Prevention – Community Oriented Primary Care

Question 12:

One model of health service that integrates clinical primary care with public health to deliver continuous targeted and prioritized services to a defined population is known as Community-oriented Primary Care (COPC).

Which one of the following examples of community health interventions most closely follows the principles of COPC?

  1. The New York City Department of Health (NYC DOH) has decided that the community of Harlem (as defined by zip code) has a significantly higher rate of HIV infection prevalence than the rest of the city. They will institute a mass mailing of HIV prevention reading materials to all residents of the zip code. The NYC DOH located culturally sensitive materials for distribution. They plan to re-measure the HIV prevalence rate in Harlem one year after the mailing.
  2. A public hospital clinic in Stamford, Connecticut has decided that annual rate of emergency room visits for pediatric acute asthma attacks is unacceptable. The hospital has decided to conduct asthma education courses in local area public schools to raise awareness. They plan to re-measure the rate of emergency room visits for acute asthma attacks after one year.
  3. A group of medical students look up census and health data for the local Washington Heights neighborhood. The students find that adult flu and pneumococcal vaccination rates in Washington Heights are below New York City target levels. The students conduct community surveys and focus groups and find that community members are also concerned about this surprising data. The students partner with a local community agency to form a consortium. The consortium sends a student – community member team to local businesses, churches, and community centers to conduct vaccination education talks and distribute bilingual handouts. The students and the agency intend to re-measure the adult vaccination rates in one year and make adjustments to their initiative if there is not an optimal outcome.
  4. A local community clinic in Tempe, Arizona found that obesity rates within its local 10 block radius are significantly higher than the state norms. The clinicians and nurses decide to conduct free exercise and yoga courses at a church hall across the street. 20 people attend the weekly sessions at first, but by the third week the attendance is low. The clinic group changes the site of the courses to a local community center to see if that will improve attendance.

Show/hide answer

In this approach to preventive care, community involvement and participation are essential. For COPC clinicians, disease prevention and health promotion is not limited to individual patients but should be extended to the community in which they practice.

Adapted from Iliffe and Lenihan, 2003
There are essential steps to develop a true COPC initiative:

1. Define the community

Identify the targeted population by collecting relevant demographic, historical, political, cultural, and economic data. Although there are several limitations to the data, some of this information may come from the U.S. Census Bureau – or from local or state agencies.

2. Identify the health problem

Identify the health needs of the target population (“community diagnosis”). This is done by reviewing local and national databases for socioeconomic, demographic, and morbidity and mortality rates. Health issues in the target population that are out of proportion to the national distribution should be benchmarked. One example of this data is the New York Department of Health and Mental Hygiene “My Community’s Health” website.

3. Prioritize health needs

Conduct neighborhood surveys and focus groups to enable community participation in prioritization of which health issue(s) to address. Include community members on the oversight team that makes final decisions on setting priorities.

4. Implement appropriate interventions to address the health need(s)

Involve community members in implementation by including community members on the teams overseeing and deploying the intervention. This may involve training community members in specific skills (human resource management, health education, etc.) or the formation of partnerships with existing community agencies and resources (e.g., Alianza Dominicana in Washington Heights, Geel Clubhouse in the South Bronx, Native American Tribal Councils at the Indian Health Service sites, etc.). Interventions might include healthy school menus, worksite injury prevention programs, community garden development, vocational training for at-risk youth, or campaigns for changes in local environmental policy (e.g., limiting school bus idling and exhaust, moving waste transfer stations or dumps).

5. Evaluate the impact of intervention(s)

Maintain ongoing surveillance, evaluation, and assessment of the outcomes of the COPC program. Train and/or partner with community members to include them on surveillance, evaluation, and assessment team.

6. Modify future intervention(s)

based upon evaluation and reassess outcomes.

The COPC cycle applies an adaptation of the individual patient clinical model (history, physical, assessment, and plan) to a community.

<< Prevention – Socio-ecologic Framework

Access to Preventive Care and Quality of Outcomes >>