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COPC ant! a State Health Department: West Virginia's Experience ~ Clark Hansbarger The West Virginia Department of Health has become a strong advocate of what we are today calling community oriented primary care (COPC). The department has been influenced to move in this direction by a variety of internal and external sources. Included in these sources are the two most recent directors (of which I am one), the community "wants," community health needs, federal community health programs, United Mine Workers of America-supported clinics, community boards of directors, the state legislature, and Governor John D. Rockefeller IV. One major result of these influences was the law passed by the state legislature in 1977 that reorganized the departments of Mental Health, Hospitals and Public Health into a new State Department of Health. The purpose of the law is "to develop and implement a coordinated and com- prehensive continuum of health and mental health services to meet current and future needs at reasonable costs; to promote the delivery of preventive care by emphasis on primary care and community-based services; tO achieve equal access tO all types of quality care for all citizens of the State; to encourage the active participation of the citizens of this State in matters relating tO the delivery of health and mental health services...." With this visionary statement, the state legislature provided the State Department of Health with a mandate for its emphasis on COPC. This set of inputs, combined with the knowledge, dedication, and values that each employee brings to the State Health Department, have resulted in an identifiable set of values and management norms that this administration intends to pursue. They are: 222

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COPC and a State Health Department 223 1. Health services should be comprehensive, coordinated, and inte- grated. 2. The least restrictive mode of care is the best. This norm is especially applied to developmental disabilities and geriatric care, but covers the con- tinuum of health services delivered and funded by the department. 3. Health care services should be community-based, and are best planned, organized, and delivered at the community level. 4. Health services should be responsive to epidemiologically defined community needs. 5. Community health services should emphasize prevention, wellness, and the reduction of the risk factors that are linked to the three major killerscancer, heart diseases, and accidents. 6. The process used in helping communities and medical practices be- come more responsive to broader health needs should be an educative/ .. . . mediative process, not a coercive one. The continuing role of the State Health Department is not so much to actually provide COPC services as it is to create a positive climate conducive to the provision of those services. Through direct communication to pro- viders and consumers we affect the knowledge, attitudes, values, and per- ceptions of both providers and health care consumers. Our work with liaison groups from various health care sectors, public health education for con- sumers, and our commitment to grass roots health planning help maintain open channels of communication and help establish the department's values and operating norms in the public mind. Through training and community organization, the State Health De- partment affects availability of resources, accessibility, referrals, and skills. In this regard, West Virginia has recently demonstrated its commitment to funding community-based health care programs by the state legislature's providing more than $1 million in new matching funds for the Primary Care Block Grant, which it expects to assume in October 1982. Statewide training programs, technical assistance programs, and conferences are also important activities in affecting these factors. The department also promotes COPC by affecting the attitudes and behavior of health personnel and employers. The importance of attitudes and behavior of State Health Department staffs cannot be overemphasized, and the formal and informal organizational structure can and does influence those attitudes. In looking for behavioral outcomes for the department's activities in COPC we may assess utilization, preventive actions, consumptive patterns, compliance, and self-care within the dimensions of earliness, frequency, quality, range, and persistence. Defining the standards against which to

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224 PART II: PRACTICAL APPLICATIONS measure these indicators presents another challenge, but changes or ex- ceptions from established patterns could be easily noted. The outcome of these behaviors is, hopefully, an improvement in the health problems facing our communities. Some of these problems are re- flected in our current statistical reporting systems, and these systems could be refined to indicate morbidity, mortality, fertility, and disability within the dimensions of incidence, prevalence, distribution, intensity, and dura- tion. Improvement in these areas, not just statistically but in the everyday lives of people, makes for an improvement in the "quality of life." It is this translation of health services into quality of life terms that is our most important and perhaps difficult task. In the future the West Virginia Department of Health hopes to hold the line on the advances we have made so far. That in itself is a fairly large order in these times of economic retrenchment. We will try to improve and strengthen the incentives offered to providers who have practiced COPC and support their efforts in practical ways. We can also offer high- quality technical assistance in the epidemiology of community health prob- lems that public and private health providers observe daily. By providing relevant support and encouragement of COPC, we hope to make COPC the standard of care for West Virginia.