Cynthia Thomas, MD Tracey Smith, PHCNS-BC, MS

 Cost?  Life expectancy?  Rank in world in healthcare?  Infant mortality?

 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.

 Sanitation  Immunizations  Preventive health services  Not Antibiotics

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

 Well your schedule is full of runny noses- how do you reach those without those runny noses?

IT IS NOT ONLY CARING FOR THE PATIENT IN THE ROOM! IT IS CARING FOR THE PATIENT NOT IN THE ROOM!

PUBLIC HEALTH  Primary Care 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.

CLINICAL: INDIVIDUALCOPC: POPULATION  Examination of patient  Individual diagnosis (subjective and objective)  Treatment  Monitoring therapy  Community Survey  Community Diagnosis (qualitative and quantitative)  Treatment  Evaluation

 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”

 Public health  School health  Environmental health  Epidemiology  Agencies on aging  Business coalitions for health  Primary health care providers

 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 sub- populations  Occupational medicine

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

 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.

 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.

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