Association of Primary and Specialty Care Integration on Physician Communication and Cancer Screening in Safety-Net Clinics

In the USA, community health centers (CHCs) provide primary care to racially/ethnically diverse and economically disadvantaged populations. However, CHCs have historically reported difficulty accessing specialty care for their patients. Primary care providers who lack reliable referral relationships with specialists may be less likely to conduct cancer screenings. Thus, this US study aimed to describe strategies CHCs use to integrate care with specialists and examine whether primary care providers with relationships with specialists have higher rates of screening for colorectal and cervical cancers and report better communication with specialists. Integration strategies commonly reported by CHCs included having specialists deliver care on-site (80%) and establishing referral agreements with specialists (70%). CHCs that were most integrated with specialists had 5.6 and 6.8 percentage-point higher colorectal and cervical cancer screening rates, respectively, than the least integrated CHCs. They also had significantly higher rates of knowing that specialist visits happened, knowing visit outcomes, receiving information after visits, and timely receipt of information. These results suggest that efforts to promote CHC/specialist integration may help increase rates of cancer screening.

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