A National Study of Community Health Centers’ Readiness to Address COVID-19

April Joy Damian; Melanie Gonzalez; May Oo; Daren Anderson

doi:10.3122/jabfm.2021.S1.200167

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Table 1.

Characteristics of Participants Who Completed Surveys Between March 3, 2020 and March 6, 2020 and Who Participated in Focus Groups Between March 10, 2020 and March 17, 2020

	Survey Respondents (n = 234)	Focus Group Respondents (n = 39)
	n (%)	n (%)
Role
Administrative leadership	139 (59%)	18 (46%)
Physician	19 (8%)	9 (23%)
Nurse	30 (13%)	4 (10%)
Medical support staff	46 (20%)	8 (21%)
Region
Northeast	90 (38%)	13 (33%)
Midwest	53 (23%)	12 (31%)
South	44 (19%)	5 (13%)
West	44 (19%)	8 (20%)
Puerto Rico	3 (1%)	1 (3%)

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Table 2.

Top Educational and Resource Needs Endorsed by Participants Who Completed Surveys Between March 3, 2020 and March 6, 2020

	Survey Respondents (n = 234)
	COVID-19 infection prevention and control n (%)	Screening, diagnostic testing, and management of patients n (%)	Safety precautions for patient-facing health care personnel n (%)	Safety planning checklists, including policies and procedures for emergency preparedness n (%)
Role
Administrative leadership	107 (46%)	90 (38%)	99 (42%)	116 (50%)
Physician	15 (6%)	14 (6%)	14 (6%)	17 (7%)
Nurse	22 (9%)	21 (9%)	18 (8%)	24 (10%)
Support staff	35 (15%)	30 (13%)	37 (16%)	42 (18%)
Region
Northeast	72 (31%)	57 (24%)	67 (30%)	77 (33%)
Midwest	41 (18%)	38 (16%)	37 (16%)	44 (19%)
South	32 (14%)	29 (12%)	32 (14%)	36 (15%)
West	33 (14%)	30 (13%)	29 (12%)	39 (17%)
Puerto Rico	1 (0.4%)	1 (0.4%)	3 (1%)	3 (1%)

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Table 3.

Focus Group Key Themes Related to Organizational Readiness to Address COVID-19

Theme	Sample Quotes
Leadership	One of the barriers is conflicting guidance between Delaware Department of Health, CDC, and World Health Organization, which creates internal conflicts since some leaders will follow one, and the others follow another. (Director of Quality Improvement, Delaware) Another barrier is with our finance administrative folks who think from an economic standpoint and if we need to close clinics and let people work from home, they are thinking about a loss of revenue, which is in opposition with the clinical people who are more concerned about the safety of our staffs and patients. (Chief Medical Officer, Illinois) Definitely challenging for us to make sure that leadership is on the same page because our executive directors and medical directors have had different opinions at time so it is really important for us to come together quickly making sure we are considering the health and well-being of our staffs and patients, and for our financial results, how much to charge for telehealth visit. (Practice Manager, Ohio)
Resources	Everybody wants testing and we don’t have the capacity to test everybody. That’s my biggest concern. Because we were in the rural side of the state, we just got the testing materials this week. The fact is everyone with a sniffle wants to get it tested and we don’t have the capacity to do that. (Director of Training and Compliance, Washington) One of the main issues we are having is geographic spread we have across the state. We have clinics that are very small, 2 to 3 rooms and one solo provider or clinician. If we have 1 or 2 to the patients that need to be isolated, that creates a significant reduction in the way that we care for patients. (Vice President of Clinical Affairs, New Mexico) The biggest problem we are having is not having enough PPE. We are running out of masks, and I also know that we are running out of all of the necessary wipes and everything although we have a plan to go to like bleaching water solution for that. Even though the California governor is issuing a million supplies, they are not falling through the system to get to community health centers. (Chief Medical Officer, California) We noticed some of our masks disappear, so we have to put out a notice that even though we know you want to protect yourself and your family, you cannot take health center’s properties and we will take action if anybody does that. (Primary Care Provider, New York)
Workforce capacity	I think it is a lot more stressed for us because we are able to see the deficits that we have in our system and those deficits are rapidly progressing. All of us here are very stressed out and we are adding that on top of the things that we do already every day. (Clinical Educator, Illinois) The other complexity is another health center near us has a significant number of the homeless population in the community, and that center closed in December. So, we still have many of those folks that have not established primary care elsewhere and then they may be showing up in our lobby or at our doorway requesting assistance without having any other route. (Director of Nursing, Michigan) In reality, most of my NPs have babies and multiple kids. When we start thinking about quarantine and women dominated workforce like I have, it’s a huge worry for me….And other organizations, they are just laying workers off and I know I have lots of people who need their pay check and so what are the consequences, how do we keep the money flow so that my employees don’t become part of the economic ripple effect, which ends up impacting the personal life. (Chief Executive Officer, Ohio)
Communication	We never really get communication out to our staffs in a desired time frame. We have a lot of providers, a lot of staff, taking a word of media, from family and communities, rather than realizing that we are the experts in health care. (Director of Training and Compliance, Washington) We implemented basically—for the administration we do a daily brief update on COVID-19, so we are able to make sure that we are standardizing every site here. So, we might have a clinical center director who really goes into details and someone from another site who doesn’t have a clinical background, they might give different messages, so we are using our daily brief to actually standardize the message to everyone across the organization, and I think that’s been very helpful. (Chief Executive Officer, Ohio) Our role as an educator is pretty massive in educating our communities, not all of them are medically educated and so they depend on us for COVID-19 information. We are going to look at how we reach out to our communities differently in the future as well. (Community Health Worker, Michigan) I think communication to the patients—some folks are not understanding fully, with what to do. They come in and they say that they have been in contact with someone who tested positive, and they have no symptoms and they are confused where they can get tested. So, it has been difficult to try to explain to the folks the processes, and I hope that there is the larger testing system coming in place that we can all use. I think that is the biggest piece—making sure that we are educated and the public is educated as well, so giving that consistency across the board has been a challenge. (Director of Facilities, Illinois)
Formal policies and procedures	We have a great big binder that has everything everyone wants to know, and quite honestly it didn’t help much at all in the preparation for this. So, having plans and policies sit on the shelves, I think we probably did ours, you know, 10 years ago, and you know with everything else we are all working on, it becomes less of the priority. So that we have to plan, which really is not much help, but we have to do everything from inventory and find out where all our supplies were, start pretty much from scratch. (Director of Clinical Best Practice and Education, New York) I am really struggling to find a written triage protocol to help providers and nurses decide in a situation like this. It seems like we are having to update our policies daily because the situation continues to change. And we also have a hard time pinning down the policies about testing. As of last week, we didn’t have any commercially available testing, so we referred and directed anyone to the health department. Today, we got a phone call from the Texas health department that said not to send anyone to the health department. It’s like every 2 days, we need to rewrite our protocols. (Associate Medical Director, Texas) Starting next week, in order to keep our medical staff and other patients healthy, we have established a triage unit outside the buildings to detect any symptoms before they get to the regular population. (Health Educator, Puerto Rico) We are not doing as many face-to-face visits, and employees are going to do home visits. So, we are looking at combined pharmacy delivering meds, home visits, and having maybe medical assistants or community outreach workers going to some of the high need people who don’t have smartphone capability. (Chief Executive Officer, Georgia)