Variation in Local Health Department Primary Care Services as a Function of Health Center Availability

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We aim to gain a clearer understanding of the effect of colocated federally qualified health centers (FQHCs) on the delivery of primary care and preventive services by local health departments (LHDs).


We collected data from the 2010 National Association of County & City Health Officials Profile of Local Health Departments, the 2010 Uniform Data System, and the 2011 Area Resource File.


Forty-eight states, excluding Rhode Island and Hawaii.


The analytic sample contained data on 2107 LHDs across the country.

Main Outcome Measures:

We modeled 4 measures of primary care activity for each LHD: provision of screening for (1) heart disease, (2) diabetes, and (3) hypertension, and (4) provision of comprehensive primary care.


Local health departments in counties with an FQHC grantee have, on average, 32% lower odds of providing hypertension screening, but having an FQHC grantee in the county does not influence LHDs' primary care provision or screening for heart disease or diabetes. However, in an alternate model examining FQHC delivery sites per capita, each site is associated with a decrease in the odds of LHDs providing primary care (4% lower odds) or screening for heart disease (2% lower odds), diabetes, or hypertension (both 1% lower odds).


Local health departments are more involved in disease screening than the provision of primary care. However, larger LHDs are more likely to provide both screening and primary care. Our current study provides evidence that the availability of an FQHC in the same county as an LHD partially explains the variation in LHDs' provision of primary care services. Local health departments with colocated FQHCs can focus on more traditional public health activities, while LHDs in areas without an FQHC may find that ensuring access to care is more challenging, possibly leading LHDs to directly provide primary care services.

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