Primary care in an underserved rural area: the Goodlark experience in Middle Tennessee

With the assistance of Federal funding and three National Health Service Corps physicians, the Goodlark Rural Health Care System was established during the first 8 months of 1979 in a four-county, medically underserved area of Middle Tennessee. Four primary care clinics and a health screening and weight reduction clinic were initiated, and efforts were made to make the clinics responsive to community needs and complementary to existing area resources.A study of the results of these efforts through December 1981 showed that community acceptance, measured by patients' use of the clinics and satisfaction with the services provided, was generally high; however, one of the small primary care clinics was closed after 1 year because of a continuing decline in patient visits. Many patients continued to follow former patterns of reliance on larger centers for specialized care (and occasionally primary care), using the Goodlark clinics primarily for convenience.The primary care clinic that provided the most comprehensive services and that represented an expansion of an area physician's family practice showed a continuing increase in the number of new- and return-patient visits during the period of the study. Indeed, this clinic generated revenue sufficient to support the remaining clinics in the system, allowing Federal funding to be discontinued. The health screening and weight reduction clinic, however, met with poor community response.Acceptance of nurse practitioners by patients of the primary care clinics was high, and the Goodlark experience suggests that these practitioners may be the most cost-effective providers of primary care in more sparsely populated areas.Innovations in health planning must take into consideration local community factors and previous patterns of health care in order to complement existing health resources. Findings with respect to the Goodlark experience may be worthy of consideration by health planners in other localities.