Community Oriented Primary Care A Practical Assessment, Vol. 2: Case Studies (1984) / Chapter Skim
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Introduction to the Case Studies
Introduction to the Case Studies
Pages 1-16
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Although originating under different names, several COPC models have been evolving in the United States for many years. Within the public sector, community health center programs, which grew out of the original Neighborhood Health Center experiment of the Office of Econamic Opportunity, provide primary care services to medically underserved populations.
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There is a sizable body of literature examining prima ry care, comprehensive care, community health care, the role of the community in planning and managing health programs, and the community health centers. This literature is supportive but somewhat peripheral to the central purposes of this study.
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. a practice or service program actively engaged in primary care · a defined community for which the practice has accepted responsibility for health care a process by which the practice, with the participation of the community, identifies and addresses the major health problems of the community; the process includes the following functions: · defining and characterizing the community · identifying the community's health problems · modifying the health care programs in response to the community's identified health needs · monitoring the impact of the program modifications.
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In the context of COPC, it is useful to view the community as a denominator, in the epidemiologic sense, which consists of subsets or numerators, the most important of which is that group of individuals in the community who are active users of the health care system. Thus, primary care outside of the COPC model strives to provide its active patients (the ~numerator.
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The major requirement and the criterion that separate orthodox primary care (stage O) from the higher stages of COPC development is that the methods employed are directed toward a denominator population that is consistent with the community for which the practice has accepted responsibility.
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STAGE III: The cam unity can be enumerated and is actively characterized through the use of a data base that includes all members of the community, and that contains information to describe its demography and socioeconomic status. (Often such a data system is constructed over time from the active users of services, but approximates the community closelY, e.g., at or above 90 percent coverage of the community.)
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Identifying Community Health Problems The second function in the COPC process is identifying the major health problems of the community, characterizing their determinants and correlates, and setting priorities among them. AS in the previous function, the criterion that separates orthodox primary care (stage 0)
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STAGE II: Community health problems are identified by extrapolation from systematic review of secondary data, such as vital statistics, census data, large area epidemiological data, etc. STAGE III: Community health problems are examined through the use of data sets specific to the community, but perhaps focusing on single health problems or health care issues.
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For most health problems, modif ication in the primary care program alone would be inadequate and thus the practitioner would advocate appropriate modification in other local community/public health programs. There being very few instances in which all components of the health care program for a community are under a single governing structure, the function probably will require a great deal of cooperation among programs.
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STAGE II: Modifications address important community health problems, but are chosen largely due to the availability of special resources to address that particular problem, and closely follow guidelines that may not be tailored to the community needs. STAGE III: Modifications in the health care program are tailored to the unique needs of the community and involve (where appropriate)
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While better than focusing on active patients, this approach suffers from lack of rigor and questionable validity of the results. A possible exception is when the health problem being addressed includes issues of the acceptability of the health care program to the community.
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STAGE IV: Program effectiveness is determined by techniques that are specific to the program objectives, account for differential impact among risk groups, and provide information on the positive and negative impacts of the program. assess the effectiveness of the program modifications.
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A practice population defined in this manner has several of the characteristics that make it a particularly well suited for the COPC process: the ca~u.`unity is not by def inition limited to active users of primary care services the households are entities with health problems that af feet all household members, but do not necessar fly reside wholly with any single member (e.g. , environmental hazards, poor family dynamics, etc.
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COPC also is a quality assurance activity but has an added concern for a broader community consisting of nonpatients as well as active users of primary care services. The COPC process strives to assure that the primary care services system is directing its primary care capability toward the health problems that are most important for the health of the overall community, including both ~users.
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1981. Cononunity~Oriented Primary Health Care.
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