Shortages of Medical Personnel at Community Health Centers

Rosenblatt, Roger A.; Andrilla, C. Holly A.; Curtin, Thomas; Hart, L. Gary

doi:10.1001/jama.295.9.1042

Cited by 252 publications

(178 citation statements)

References 48 publications

Supporting

Mentioning

174

Contrasting

Unclassified

Order By: Relevance

“…Our data suggest that automatic reporting of eGFR might increase CKD documentation by nonphysician practitioners. A study of US rural community health centers reported 46% of direct clinical care being provided by nonphysician practitioners (25). Automatic reporting of eGFR could have a greater impact in a rural environment, where nonphysician practitioners often function as PCPs.…”

Section: Discussionmentioning

confidence: 99%

Documentation and Management of CKD in Rural Primary Care

Rao

Morris

O’Malley³

et al. 2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives Recognition of CKD by primary care practitioners is essential in rural communities where nephrology access is limited. This study determined the prevalence of undocumented CKD in patients cared for in rural primary care practices and evaluated characteristics associated with undocumented CKD as well as CKD management.Design, setting, participants, & measurements A retrospective cohort study, conducted within the Oregon Rural Practice Based Research Network, consisted of 865 CKD patients with serum creatinine$1.5 mg/dl in males and $1.3 mg/dl in females and an estimated GFR,60 ml/min per 1.73 m 2 . Documentation of a CKD diagnosis and laboratory values were abstracted by chart review.Results Of CKD patients, 51.9% had no documentation of CKD. Undocumented CKD occurred more frequently in female patients (adjusted odds ratio=2.93, 95% confidence interval=2.04, 4.21). The association of serum creatinine reporting versus automating reporting of estimated GFR on CKD documentation was dependent on patient sex, years of practitioner experience, and practitioner clinical training. Hypertensive patients with documented CKD were more likely to have a BP medication change than patients with undocumented CKD (odds ratio=2.07, 95% confidence interval=1.15, 3.73). Only 2 of 449 patients with undocumented CKD were comanaged with a nephrologist compared with 20% of patients with documented CKD (odds ratio=53.20, 95% confidence interval=14.90, 189.90).Conclusions Undocumented CKD in a rural primary care setting is frequent, particularly in female patients. Depending on practitioner characteristics, automatic reporting of estimated GFR might improve documentation of CKD in this population.

show abstract

Section: Discussionmentioning

confidence: 99%

Documentation and Management of CKD in Rural Primary Care

Rao

Morris

O’Malley³

et al. 2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…In 2004, 9% of nurse practitioner, 5.2% of certified nurse midwife, and 10.6% of registered nurse positions at CHCs were vacant. The numbers of these professionals per grantee were significantly lower in rural than in urban locations, and rural centers were more likely than urban centers to report that recruiting nurses and certified nurse midwives was very difficult [10] .…”

Section: Chc Nursing Shortfallmentioning

confidence: 97%

An adequate nursing workforce is essential to health centers and their expected growth under health reform

Shin

Sharac

2013

JNEP

View full text Add to dashboard Cite

Community health centers serve as an important source of care to a patient population of 20.2 million patients that is largely low-income and insured by Medicaid or uninsured. The Patient Protection and Affordable Care Act (ACA) allocated $11 billion in funds through 2015 to community health centers (CHCs) to grow their capacity. Nurses are essential to the ability of CHCs to provide care to a patient population at higher risk for chronic health problems. This article draws on federal CHC staffing data and CHC growth estimates to examine the nursing workforce challenges that will need to be overcome in delivering care to 20 million new patients.

show abstract

“…One reasonable approach would be to give preference to disciplines that are hardest to recruit into needy areas without external incentives. 31 Another rea- 22.8% of the 10,029 clinician shortages in dental HPSAs. Against these numbers, the NHSC workforce after the Recovery Act period has 54% too few dental health clinicians, 51% too many mental health clinicians, and 13% too many primary care clinicians.…”

Section: Continuedmentioning

confidence: 99%

Growth and Changes in the National Health Service Corps (NHSC) Workforce with the American Recovery and Reinvestment Act

Pathman

Konrad

2012

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

Background: From March 2009 through February 2011, the National Health Service Corps (NHSC) received a $300 million supplement through the American Recovery and Reinvestment Act to grant more loan repayment awards to clinicians who agree to work in underserved areas. This study assesses how this unprecedented funding increase affected the size, composition, and location of the NHSC's workforce.Methods: This was a descriptive, time-linked, observational study using NHSC administrative data. Main outcomes were growth and changes in disciplinary composition of the NHSC's workforce and in its rural/urban and state-to-state distribution.Results: During the Recovery Act period, the NHSC's workforce increased by 156%, from 3017 to 7713 clinicians. Mental health clinicians grew most numerically (210%) and as a proportion of the NHSC's workforce (from 22.7% to 27.4%). Primary care clinicians grew least and decreased as a proportion of the NHSC's workforce to 58.9%; dental health clinicians remained steady at approximately 13.5%. Among individual disciplines, physicians decreased most as a component of the NHSC's overall workforce, from 38.6% to 26.7%, whereas the proportion of nurse practitioners grew most, from 10.1% to 16.0%. Proportions of the NHSC's workforce serving in rural areas changed only modestly. NHSC clinician numbers grew most in states with the lowest NHSC clinician-to-poverty population ratios before the Recovery Act.Conclusions: With Recovery Act funding, the NHSC's workforce become far larger and more diverse than ever and more evenly distributed across states. The NHSC should now set targets and be more deliberate in managing its growth across disciplines and where its clinicians serve. (J Am Board Fam Med 2012;25:723-733.)

show abstract

Shortages of Medical Personnel at Community Health Centers

Cited by 252 publications

References 48 publications

Documentation and Management of CKD in Rural Primary Care

Documentation and Management of CKD in Rural Primary Care

An adequate nursing workforce is essential to health centers and their expected growth under health reform

Growth and Changes in the National Health Service Corps (NHSC) Workforce with the American Recovery and Reinvestment Act

Contact Info

Product

Resources

About