While the PRMH/USCSM family medicine residency program has
consistently turned out physicians dedicated to providing the very best clinical care, the
faculty recognizes that producing clinicians well-trained in disease management is no
longer enough
to meet patients’ needs. Training in one-on-one medicine will not be sufficient for
the family physician of the future. (Greenlick, 1991) The leading causes of
morbidity and mortality in the United States—heart disease, cancer, intentional and
unintentional injury, stroke and chronic lung disease—are, in large part, lifestyle
conditions.
Significant improvements in individuals’ and communities’ health will require
that physicians and patients work together to reduce the risk of illness,
disability or premature death. In addition, managed care companies will continue to
pressure physicians to assume responsibility for the health of all of their "covered
lives."
One approach to attaining and maintaining community health is community-oriented
primary care (COPC). COPC allows a primary care physician to expand his or her focus
beyond the office and examining room and to affect the health status of a community.
Through the processes of data collection, collaboration, intervention, and evaluation,
COPC provides a strategy for identifying health needs and planning health services to meet
those needs. This proactive approach allows the physician to assume a leadership role and
to work as a partner with others in the community to address community health needs
(Nutting and Garr, 1989).
COPC consists of three components: a primary care practice or program, a community or
target population, and the COPC process. The COPC process consists of four steps. First,
the physician defines and characterizes the community he or she serves. The community may
consist of current patients and their families, the physician’s "covered
lives," a group of people with specific characteristics or health needs (i.e. persons
with HIV/AIDS, women of childbearing age), or the geographic region served by the
physician or practice. The latter is more common in rural settings, where physicians are
few and responsibilities are broad. Second, the physician uses quantitative and
qualitative methods to identify community health problems. Quantitative methods include
analyzing practice statistics, public health statistics, and other sources of health data.
Qualitative methods include soliciting input from community leaders and other providers
regarding local health problems and their likely causes.
Third, the physician, working with others in the community, develops services or
programs to address leading health problems. A program may be as simple as sending
postcards to elderly patients to remind them to have a flu shot or as complex as a
community-wide effort to reduce teen pregnancy. Finally, the physician and other key
players evaluate the program or service, in order to determine if the intended
changes occurred.
