Community-oriented Primary Care Model Research Articles

Healthcare Service Quality Evaluation in a Community-Oriented Primary Care Center, Italy.

Community-oriented primary care (COPC) is an inclusive healthcare approach that combines individual care with a population-based outlook, striving to offer effective and equitable services. This study concentrates on assessing the perceived quality of a "Casa della Comunità" (CdC) implemented by the Romagna Local Health Authority, which embraces the COPC model. Through the examination of user experiences, the study aims to comprehend the influence of the CdC's care delivery model on the community's perception of service quality. From 13-18 March 2023, paper questionnaires were distributed by trained healthcare professionals and volunteers. The cross-sectional study enrolled participants aged 18 or older, capable of understanding written Italian, and willing to take part voluntarily. A total of 741 questionnaires were collected, resulting in an overall acceptance rate of 85.6%. Among the respondents, 37.9% were female, with an average age of 55.4 ± 16.2 years. While the respondents generally held a positive view of the quality, the results displayed varying levels of satisfaction across the different areas. Multivariate analysis revealed significant associations between factors such as gender, employment status, financial resources, education level, and distance from the healthcare center with the perceived quality of the facility in terms of accessibility, environment, staff, continuity of care, and overall satisfaction. The study yielded valuable insights, identifying strengths and areas for improvement and underscoring the importance of ongoing monitoring studies to enhance patient satisfaction continuously.

Community-oriented primary care for National Health Insurance in South Africa.

This is a report on Chiawelo Community Practice (CCP) in Ward 11, Soweto, South Africa, a community-oriented primary care (COPC) model for National Health Insurance (NHI) in South Africa, developed by a family physician. A shift to capitation contracting for primary health care (PHC) under NHI will carry risk for providers – both public and private, especially higher number of patient visits. Health promotion and disease prevention, especially using a COPC model, will be important. Leading the implementation of COPC is an important role for family physicians in Africa, but global implementation of COPC is challenged. Cuba and Brazil have implemented COPC with panels of 600 and 3500, respectively. The family physician in this report has developed community practice as a model with four drivers using a complex adaptive system lens: population engagement with community health workers (CHWs), a clinic re-oriented to its community, stakeholder engagement and targeted health promotion. A team of three medical interns: 1 clinical associate, 3 nurses and 20 CHWs, supervised by the family physician, effectively manage a panel of approximately 30 000 people. This has resulted in low utilisation rates (less than one visit per person per year), high population access and satisfaction and high clinical quality. This has been despite the challenge of a reductionist PHC system, poor management support and poor public service culture. The results could be more impressive if panels are limited to 10 000, if there was a better team structure with a single doctor leading a team of 3–4 nurse/clinical associates and 10–12 CHWs and PHC provider units that are truly empowered to manage resources locally.

Community-oriented primary care for National Health Insurance in South Africa

This is a report on Chiawelo Community Practice (CCP) in Ward 11, Soweto, South Africa, a community-oriented primary care (COPC) model for National Health Insurance (NHI) in South Africa, developed by a family physician. A shift to capitation contracting for primary health care (PHC) under NHI will carry risk for providers – both public and private, especially higher number of patient visits. Health promotion and disease prevention, especially using a COPC model, will be important. Leading the implementation of COPC is an important role for family physicians in Africa, but global implementation of COPC is challenged. Cuba and Brazil have implemented COPC with panels of 600 and 3500, respectively. The family physician in this report has developed community practice as a model with four drivers using a complex adaptive system lens: population engagement with community health workers (CHWs), a clinic re-oriented to its community, stakeholder engagement and targeted health promotion. A team of three medical interns: 1 clinical associate, 3 nurses and 20 CHWs, supervised by the family physician, effectively manage a panel of approximately 30 000 people. This has resulted in low utilisation rates (less than one visit per person per year), high population access and satisfaction and high clinical quality. This has been despite the challenge of a reductionist PHC system, poor management support and poor public service culture. The results could be more impressive if panels are limited to 10 000, if there was a better team structure with a single doctor leading a team of 3–4 nurse/clinical associates and 10–12 CHWs and PHC provider units that are truly empowered to manage resources locally.

