Rapid Synthesis: Identifying the Features and Impacts of Community Health Centres

#Key Messages

Questions

• What are the key features of community health centres?
• What impacts have community health centres had on enhancing client experiences and improving health
• outcomes with manageable per capita costs and positive provider experiences?

Why the issue is important

• Community Health Centres (CHCs) deliver integrated primary care and social services and programs within communities who experience systemic barriers to care.
• CHCs can also address and provide support to underserved populations by coordinating efforts related to social determinants of health (e.g., housing, employment and nutrition).
• However, there is a need to better understand how CHCs can be effectively integrated into a coordinated delivery system.
• There is a need to identify features of CHCs, and the impact of CHCs on enhancing client experiences and improving health outcomes with manageable per capita costs and positive provider experiences.

What we found

• We identified three systematic reviews (which were assessed as being of low, medium, and high methodological quality) and 37 primary studies, which we supplemented with information from websites of relevant stakeholder organizations such as the Canadian Association of Community Health Centres.
• The Canadian Association of Community Health Centres indicates that “CHCs are multi-sector, not-forprofit organizations” that share five core attributes:

1.  providing team-based interprofessional primary care (involving clients, providers, allied health professionals, patient navigators, and others who connect health and social services in the community);
2. integrating the provision of a diverse array of health and social services (including health-promotion programs, disease prevention and management, and services to address social determinants of health);
3. being community centred (integrating community partnerships and community-elected governance within CHCs);
4. addressing the social determinants of health (supporting clients to help address different needs such as access to housing, food security, education, and/or language barriers); and
5. committing to health equity and social justice (advocating for systemic changes to reduce health disparities and providing culturally appropriate services).

• We found that CHCs enhanced patient experiences and increased satisfaction in the delivery of care, especially when there was a positive relationship between patients/clients and providers.
• CHCs helped address health-equity issues among underserved populations (e.g., LGBTQ+, Indigenous peoples, new immigrants, youth, and individuals with severe mental illness or physical conditions), and increased engagement with screening programs, cardiovascular-disease prevention, and management of chronic conditions such as diabetes.
• The literature indicated that CHCs are found to have lower costs of care and provide cost savings to health systems.
• A supportive work environment with shared values of advocacy and equity were described when discussing the perceptions of staff at CHCs, but there were mixed findings related to fairness in decisionmaking processes in CHCs, specifically for nurse practitioners and family physicians (e.g., in relation to decisions from administration about services and programs in CHCs).