COMMUNITY ORIENTED PRIMARY CARE COPC Cynthia Thomas MD

COMMUNITY ORIENTED PRIMARY CARE (COPC) Cynthia Thomas, MD Tracey Smith, PHCNS-BC, MS

What is our current health care practice in the US?

So is this working? � � Cost? Life expectancy? Rank in world in healthcare? Infant mortality?

Why? � � Those not in the room are excluded from care! So if not in room- why not in room? � Barriers Financial Accessibility Acceptablity Availability Lack of coordination Etc.

So what has made the greatest improvements in health? � � Sanitation Immunizations Preventive health services Not Antibiotics

Coordinated Care � This is often misunderstood. We often think of just the health care providers talking to each other but really: Medical care/Preventive Care Food Shelter

So your schedule is full so you must be caring for your community! � Well your schedule is full of runny noses- how do you reach those without those runny noses?

So what is COPC? IT IS NOT ONLY CARING FOR THE PATIENT IN THE ROOM! IT IS CARING FOR THE PATIENT NOT IN THE ROOM!

Primary Care PUBLIC HEALTH Community

Is primary care COPC and do you have to be a primary care provider to do COPC? It can be practiced in a number of settings (hospitals, public health departments, health centers, academic centers, etc. ) COPC is a means to empower a community to address selected problems using a logical, systematic approach.

Complementary Functions of Clinical Care and COPC CLINICAL: INDIVIDUAL Examination of patient Individual diagnosis (subjective and objective) Treatment Monitoring therapy COPC: POPULATION Community Survey Community Diagnosis (qualitative and quantitative) Treatment Evaluation

Community Medicine? � � Free online dictionary by Farlex: “Community medicine: public health services emphasizing preventive medicine and epidemiology for members of a given region” Reference MD: “Community Medicine: A branch of medicine concerned with the total health of the individual within the home environment and in the community, and with the application of comprehensive care to the prevention and treatment of illness in the entire community”

Facets of COPC � � � � Public health School health Environmental health Epidemiology Agencies on aging Business coalitions for health Primary health care providers

Topics of COPC � � � � � Assessment of risks for abuse, neglect, and family and community violence Reportable communicable disease Population epidemiology and the interpretation of public health statistical information School health Environmental illness and injury Immunizations Disaster responsiveness Community based disease screening, prevention, health promotion Factors associated with differential health status among subpopulations Occupational medicine

The COPC Process � � � Step 1: Step 2: Needs Step 3: Step 4: Step 5: Define the Community Characterize the Community’s Health Identify Community Health Problems Develop Intervention Monitor Impact of Intervention Rhyne et al

Define and involve the community example � A community meeting defines the community �A community health center defined its community as the southern end of the county and used radio, tv, etc. to advertise a community meeting on local problems. � People came from northern parts of the county as well. � Because of this the staff changed their community to be countywide.

Define the problem (use both subjective and objective data too) example � Problem changes from teen pregnancy to lack of prenatal care �A rural, Hispanic community organized a COPC process and was led by the medical practice who wanted to address teen pregnancy (considered the biggest health problem facing the community) � After searching data they found that teen pregnancy for the community was actually lower than for the county and state. What they found was the prenatal care was much lower than the state as whole. � They changed the problem to focus from teen pregnancy to prenatal care among pregnant teens.

References � � � Rhyne, R. Bogue, R. , Kuklka, G. , and Fulmer, H. Community-Oriented Primary Care: Health Care for the 21 st Century, 1998. Community Needs Assessment of Lower Manhattan Residents Following the World Trade Center Attacks- Manhattan, New York City, 2001. Jama. 2002, 288: 1227 -1228. Demasio, K. The complexity of finding solutions to reducing racial/ethnic disparities in health care outcomes. Public Health Reports, July. August 2003, Volume 118: 338 -348.