important health care resource for all of our communities and particularly for vulnerable populations such as children, the disabled, racial/ethnic/social minorities, the poor and the medically uninsured and underinsured.
To better understand the role of CHCs in promoting community health, we talked with Jeannette South-Paul, MD, Andrew W. Mathieson Professor and chair of the Department of Family Medicine at the University of Pittsburgh School of Medicine. Dr. South-Paul is a family medicine physician who maintains an active clinical practice at the UPMC Matilda Theiss Clinic and whose research interests include maternal child health and fitness and evaluation of cultural competence in clinicians and trainees.
How did community health centers (CHCs) come about?
JSP: It’s important to realize that CHCs are not an original primary care model. The original model was the solo community general physician (GP) who graduated from medical school, put up his/her shingle and started a practice. Over time, the model has expanded and matured into today’s family medicine physicians. Family medicine physicians now complete multi-year, post-medical school residencies under the guidance of a preceptor and focus their training on ambulatory care.
How has the need for CHCs
grown over time?
JSP: It’s become clear that there are certain populations that pose particular challenges for the family medicine physician. Some people go to an independent practicing physician and manage to get a physical, have their blood drawn, an X-ray taken and secure a specialist referral. All that would probably happen because those people are educated, employed and focused on their health care. But, what if you’re not? There are patients who are part of a vulnerable population for whom these tasks would be virtually impossible. For example, if I get out of bed in the morning and have no energy, what do I do about that? Do I have no energy because I haven’t had breakfast yet and my blood sugar is low? Or am I depressed and need to talk to a mental health professional? Or am I anemic and need a blood test? Or maybe I stayed up late and just didn’t get enough sleep? We expect the public to make these decisions and to do so in an efficient manner, choosing the right clinician who can take care of their health care issues without spending too much time or money. In our “non-health care” system, you have to figure out how to do for yourself to ensure that you get adequate care, and that is simply beyond the capacity of a lot of folks.
How do CHCs fit with the idea of the patient-centered medical home (PCMH)?
JSP: CHCs grew out of the need for a medical home for patients. In recent years, this has grown into the notion of a patient-centered medical home (PCMH). CHCs support the concept of the PCMH, providing comprehensive physical, behavioral, pharmacy and oral health services all in one location. It’s one-stop care that is rational, organized, accessible and affordable. When a patient has a PCMH, she/he also does not have to rely on a bus or cab in the middle of the night to get to an urgent care clinic or an emergency room because the CHC has a physician or nurse who knows about you and your health and is available 24-7 either in person or over the phone. So, to me, CHCs are the embodiment of the PCMH and are a wonderful resource to rationalize and organize care that is compassionate, coordinated, continuous and patient-centered.
What CHCs exist in Pittsburgh for
people to go to?
JSP: There are six CHCs operating in the UPMC health care system—three out of UPMC St. Margaret, one from UPMC Shadyside, one from UPMC McKeesport and one run jointly between UPMC Presbyterian and UPMC Shadyside. Primary Care Health Services, Inc., runs 13 CHCs throughout Allegheny County, and there are also several faith-based CHCs—Metro Family Health in Wilkinsburg and North Side Christian Health Center. All of these community health centers provide invaluable services to the community.
What do you see in the future for CHCs, especially locally?
JSP: I definitely think we will see an increased demand for CHCs. If we as a country have decided that we are going to expand health care coverage for greater segments of the population, then we can’t afford hospital-level or hospital-priced care. CHCs offer a lower cost, higher quality, more longitudinally sustainable model for care than inpatient care.
Even here in Pittsburgh, we have not yet recognized the potential for CHCs. We need to do a better job of marketing CHCs so that people are aware of their benefits and availability. Instead of touting the new specialist in town, we need to promote the general practitioner working right in the neighborhood.
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