Medical College of Georgia

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Department of Family Medicine
Community Oriented Primary Care

Community-Oriented Primary Care (COPC) is an approach to health care delivery that undertakes responsibility for the health of a defined population. COPC is practiced by combining epidemiologic study and social interventions with clinical care of individual patients, so that the primary care practice itself becomes a community medicine program. Both the individual patient and the community or population are the foci of diagnosis, treatment and ongoing surveillance.

Why is COPC important now?
Because the traditional model of physician to patient (one-to-one orientation) is limited in today's health care marketplace. Managed care forces us to find community solutions for community problems.

What does COPC offer me, as a physician?
The concept of COPC offers physicians the opportunity to impact significantly larger populations and ultimately alter a community's health. A change in the overall health in the community is reflected in better health for each individual patient the physician treats on a daily basis.

How do I implement COPC in my practice?
There are basically four steps you will need to follow to transform your primary care practice into a community medicine program:

1. Define the population.

2. Assess the defined population's health needs.

3. Organize an effective intervention strategy.

4. Evaluate the success of the intervention.

Step 1: Defining the Population

In order to get an understanding of who your clinical population is and what their health needs are, you:

	Conduct Direct Inquiries. This can be done using surveys of members of the community or of its leaders.
	Examine Community-Generated Data. Examples of such data are census reports, and disease reports from the local Health Department, Department of Social Services, and other community agencies. Hospices, Hospitals, Schools, Churches, and other organizations can provide data for a comprehensive survey.
	Study Your Own Practice. This may involve creation of data systems in your practice that allow you to ask certain questions of your medical records. This need not be an expensive undertaking--a local information management or computer consultant (perhaps at a local community college) can assist you. When you examine your own practice beware of drawing conclusions about the community population from your practice sample. Your practice may have certain types of community members whose health status does not reflect that of the overall community.

Step 2: Assessing the Defined Population's Health Needs

To find out what your population's health needs are you can take the data you collected in Step 1 and ask of it the following questions:

	What areas of need, weaknesses, or strengths do I see in my own practice?
	What collective areas of need, weaknesses, or strengths does my group of physicians see in our practices? (This presumes that you have shared your observations with a larger group of physicians who agree to work with you in discerning community health issues).
	How can I develop a "group ownership" relationship by working with the community and its agencies to address these problems?

Step 3: Organizing an Effective Intervention Strategy

Remember, a strategy is an overarching plan that is based on a vision and uses a combination of forces to make the vision a reality.

When developing a effective intervention strategy, it is important first to have a clear idea or vision of what you are trying to achieve or change. For example, do you want all babies to have immunizations up-to-date? If so, that is your vision.

Once your vision is clearly stated, it drives the plan you develop. Your plan should include a combination of creative actions that will work together to make your vision a reality. If your vision was up-to-date immunizations for all babies in your community you could develop a plan that involves:

	Start at Home: Search your medical records to determine which children are in need of immunizations and have your staff contact parents by phone or letter (or both).
	Point of Care Information: Place immunization information in your clinic lobby and exam rooms. Work with other physicians and hospitals so that they also place this information in their clinics.
	Involve Churches and Schools: Work with local churches asking them to give a brief immunization information card to all parents who bring their children for baptism. Provide this information to all churches and public schools.
	Poster Campaign: Create attractive posters with immunization information and post them in local churches, grocery stores, schools, day care centers, etc.
	Involve Community Agencies: Work with existing community agencies such as the local Health Department, Salvation Army, County Extension Service, Department of Family and Children's Services, Parent-Teacher Organizations through local schools and school boards.
	Involve Local Politicians, Local Government, and the Chamber of Commerce in Your Effort–Help them to see how making your vision a reality benefits the entire community. They may be able to offer support or open doors that are key to your success.
	Seek Out National Organizations and Their Chapters:  Find out if there is a local chapter of a National Organization that is relevant to the disease or clinical intervention you are attempting to address.  Locate their nearest local chapter if one is available. Their help may be invaluable.
	In general, your goal is to formulate interventions that are creative and to involve others in the community. Of course, this does not take the place of individual interventions that you apply daily in your practice.
	Need more ideas?  Below you will find some world wide web sites and approximately 70 journal references that may help you understand COPC and implement it in your practice.

Step 4: Evaluating the Success of the Intervention

	At some point during and after your strategy has been implemented, reassess the impact your intervention has had in your practice by examining your medical records.
	Ask the physicians involved in your efforts about changes they have noted in their practices.
	Contact all the agencies who contributed to your strategy and inquire about changes they have noted on your local level.

If you note positive changes, be sure to publicize them. Your local newspaper and radio stations will be glad to report your success. Let everyone who helped you know of the success of the joint venture. This encourages similar efforts in the future and helps create a "can-do" attitude among all. If no changes were noted, ask all involved for their assessments of why the strategy was not successful. It may be that some part of the strategy needs to be changed or an additional element added. Do not be discouraged by having not yet made your vision a reality. It may be that the strategy simply needs more time. Get everyone's assessment, reevaluate, and make the needed changes. Large, community-wide efforts usually take time to be successful.

Where can I go to learn more about COPC?

	COPC Template
	Society of Teachers of Family Medicine Rural Interest Group
	References

Contact Information

Institute of Medicine
Community Oriented Primary Care: A Practical Assessment
Washington, DC: National Academy Press, 1984

Research and Faculty Development  |  Department of Family Medicine
 Medical College of Georgia

Please email comments, suggestions or questions to:
Stan Sulkowski, ssulkowski@mcg.edu.

January 10, 2008