The STFM Group on Community Medicine

Educating the Reflective Community Oriented Practitioner

Group on Community MedicineSTFM Toronto, May 2004

Presenters: JL Benson, A Perkins, M Stearns, L Michener

Agenda History lesson: COPC lit & group on

Comm Med activities Play with Allen’s website for curriculum

(Perkins/group)

COPC & ACGME competencies (Stearns)

Making trouble-are we really working with community? (Michener)

Future plans-web & beyond (group)

What Is COPC?

Four process steps Identify the community of interest Identify the health problem Develop and implement interventions Conduct ongoing evaluation

One Minute History of COPC

Will Pickles, MD kept diligent records of patient information in 7 rural villages in England “epidemiology in a country practice” 1939.

One Minute History of COPC

Sidney Kark, MD given team & developed “comprehensive, curative, and preventive service” named community oriented primary health care in South Africa, then Israel

One Minute History of COPC

U.S. “Community responsive initiatives” in 1950s and 60’s for Native Americans, Kentucky rural areas

One Minute History of COPC

OEO mandates to eliminate poverty created funding for neighborhood health centers in 60’s. Geiger goes to Mississippi Mound Bayou in Mississippi delta, Gibson-Columbia point NHC

One Minute History of COPC

IOM 1982 study and 1987 Nutting book on COPC

One Minute History of COPC

APHA 1998 book “COPC Health Care for the 21st Century”

One Minute History of COPC

Pathman & colleagues describe doctor training 1998

COPC Lit Review, 2001 on

Read “community-oriented primary care….” 2 part, Longlett, Kruse, Wesley, JABFP 2001.

Update search: pub med/medline for “community oriented primary care, 2001-2004 English only

200 found, only 169 unique and 79 not COPC 90 total COPC or close enough Where and what is being written?

COPC Lit Review, 2001 on

Where done or written? • Brazil, Bolivia, Peru, Finland, Netherlands, UK, S

Africa, Russia, Saudi Arabia, Jerusalem, India, Canada….. & DC to NC to CA to Dallas

What is being described? • 3 types: service/care, policy, education

Service/care:• Comprehensive care, seniors, leprosy,

school based health, mental health, child health, oral care, pharmacy, hypertension, diabetes

COPC Lit Review, 2001 on

Policy, history, exhortations

COPC Lit Review, 2001 on

“Vague processes of client representation need to be replaced by robust community based participatory research models”(Cawston 2003)

COPC Lit Review, 2001 on

In 18 wealthy OEDC countries, “strong primary care system and practice characteristics such as geographic regulation, longitudinality, coordination, and community orientation were associated with improved population health” (Macinko 2003)

COPC Lit Review, 2001 on

Sustained community health partnerships display 5 key qualities, “outcomes-based advocacy, vision-focus balance, systems orientation, infrastructural development and community linkages” (Alexander JA 2003)

COPC Literature, 2001-4

Education and curriculum Medical students, nurses, docs,

community health workers, teams Longitudinal project work Short-term training, rotations In-service education

Group on Community Medicine Activities

STFM group since 1990• HRSA funding preferences inspired

new FP curricula experiments Special session, STFM Chicago 1998

• Curriculum from 6 programs

Group on Community Medicine Activities

Pre-conference, STFM San Francisco, 2002• “Art walk” of 18 programs

presentations on • Field visit with community activists to

environmentally-challenged SF community

Plans for web-site to share curriculum Beginning electronic discussion forums

• Funding, working with community

So What to Do Next?

Review Community Medicine Competencies• How do we make them real, sincere, not-

just-a-checklist? Reconsider our community medicine

work• What does it take to work sincerely with

community? Decide on future community

medicine activities, conversations