Community-Oriented Primary Care: A Framework for Service Learning?

Historical Context of COPC Merge medicine and public health Community responsive systems of care Medicine/Public health initiative Preventive medicine and COPC

The Beginning • Sidney Kark, MD and Emily Kark health center in Pholela, South Africa (1942), • Developed a unique marriage of public health and clinical care • Beginning of the concept of COPC requiring multidisciplinary, team practice • Karks developed three COPC principles: – define the community – practice with the community – develop monitoring, evaluation and research.

• Applied model to syphilis and nutrition in Phoela • With imposition of official apartheid Karks could no longer practice COPC and appropriate health care in South Africa and immigrated to Israel

Susser, M. (1999)

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Parallels between Clinical Care and COPC Clinical Care

Step

COPC

Who is the patient?

1

Define and characterize the community

Engage the pt.; Initiate PAPt. Relationship

2

Involve the community; initiate communityprofessional relationship

Differential Diagnosis

3

Conduct community diagnosis; prioritize issues

Treatment

4

Develop and implement intervention

Follow-up: Is the pt. Improving?

5

Monitor and evaluate

Operational Model for COPC •Step 1: Define Community •Step 2: Involve Community •Step 3: Identify Community Health Problems •Step 4: Develop Intervention •Step 5: Monitor Impact of Intervention: Evaluation

COPC Cycle

O'Connell, 2008

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Defining and Characterizing Community • Community vs. populations • History of community • Multiple communities to which health care system might relate • Importance of definition of community in developing and implementing successful programs • Ways in which official health agencies view community and each other

Involving the Community

Empowerment • • • •

Listen to community leaders and others Create a structure of participation Create a visioning process Gather data on perceptions, needs and resources

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Methods of Gathering Data • Social environment map • Interviews • Questionnaires or surveys – Windshield survey – Choose sample population

• Focus groups

Community Problem Prioritization Techniques Brainstorming Nominal Group Technique Problem Analysis Action Planning

Identifying Level of the Health Problem • • • • • • • •

Community Age groups Population at risk Population with potentially modifiable risk Condition present but asypmtomatic (screening) Disease/Injury/Condition Complications Death

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Evaluation

Assessing the Project • Evaluation levels – – – – –

Individual Program Institution Community Policy

• Process evaluation measures – Knowledge/skills acquisition – Participant satisfaction

• Outcome evaluation measures – Impact on community – Policy implications

Levels of Evaluation Evaluation Levels

Process Evaluation Measures

Outcome Evaluation Measures

Policy

Document: policy discussions, media attention, lobbying efforts

Actual change in policy

Structural/Organizational

Document: line-item budget allocations, discussions

Quantify pre/post intervention results

Community

Document: media use, public relations campaigns

Assess change in community

Social network

Document: participation in Assess change in target intervention activity by population’s social target population’s social network network

Individual

Document: participation in Assess change in target intervention activity by population target population

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Evaluation Tools Qualitative

Quantitative

• • • •

• Surveys • Epidemiological measurements • Statistical measurements • Statistical data analyses

Observation Focus group In-depth interviews Data analysis – Coding – Content analysis

Factors to Consider when Choosing an Intervention • • • •

Determinants amenable to intervention Financial risk Objectives are measurable Level(s) at which intervention can be implemented • Identify and coordinate with existing programs • Interdisciplinary team • Time constraints

Group Discussions: Creating a COPC Project • Outline assets and How can Steps of Operational deficits of your local Model be accomplished? community • Consider your program’s curriculum and student body – – – – –

service learning community service research elective interprofessional courses

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References Bayer, B and Fiscella, K. (1999). Patients and community together: A family practice community oriented primary care project in an urban private practice. Archives of Family Medicine, 8, 546-9. O’Connell, C. (2008) Students’ perceptions of a community-oriented primary care program. Journal of Physician Assistant Education,19(4). Rhyne, R et al., eds. (1998). Community-oriented primary care : Health care for the 21st century. Washington, DC : American Public Health Association. Susser, M. (1999). Pioneering community-oriented primary care. WHO Bulletin, 77(5), 436-440.

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