Question

Explain the model of Community-oriented primary care (COPC) AND why its important ?

Answer 1

The Steps in the COPC Process Define and Characterize Proeeed with the next COPC initiative Data sources & Community surveys He alth CareProviders Monitor Identify Community's Health Impact Of Intervention Involve Community Problems Community Members/ VGroups Prioritize problems of greatest interest/ need Measure |outcomes Develop Intervention A health care program addressing a specific health care need (examples: presentations/classes, health fairs, screening programs, chart audits)
Community oriented primary care (COPC) is a strategy whereby elements of primary health care and of community medicine are systematically developed and brought together in a coordinated practice. ... The primary physician is the doctor to whom a patient first turns when ill or when seeking advice on personal health.

Community oriented primary care (COPC) is a strategy whereby elements of primary health care and of community medicine are systematically developed and brought together in a coordinated practice. Focus on this kind of integration was one of the features of the declaration on primary health care of the Alma-Ata conference:

Primary health care addresses the main health problems in the community, providing promotive, preventive, curative, and rehabilitative services . . . (it) includes at the very least education concerning prevailing health problems and the methods of preventing and controlling them, promotion of food supplies and proper nutrition, an adequate supply of safe water and basic sanitation, maternal and child health care, including family planning, immunization against the major infectious diseases, prevention and control of locally endemic diseases, appropriate treatment of common diseases and injuries, and provision of essential drugs. ¹

COPC unifies two forms of practice—the clinical care of individuals in the community and aspects of community medicine. ² In more developed countries the main primary care practitioners are physicians and nurses. For purposes of the present discussion, attention will be focused on the physician. The clinical care provided by primary care physicians may include promotive, preventive, curative, and alleviative functions, but the dominant function is care of the ill or disabled patient who turns to them for treatment. The five attributes that are essential to the practice of good primary care, according to a definition of primary care prepared by the Institute of Medicine of the National Academy of Sciences of the United States, ³ are accessibility, comprehensiveness, coordination, continuity, and accountability. The primary physician is the doctor to whom a patient first turns when ill or when seeking advice on personal health. Another important feature of such primary care in the community is its continuity over long periods of time; this builds a special relationship between practitioners, patients, and their families. Primary care practitioners who come to know several members of the same family in the course of their practice are more able to use this knowledge of the family's state of health, its resources, relationships, and perception of health when members of the family turn to them, from time to time, for care. The doctor's interest often extends to the school and other institutions in the community, as resources in the care of individual patients.

The provision of health care in the community, i.e., the practice of medicine outside the hospital, is sometimes equated with community medicine. We use the term “community medicine” with a different connotation to signify health care focused on population groups rather than on individual patients. So construed, community medicine has its roots in the disciplines of public health and medical administration. In the present context, community medicine may be distinguished from other forms of personal health care in the community in that its interest is centered on the community as a whole and on the groups of which communities are composed.

Basic Features of COPC

The cardinal features of COPC are:

1.

The provision of primary clinical care for individuals and families in the community, with special attention to the continuity of care. Suitable arrangements need to be made for consultative services, specialist care, and hospitalization.

2.

A focus on the community as a whole and on its subgroups when appraising needs, planning and providing services, and evaluating the effects of care.

The “community” in COPC may be any of the following (in order of preference):

• a “true” community, in the sociological sense;

• a defined neighborhood;

• workers in a defined factory or company, students in a defined school, etc;

• people registered as potential users of a physicians' group practice, health maintenance organization, neighborhood health center, or other defined service; and

• users of a defined service, or repeated users of the service.

Although from a puristic viewpoint the application of the term “community” to a group of patients may rightly be criticized, especially when these patients constitute a small selected part of a population, there is little doubt that the principles and practice of COPC can profitably be applied to such groups, although its full development may not be possible. At this stage it would not be constructive to suggest that COPC should be confined to “true” communities and defined neighborhoods. When COPC is applied to a selected part of a population, an effort should be made to determine how the characteristics of this subgroup compare with those of the population at large.

The following can be regarded as the five essential features of COPC:

1.

The use of epidemiologic and clinical skills as complementary functions; both the epidemiologic and the clinical activities should be of as high a standard as possible.

2.

Definition of the population for which the service is or feels responsible. This defined population is the target population for surveillance and care and the denominator population for the measurement of health status and needs and the evaluation of the service.

3.

Defined programs to deal with the health problems of the community or its subgroups, within the framework of primary care. These community health programs may involve health promotion, primary or secondary prevention, curative, alleviative or rehabilitative care, or any combinations of these activities. The programs are based on the epidemiologic findings.

4.

Involvement of the community in the promotion of its health. Community involvement may be seen as a prerequisite for the satisfactory and continued functioning of a COPC service.

5.

Accessibility that is not limited to geographic accessibility (the COPC practice should ideally be located in the community it serves) but that refers also to the absence of fiscal, social, cultural, communication, or other barriers.