ORIGINAL RESEARCH
Mackenzie L. Costello, MSN; Katherine M. Winter, MSN; Conor M.C. Duffy, PhD; Rebecca S. Etz, PhD; Kurt C. Stange, MD, PhD
Corresponding Author: Mackenzie Costello, MSN; The Catholic University of America School of Nursing.
Email: costellomac@cua.edu
DOI: 10.3122/jabfm.2025.250464R1
Keywords: Access to Primary Care, Community Health Centers, Community Medicine, Health Workforce, COVID-19, Health Disparities, Pandemics, Primary Health Care
Dates: Submitted: 12-08-2025; Revised: 02-10-2026; Accepted: 02-23-2026
Status: In Press.
PURPOSE: Community Health Centers (CHCs) are vital for delivering primary care, dental, and behavioral health services to vulnerable populations in the US. This study aims to identify sustainable and responsive insights and innovations for primary care by investigating how CHCs transformed care delivery and workforce strategies during and after the COVID-19 pandemic.
METHODS: Semi-structured qualitative interviews were conducted with 41 staff members from seven primary care CHCs in the OCHIN national health center network across five states from 2022-2025, exploring changes in organizational operations and workforce dynamics during and after the pandemic.
RESULTS: Three themes emerged from significant shifts in CHC care delivery and workforce management occurring during the pandemic: 1) rapid restructuring of healthcare delivery; 2) pandemic-driven practice change; and 3) diverse impacts on patients and clinicians. Pandemic adaptations included flexible scheduling, enhanced mental health supports, and strategic furloughs, which effectively mitigated burnout and improved staff retention. Telehealth, patient portals, and remote monitoring expanded substantially, improving patient access. Social barriers initially intensified but stabilized by the end of the pandemic. CHC staff reported high fulfillment from flexible care models, strong team cohesion, and meaningful patient relationships, despite persistent challenges such as staffing shortages and digital infrastructure gaps. These challenges, however, were often outweighed by a strong sense of mission-driven care.
CONCLUSIONS: Adaptable strategies prioritizing workforce well-being and equitable access are perceived as both impactful and sustainable. Continued integration of pandemic-era innovations holds potential for fostering more resilient primary care for underserved populations, enhancing CHC stability and access to care.