Research Article
The First Year of the COVID-19 Pandemic: Changes in Preventive Services in Community Health Centers

https://doi.org/10.1016/j.amepre.2022.08.023Get rights and content

Introduction

Community Health Centers provide comprehensive primary healthcare services to many underserved populations. It is unknown how routine preventive and chronic care services in Community Health Centers may have changed nationwide during the COVID-19 pandemic.

Methods

The 2014–2020 Health Resources and Services Administration Uniform Data System of Community Health Centers was used, and data analysis was conducted from November 2021 to May 2022. Data for clinical quality measures in 2020 were treated as during the pandemic, whereas receipt of care in 2019 and before were treated as before the pandemic. Outcomes included 6 clinical quality measures of being up to date for colorectal cancer screening, cervical cancer screening, tobacco screening and cessation counseling, BMI screening and follow-up, depression screening and follow-up, and aspirin use for ischemic vascular disease. A mixed effects regression model was used to estimate changes in measures by year.

Results

Between 2019 and 2020, receipt of preventive services declined for each of the 6 clinical quality measures: from 40.8% to 37.7% for colorectal cancer screening, from 48.8% to 44.9% for cervical cancer screening, from 85.8% to 83.4% for tobacco screening and cessation counseling, from 70.7% to 65.4% for BMI screening and follow-up, from 71.1% to 64.9% for depression screening and follow-up, and from 81.5% to 79.4% for aspirin use for ischemic vascular disease.

Conclusions

Receipt of preventive services in Community Health Centers declined during the COVID-19 pandemic for each of the 6 clinical quality measures considered in the study. Immediate action is required to support ongoing high-quality, primary healthcare services in Community Health Centers across the nation.

Section snippets

INTRODUCTION

Community Health Centers (CHCs) play an important role in providing comprehensive primary healthcare services, including preventive and chronic care, to underserved populations, many of whom are uninsured.1,2 Evidence of changes in preventive care among CHCs during the coronavirus disease 2019 (COVID-19) pandemic is limited. According to a small-scale study, approximately 50%–90% of CHCs stopped offering colorectal cancer screening and cervical cancer screening, respectively, during the

METHODS

Data for this cross-sectional study were obtained from the 2014 to 2020 Health Resources and Services Administration Uniform Data System (UDS) as reported nationwide by each CHC that received federal funds under the Health Center Programs authorized through Section 330 of the Public Health Service Act.8 CHCs located in U.S. Territories were excluded from the analysis. The UDS provides information on demographic, clinical, operational, and financial data per CHC. From 2014 to 2020, between 1,278

RESULTS

Table 1 provides descriptive statistics for all covariates in 2014–2018, 2019, and 2020. Covariates were generally similar across the 3 time periods. For example, the proportion of patients aged 18–64 years remained at 62.6%–64.0%, and the proportion of Hispanic patients remained at 26.4%–27.6%. Exceptions to this pattern were the proportion of clinics in urban locations, which increased from 51.5% in 2014–2018 to 57.8% in 2019 and to 58.0% in 2020, primarily driven by an increase in the number

DISCUSSION

In this nationwide study of CHCs during the COVID-19 pandemic, there was a clear decline in 6 clinical quality measures that can serve as proxies for long-term health outcomes.7, 8, 9, 10, 11, 12, 13, 14 The declines in colorectal cancer screening, BMI screening and follow-up, and depression screening and follow-up represented a divergence from improvements observed in previous years, likely related to competing priorities and the urgent and acute needs of the early part of the COVID-19

CONCLUSIONS

Unique declines in all clinical quality measures that diverged from previous trends indicated pandemic-related disruptions in care within CHCs. As practices adapted to the pandemic, there may be evidence of preventive services rebounding more recently.25 However, gaps may persist unless screening rebounds are high enough to mitigate these declines.6 As more years of data are released, future studies to assess interventions that reduce disruptions in the care provided by CHCs will be helpful, as

ACKNOWLEDGMENTS

All authors are employed by the American Cancer Society, which receives grants from private and corporate foundations. The authors are not funded by these grants and are solely funded through the American Cancer Society funds.

XH has received a grant from AstraZeneca for research outside of this study. No other financial disclosures were reported.

CRediT AUTHOR STATEMENT

Jessica Star: Conceptualization, Data curation, Formal analysis, Methodology, Writing–original draft, Writing–review and editing. Xuesong Han: Writing–review and editing. Laura Makaroff: Writing–review and editing. Adair K. Minihan: Writing–review and editing. Ahmedin Jemal: Writing–review and editing. Priti Bandi: Conceptualization, Supervision, Writing–review and editing.

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