摘要：Objectives. We examined primary care and public health activities among federally funded health centers, to better understand their successes, the barriers encountered, and the lessons learned. Methods. We used qualitative and quantitative methods to collect data from 9 health centers, stratified by administrative division, urban–rural location, and race/ethnicity of patients served. Descriptive data on patient and institutional characteristics came from the Uniform Data System, which collects data from all health centers annually. We administered questionnaires and conducted phone interviews with key informants. Results. Health centers performed well on primary care coordination and community orientation scales and reported conducting many essential public health activities. We identified specific needs for integrating primary care and public health: (1) more funding for collaborations and for addressing the social determinants of health, (2) strong leadership to champion collaborations, (3) trust building among partners, with shared missions and clear expectations of responsibilities, and (4) alignment and standardization of data collection, analysis, and exchange. Conclusions. Lessons learned from health centers should inform strategies to better integrate public health with primary care. The Health Center Program, administered by the Bureau of Primary Health Care in the Health Resources and Services Administration of the US Department of Health and Human Services, provides funding for primary and preventive health care services for almost 20 million patients each year. 1 Health centers (HCs) provide a safety net for the nation’s medically underserved populations, such as the uninsured, the poor, racial/ethnic minorities, homeless persons, migrant and seasonal farmworkers, and public housing residents. 2 Previous research has documented that HC quality of care is comparable to or better than that of other primary care providers and that HCs help reduce health care disparities. 3–5 HCs also have a recognized history of community involvement and empowerment that facilitate integration of their primary medical care services with public health activities to affect the social determinants of health and well-being. 6–12 Despite this history, few systematic descriptions and assessments of such efforts exist. More efforts are needed to illuminate how the safety net system can be organized to address the public health needs of the nation’s most vulnerable populations. 13,14 We therefore conducted a cross-sectional study to highlight the successes of several exemplary HCs in integrating primary care and public health, identify barriers to success, and offer lessons learned that might enlighten other HCs considering similar integrated programs.
