Barriers and Strategies for Specialty Care Access through Federally Qualified Health Centers: A Scoping Review

Federally qualified health centers (FQHCs) provide health care to vulnerable patients with limited resources. We conducted a scoping review on barriers to specialized care and strategies implemented by FQHCs. We searched PubMed, CINAHL, Health Business FULLTEXT, and Web of Science databases. Barriers and success measures were categorized based on the Donabedian framework of structure-process-outcome. We conducted a thematic analysis of identified strategies using Arksey and O'Malley's framework for scoping reviews. Across 19 articles, the most common patient-level barriers were cost and insurance status. The most common system-level barriers were wait time and office accessibility. Six themes emerged from the analysis of strategies, identified across 46 articles: 1) virtual consults, 2) substitution, 3) referral coordinators, 4) network-building, 5) on-site specialty care, and 6) algorithmic screening. Strategies to increase specialty care access via FQHCs do not necessarily align with the most commonly documented barriers. Instead, strategies are highly dependent on clinic context.