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Specialty-care access for community health clinic patients: processes and barriers

Authors Ezeonwu MC

Received 26 September 2017

Accepted for publication 4 January 2018

Published 22 February 2018 Volume 2018:11 Pages 109—119

DOI https://doi.org/10.2147/JMDH.S152594

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser


Mabel C Ezeonwu

School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, USA

Introduction: Community health clinics/centers (CHCs) comprise the US’s core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge.
Materials and methods: In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients’ access to specialty care. Analysis of data was done using content analysis.
Results: The process of coordinating care referrals for CHC patients is complex and begins with a provider’s order for consultation and ends when the referring provider receives the specialist’s note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic–hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients.
Conclusion: Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care.

Keywords: community health clinics and centers, access to healthcare, barriers to health care access, specialty-care referral process, care coordination, safety-net, undeserved populations, health care system, vulnerable populations, affordable comprehensive health insurance

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