Collaborative Learning Through Global Partnerships: Student-Led Community-Engaged Research

Public health research in an international setting demands a framework that encourages collaboration between investigators and their host country during the planning stages of the research project and throughout its execution phase. The aim of the current project was to develop a needs assessment with rural Nicaraguan communities. The Community Oriented Primary Care model, which promotes commitment to partnerships and sustainability, was used to guide the needs assessment and research process. A multidisciplinary team of students traveled to three rural communities in Nicaragua to conduct a comprehensive needs assessment, focused on risk factors for cardiovascular disease. In this paper, the authors highlight the experience, challenges, and facilitators experienced by this team of students during the global health research process. Findings indicate using the COPC model as a guide afforded the research team with the opportunity to assess community needs, from community member perspectives, as a first step toward partnering with the community to develop appropriate future intervention projects.

A Systematic Review of COPC: Evidence for Effectiveness

This systematic review was conducted to assess the evidence for effectiveness of the community oriented primary care (COPC) model and discuss alternative approaches to community medicine practice and education. A literature search for all articles referring to COPC was conducted. Articles were categorized by type, and the extent of the use of elements of the COPC model, and the level of community involvement. The majority of articles on COPC (60% of those reviewed) describe the general theory or educational use of the methodology. Many published studies are project descriptions not utilizing the complete model as initially described. Few of project descriptions include all elements of COPC or document community participation. Evidence for or against the effectiveness of the COPC model in improving community health outcomes (using the Strength of Recommendation Taxonomy (SORT) classification system as evidence) was found to be limited. Most publications related to COPC do not use the complete COPC model as originally described and evidence for its effectiveness is lacking. Further research with evaluation of community health outcomes and community participation is needed. Diverse models of community health intervention can be considered for training and collaborative practice with underserved populations.

Studentsʼ Perceptions of a Community-Oriented Primary Care Program

Community-oriented primary care (COPC) is a model of health care delivery that fosters community involvement in the development, implementation, and evaluation of health care services. It is postulated that providing COPC-based training experiences will nurture the ideals of COPC in students and thus promote the use of the model in their future practice settings. The PA Program at the University of Medicine and Dentistry of New Jersey has partnered with the Robert Wood Johnson Medical School Department of Medicine and the New Jersey Primary Care Association to offer an 8-week full-time training experience in COPC. Students rated several elements of the COPC model as well as their attitudes and confidence at the beginning and end of the experience. This report highlights the findings of this evaluation.

Atención primaria orientada a la comunidad: un modelo de salud pública en la atención primaria

The community-oriented primary care (COPC) model strives to efficiently distribute, organize, and systematize existing health care resources. In addition to promoting healthy lifestyles within the community, the COPC model enables the health care team and the community to cooperate in identifying and prioritizing health issues. Together they develop and implement prevention and treatment plans for those priority areas. With COPC, the health services assume responsibility for the health of a defined population. The health services not only treat diseases but also develop programs for health promotion, protection, and maintenance. Taking this approach, COPC integrates individual and family clinical care with public health, reflecting the spirit of the International Conference on Primary Health Care held in Alma-Ata in 1978. COPC is a systematic process, with flexible principles and methodologies that can be modified to meet the specific challenges of any health care team and community. An analysis of various countries' experiences with COPC shows that applying the model appropriately can improve the general health status of the community and its members.

Integrating primary care and public health: learning from the community-oriented primary care model.

Community-oriented primary care (COPC), a 50-year-old widely applied innovative approach to primary care development, seems to be the same combination of public health and general practice perspectives currently sought in the formation of primary care trusts in Britain's NHS. The article reviews the experience of implementing COPC methods, the outcomes, and the applicability to and implications for primary care policy, taking the current British reforms as an example. The COPC model has been developed mainly in underserved populations to integrate public health objectives and primary care through interdisciplinary approaches, with active involvement of the target population. COPC methods are time consuming, can create problems with professional boundaries, and are vulnerable to socioeconomic changes. They can also deliver complex packages of care for target populations, particularly in poor areas underserved by traditional medical services. British primary care reforms may be seen as an unplanned, uncontrolled, nationwide experiment in applying COPC methods. They differ from COPC as applied elsewhere because change has been introduced from above rather than below, into a well-developed primary care system rather than underserved communities. International experience suggests the need for attention to factors promoting and impeding success and to reliable outcome measures. If this experiment succeeds, COPC methodology may facilitate similar changes in other health care systems.

