Community Oriented Primary Care New Directions for Health Services Delivery (1983) / Chapter Skim
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Community Oriented Primary Care: Lessons Learned in Three Decades
Community Oriented Primary Care: Lessons Learned in Three Decades
Pages 6-18
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From page 6... ...
Three of these practices were domestically initiated: the first on the Navajo Indian Reservation; the second in Martin County in Kentucky's Appalachian area; the third in the inner-city East Harlem section of New York City; and the fourth, now in the early development stage, in the Dominican Republic is international. These efforts span 27 years of work in these four different areas and, together, they illustrate many of the principles of community oriented primary care (COPC)
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From page 7... ...
and the Navajo tribal government to obtain help from a university academic medical center to improve the Navajo health care system and make it more responsive to the needs of the Navajo nation. Expectations ran high for quantum jumps in health care improvements.
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From page 8... ...
This barrier was tackled from two sides. The Navajo community health workers were given extensive education and training in medical interpretation, through the team efforts of a Navajo nurse and linguistic experts, with frequent monitoring of ongoing medical interpretation problems.
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From page 9... ...
In addition to annual census and demographic studies, epidemiologic surveys, analyses of patient care utilization, and nutrition studies, a variety of other relevant studies were carried out periodically.8 It was soon documented that the primary care problems seen in the clinic were, for the most part, preventable and that overall improvement in the health picture would require major work in health education and health promotion as well as improvement in socioeconomic levels. The extensive academic field research conducted in the Navajo example was considered vital to the tribal/USPHS health planners.
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From page 10... ...
On completion of this tuberculosis project, the community sought help from the UKMC in establishing a modern primary care practice program.~° They obtained a federal grant to construct a clinic building. A University of Kentucky Medical School graduate, born and raised in the county adjacent to Martin County, had worked with the TB eradication team during his junior and senior years of medical school.
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From page 11... ...
I can only speculate as tO what factor or factors produced the fatal flaw in this COPC practice. CASE #3: 1970-Present The Boriken Neighborhood Health Center, East Harlem, New York Mount Sinai School of Medicine became operational in 1968.
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From page 12... ...
The staffing emphasis is placed on nurse practitioners and community health workers. A full complement of physicians, dentists, nurse practitioners, dental hygienists, psychiatric social workers, health educators, nutritionist, nurse midwives, and appropriate M.D.-specialist/consultants round out the professional health care team.
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From page 13... ...
Therefore, the involvement of academia in providing technical assistance in this Caribbean setting provides yet another challenge in constructing a COPC delivery system. Certainly our past experience in rural and urban health settings in the United States offered the Mount Sinai academic group a basis for developing this private enterprise COPC model.
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From page 14... ...
The evolution of the plan thus comes out of local staff effort with the technical assistance of the Mount Sinai health planners. It is too early tO say that the La Romana health system now being put into place will be the appropriate model for COPC practice.
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From page 15... ...
development of a cadre of local community health workers to assist the professional staff in outreach activities. There are obviously many significant barriers to the development of COPC practices.
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From page 16... ...
The political dynamos within the practice and forces in the local community, as well as broader political, economic, and social changes, all impact on the COPC practices and make them highly vulnerable. It is important to examine the potential of experimenting with the COPC practices in the more affluent sectors of our society.
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From page 17... ...
Mount Sinai School of Medicine, New York.
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