Administrative impacts on selected primary health care centers

Poverty and ill health have long been recognized as a major focus of community concern and action in the United States. The prevalence of disease among the poor and the inadequacy of the health care generally available to them have at various times spurred efforts in providing them access to health care. From the dispensaries of the l8th century to the current community primary health care centers, programs and facilities have been established in response to meeting the health care needs of the poor.

The purpose of this study was to provide data regarding administrative impacts on the operation of primary health care centers in East Tennessee. 1 The data were gathered by means of a questionnaire administered to directors of the primary health care centers. Usable responses totaled l00 percent.

Three research questions were developed for this study. The questions and brief summaries of their answers are as follows:

1. Are there administrative impacts which are common to a majority of the primary health care centers?

Analysis of the data revealed that 17 of the 24 administrative areas included in the study posed problems which were common to a majority of the participating centers. Of these, record keeping, relations with government organizations, and iv

employee orientation posed difficulties to more centers than any other category, being respectively reported by l00 percent of the clinics. Other areas that impacted on the administration of a majority of the centers included meeting demand for services, determining manpower needs, recruitment, training, community agencies, and patient fees. 2. Are there administrative impacts which are disruptive to the service functions of centers?

Findings showed that each administrative area included in this study posed major problems, that is, problems which have been disruptive to the service functions of centers. Five of these areas are specially noteworthy, as they had been disruptive to the service functions of a majority of the participating centers. Recruitment was a major impact on over eight-tenths of the centers, and record keeping had led to disruptive difficulties in over three-fourths of the programs. Relations with government organizations, employee turnover, and professional community had been major impacts on over one-half of the centers. 3. Do administrative impacts which may be disruptive to the service functions of centers vary in regard to selected characteristics of centers? These characteristics are clinic type, administrative structure, ownership, demographic location, and policy-making body. Findings of this study indicated that there were administrative problems which tended to vary with respect to selected characteristics of centers. Some noteworthy findings are as follows: a relatively small percentage of group practice clinics experienced major impacts in most of the areas studied, and a relatively large percentage of the clinic federation experienced major difficulties in the areas of external relations and general administration.

The gap in knowledge with respect to administrative impacts on primary health care centers in medically underserved and economically depressed areas in East Tennessee and a nearby Kentucky county extends far beyond the scope this study. However, it is hoped that the findings in this study will offer incentive and provide aid to other researchers in the conduct of future study. The need for such research is urgent not only in determining why administrative difficulties exist, but also in offering possible remedies before patterns of practice become solidified.