SCHOOL-BASED HEALTH CENTER VIABILITY: APPLICATION OF THE COPC MODEL

Providing effective primary and preventive health care to adolescents is challenging. Traditional medical and nursing models have had little success in guiding health care for the individual adolescent. A community-based model would aim programs and intervention at high-risk adolescents identified as needing treatment. Community-Oriented Primary Care (COPC) bridges the gap between primary care and public health to evaluate and improve the delivery of health care to identified populations. The COPC model was used to develop and implement an adolescent school-based health center in a southwestern border community. The four process steps based on the COPC model include: identifying the community of interest, identifying the health problem, developing and implementing intervention(s), and conducting ongoing evaluation. Key stakeholders from the medical, educational, and consumer groups were invited to participate in the first and second steps. Representatives of various school adolescent subcultures formed a group of promotores (health promoters) to monitor, advise, and contribute to the process. The Dartmouth COOP survey was selected to identify health concerns and risks of the targeted high school. The promotores prepared and administered the survey to 1,116 students. Results were used to design the initial health center program components using an interdisciplinary team to implement interventions aimed at the major health concerns and risks identified by the COOP. A short feedback loop contributed to program refinements, and ongoing evaluation continues to shape the practice of health care providers in the school-based health care center.

Community-oriented primary care in action: a Dallas story.

Dallas County, Texas, is the site of the largest urban application of the community-oriented primary care (COPC) model in the United States. We summarize the development and implementation of Dallas's Parkland Health & Hospital System COPC program. The complexities of implementing and managing this comprehensive community-based program are delineated in terms of Dallas County's political environment and the components of COPC (assessment, prioritization, community collaboration, health care system, evaluation, and financing). Steps to be taken to ensure the future growth and development of the Dallas program are also considered. The COPC model, as implemented by Parkland, is replicable in other urban areas.

Community‐oriented primary care: a multidisciplinary community‐oriented approach to primary care?

Developing more of a local public health focus, and involving local communities in Great Britain in health care decision-making, are key aspects of the radically changing face of primary care. Community-oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ‘Modern and Dependable NHS’, but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd.

Community‐oriented primary care: a multidisciplinary community‐oriented approach to primary care?

AbstractDeveloping more of a local public health focus, and involving local communities in Great Britain in health care decision‐making, are key aspects of the radically changing face of primary care. Community‐oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ‘Modern and Dependable NHS’, but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd.

Counselling the community: The contribution of counselling psychologists to the development of primary care

The primary care groups (PCGs) newly introduced to the National Health Service require general practitioners and primary care teams to improve the health of their communities by addressing the health needs of their population, promoting the health of that population and working with other organizations to deliver effective and appropriate care. Community-oriented primary care (COPC) is an internationally tested model for primary health care development which is now being employed within the UK. This paper outlines the COPC model, and demonstrates how the skills and knowledge base of counselling psychologists and primary care counselling can contribute to a community-oriented primary care approach.

Community Oriented Primary Care and Macro Social Work Practice

Community Oriented Primary Care (COPC), an approach based on community-professional partnerships and incorporating the principles of empowerment, links medicine, public health, and macro social work practice through interdisciplinary teams. The steps of the COPC model systematically identify, prioritize, and address health problems. This process works by forming “cluster committees” of public health stakeholders. The approach draws heavily on skills associated with community organizing, task-oriented group work, planning, program development, and participatory evaluation. It shows great promise for both improving public health practice and increasing the role of macro social work in this process.

COMMUNITY-ORIENTED PRIMARY CARE

Community-oriented primary care (COPC) combines elements of clinical medicine and public health to provide an effective strategy in tackling today's health problems. A primary care practice or program that develops a partnership with an identified community to describe and prioritize health concerns and design and monitor the impact of an intervention can make a difference to the health of a community. The key ingredient to a successful COPC venture is a motivated practitioner. Familiarizing health care providers with the COPC model will enable them to form enriching relationships with the communities they serve.

Community-Oriented Primary Care

The current high-cost health care delivery system, which places greater emphasis on acute hospital care than on community-based primary and preventive care, is no longer viewed by policymakers, politicians, and the American public as the ideal model for organizing and providing health care services. Americans want change; however, politicians are responding with a barrage of disjointed finance and cost-containment proposals that fail to address the organization and provision of health care services. Nevertheless, to adequately address problems of cost, access, and quality, reform proposals will need to consider delivery models that create a balance between medical care and health care, between public health and personal health services, and between curative and preventive care. The community-oriented primary care model and the discipline of community and socially responsive medicine is a process for making a health care system more rational, accountable, appropriate, and socially relevant to the public. Consequently, this model, which is now at a pivotal point in its evolution, may serve as a paradigm for reforming the organization and provision of health care services in America.

