Just One-Third of FQHCs Offer Vision Services. And There Is This Problem

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Researchers find a mismatch between demographics of the neighborhoods where the FQHCs with vision care are located and those using the vision services.

The number of people who received healthcare at federally qualified health centers (FQHCs) has tripled since 2000, and roughly 1 in 11 Americans use them as their “medical home.”Federal rules require FQHCs require the centers to provide primary healthcare services but eye care is not included in that definition.

Research results reported recently in the journal Ophthalmology showed that approximately one-third (432%) of FQHCs provide vision care but those that do are concentrated in a handful of states, namely Massachusetts, California and New York.

First author Maria A. Woodward, M.D., M.S., of the Department of Ophthalmology and Visual Sciences at the University of Michigan, and her colleagues also found that although the centers that offered vision services were more likely to be in neighborhoods with a higher percentage of Hispanic individuals, people with Medicaid coverage and no car than the centers without vision services, those with vision services served a lower percentage of Hispanic individuals, people with Medicaid coverage and those living at or below 100% of the federal poverty line. They called that finding “paradoxical.”

This finding, they say, shows that “expanding FQHCs into medically underserved areas does not ensure that patients in those specific neighborhoods will utilize care. “ They suggest that using the social work infrastructure of FQHCs to address social needs and integrating that vision referrals into that infrastructure could increase the utilization of eye care. They add that community outreach has been shown to engage people of color and those with lower socioeconomic status in eye care.

The lack of eye care for people in disadvantaged circumstances is concerning because, as Woodward and her colleagues point out, social risk factors and the risk of severe manifestations of eye health are linked. In short, there is even greater need for eye care in the populations served by FQHCs.

The proportion of FQHCs that offer vision care has been slowing increasing, they note. In 2009, just 19% of centers offered vision services. By 2017, that proportion had increased to 28.5% and in 2021, it was 32%. They found that among the 435 FQHCs that provided vision care in 2021, 118 (27.1%) had added vision care between 2017 and 2021.

Vision care accounts for a small proportion of the services provided by FQHCs: Just 2.6% of the people who used FQHC services received eye care.

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