Community-oriented primary care. The cornerstone of health care reform

The current high-cost health care delivery system, which places greater emphasis on acute hospital care than on community-based primary and preventive care, is no longer viewed by policymakers, politicians, and the American public as the ideal model for organizing and providing health care services. Americans want change; however, politicians are responding with a barrage of disjointed finance and cost-containment proposals that fail to address the organization and provision of health care services. Nevertheless, to adequately address problems of cost, access, and quality, reform proposals will need to consider delivery models that create a balance between medical care and health care, between public health and personal health services, and between curative and preventive care. The community-oriented primary care model and the discipline of community and socially responsive medicine is a process for making a health care system more rational, accountable, appropriate, and socially relevant to the public. Consequently, this model, which is now at a pivotal point in its evolution, may serve as a paradigm for reforming the organization and provision of health care services in America. (<i>JAMA</i>. 1993;269:2544-2547)

Community-Oriented Primary Care

256 Brief communication COMMUNITY-ORIENTED PRIMARY CARE TO THE EDITOR: I read with great interest Dr. Xylina Bean's description [Vol. 2, No. 1:147-153] of her group's efforts to address the health care needs of an underserved community in Los Angeles. They employed a method called "ecoprimary care" to improve prenatal care for women living in two local housing projects. Their approach included organizing community providers, defining a target population, conducting a needs assessment, designing and implementing interventions, and evaluating the results of the interventions. We have used a similar approach in an attempt to improve health care for the poor in Orange County, California. Despite the count/s relative affluence, approximately 22 percent of its residents lack any form of health insurance. Moreover, becauseofaburdensome bureaucracy and low reimbursementrates, relatively few providers accept Medi-Cal (California's Medicaid). Making matters worse, the county government's spending for indigent health care is quite low. Orange County ranks at the bottom of the 10 most populous California counties in per capita expenditures from local funds. The county operates no public hospital and administers no comprehensive care clinic for anyone over the age of five. These and other factors have resulted in substantial barriers to access that affect uninsured and low-income residents. We based our approach on community-oriented primary care (COPC), a method from which "ecoprimary care" probably evolved. COPC, developed initially by Kark in South Africa1 and applied subsequently in various localities in the United States2-3, ideally consists of four sequential steps. First, an organization that provides primary care defines and characterizes a community that it intends to serve. Second, through research, the organization identifies community health care needs; this phase of the work comprises a "needs assessment." Third, the organization develops and implements emphasis programs to meet needs or to correct problems revealed in the second stage. Fourth, an evaluation takes place to monitor the impact of emphasis programs accomplished in its catchment area. We were fortunate that a private Catholic hospital decided to develop and implement emphasis programs to improve access to needed services in its catchment area. To identify needs and to rank them, this hospital contracted with our research group to perform a systematic, community-based survey in Journal of Health Care for the Poor and Underserved, Vol. 2, No. 2, Fall 1991 ___________________________________________________________257 the northern part of Orange County. In terms of the four stages of COPC, the contracting hospital first defined the targeted community as all individuals and families within its geographic area whose incomes were below or near the federal poverty level. Second, we conducted a random survey of health care needs of low-income families within the catchment area. We found that prenatal care and preventive services for children were particularly deficient.4 Third, the contracting hospital initiated emphasis programs, including educational materials, a mobile medical van, a child immunization program, and a prenatal care program, that responded to some but not all of the needs that we identified through the survey. As for COPCs fourth step, the hospital elected to evaluate their emphasis programs solely by numbers of patients served, rather than by more extensive and costly evaluative measures. Because of the inadequacy of our county's indigent health care system, advocacy for improved services has been an important component of our work.5 We have used the research results to bolster political and, occasionally, legal activities—actions that can also be considered emphasis programs in the COPC model. The political activities have included publicizing the research findings in local newspapers, meeting with local government officials, and testifying at county budget hearings. To date, legal action has been limited. However, on some occasions, we have encountered medically indigent patients whose treatment by county officials or private providers seemed to fall outside the bounds of the law. Legal professionals have initiated actions for individual patients facing financial barriers to care, and have testified that the county's health programs do not comply with federal and state standards. Dr. Bean and her colleagues should be congratulated for their excellent work. Because of the group's efforts, there is no doubt that residents in the targeted community have received improved...