COPC in the RMED program M MacDowell 2015 STFM smaller

PARTNERSHIPS WITH RURAL COMMUNITIES – 16 YEARS OF IMPLEMENTING MEDICAL STUDENT
COMMUNITY HEALTH IMPROVEMENT PROJECTS OF COMMUNITY ORIENTED PRIMARY CARE (COPC)
Society for Teachers of Family Medicine · 2015 Annual Meeting, Orlando, FL · April 26, 2015
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Martin MacDowell, DrPH , Michael Glasser, PhD, Dana Evans, MS , Jaime Gofin, MD, MPH
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National Center for Rural Health Professions, University of Illinois College of Medicine at Rockford, College of Public Health, University of Nebraska Medical Center, Omaha, NE
• Tollman (1991) and Gofin (2006) discussed the history of COPC
originated in South Africa in the 1940s by Sidney Kark and later
developed in Jerusalem since the 1960s.
• An example of the COPC process in the U.S. as applied to
cardiovascular disease in an African American community is
provided by Plescia and Groblewski (2004).
• Application of COPC in a family medicine primary care settings in
Spain is discussed by Gofin and Foz (2008).
Framework for COPC Projects
There are five distinct types of definitions of community within the
context of COPC:
1. a true community in the sociological sense;
2. a defined neighborhood (or small town);
3. workers in a factory, company or students in a school;
4. persons registered as potential users of a medical practice, a
health maintenance organization, a neighborhood health center, or
other defined service; and
5. users of a defined service or repeated users of the service
Source: Abramson and Kark (1983)
COPC Principles
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•
•
•
Responsibility for the health of a defined population
Care is based on the identified health needs at the population level
Prioritization
Program of intervention covering all stages of the health-illness
continuum of the selected condition (health promotion, prevention,
treatment, rehabilitation – physical, social, mental)
• Community involvement
Pr
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J. Gofin & R. Gofin. Essentials
of Global Community Health.
Jones & Bartlett Learning, 2011
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Background about COPC
The COPC Process / Cycle
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Purpose and Aims
Purpose
Review the framework for community oriented
primary care (COPC), discuss the relevance
of COPC projects in the current healthcare
environment, explain the rationale for a COPC
project being included in the senior year family
medicine 16-week rural preceptorship, and
describe characteristics of COPC projects from
1997-2013.
Aims
• Describe how the COPC approach has been
implemented in the curriculum of the University of
Illinois Rural Medical Education program (RMED)
program during the past 16 years, and
• Describe the characteristics of the 237 COPC
projects including: topics, locations, participants,
community partners and impact.
In t e
rv
in g
& imention plannn
plementatio
Setting for Fully Implementing COPC
A primary care practice environment
• That provides accessible, comprehensive, coordinated,
continuous-overtime, and accountable health care services.
A defined community
• Whose health the practice has assumed responsibility.
• Refers to geographic or social communities; groups that form
within the workplace, church, or schools; or persons enrolled in
a common health plan. Specifically excluded are communities
consisting only of active patients in a practice.
A process including these steps:
a. defining and characterizing the community,
b. describing community health problems,
c. modifying the health care program to address high-priority health
needs,
d. monitoring the effectiveness of program modifications.
Source: Longlett, Kruse and, Wesley (2001)
Rationale for COPC in the RMED Curriculum
• A major focus of the RMED curriculum is to have students engage
with the community where they are doing a clinical rotation
encouraging the future rural physician to engage, interact and
contribute to efforts that improve the health of the community – not
simply treat symptoms, illness or injury. An essential first step is
completion of a written community
health assessment in which health
problems are systematically
identified and interventions are
presented.
• The student then plans,
implements, and evaluates a
IRB approved COPC project
culminating in a poster
presentation at the annual campus
research day.
Rationale for Engaging the Community
• The current era of health reform in the United States primary care
is emphasized as an essential component at the foundation of an
improved healthcare system with renewed emphasis on the goal of
preventing health problems. The focus is on community residents
implementation of wellness behaviors and early detection and
intervention related to medical problems that occur.
• The intent is for students to adopt a broad view of primary care
when they enter practice and implement a right place, right time,
right care team based approach.
Methods
• Over the last 16 years (1997-2013) all
237 students in the University of Illinois
Rural Medical Education (RMED) program
have conducted a COPC project while
completing a required senior year 16-week
rural preceptorship and developed a poster
presentation describing their COPC project
and evaluation results.
• An SPSS (Version 21 [Software] 2013 SPSS
Chicago, IL) file was created to analyze
project characteristics. Tabulation of the specific reason for the
project topic choice, organizational setting for the COPC project
implementation, participant type/characteristics, and the types of
community partners who assisted with the project were analyzed.
Student COPC poster presentations were also assessed regarding:
purpose of the project, research design used, and types of results/
impact identified in the project evaluations.
• Topics of COPC projects were community health improvement
related to a health condition (58%), wellness/prevention (33%),
health system/community medicine such as access to care (6%),
and other (3%).
• Location of project implementation: elementary school (7%),
middle school (6%), high school (10%), working age adults in a
community setting (24%), senior centers in the community (12%)
and multiple settings (40%).
• COPC project purpose or activities were: education (65%),
research (12%), research and education (8%), educational
involving participant activity (15%).
35
30
25
20
%
15
10
5
References
0
No impact
observed
Basis for COPC Projects, 1997-2013
Some positive
impact
Clear positive
impact
Substantial
Evidence of
impact
Qualitative
description
impact
Impact unclear
Figure 5.
Basis/Background for COPC Projects, 1997-2013
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COPC Project Topics, 1997-2013
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70
70
60
60
50
%
50
40
30
40
%
20
30
10
20
0
RMED student's or a prior
community needs
assessment
Professional
interest in topic
No information
Community
interest in topic
10
0
Figure 2. Over 80% of the projects were based on a needs assessment done by the
student or the community, an essential component of the COPC process.
Results
Specific Community Health
Topic
Wellness/Prevention
Health System/Community
Medicine
Other
Figure 6. The majority of project topics were related to community health improvement
(58%) and wellness/prevention (32%).
Partners for COPC Projects, 1997-2013
• The basis for reseach projects were: a needs assessment done
by students or community (81%), professional interest (5%),
community interest (12%), no information (2%).
• Community partners assisting with the projects were local rural
hospitals (8%), county health departments (13%), primary care
providers (23%), schools (18%), and other partnering organizations
such as nursing homes, senior centers, voluntary agencies (about
38%).
• Major study designs used in the projects were:
ŠŠ Cross-sectional (often of a part of the population) 36%,
ŠŠ Pre surveys and post comparison (29%),
ŠŠ Pre survey only to assess needs or engage audience (8%),
ŠŠ Qualitative (9%),
ŠŠ No evaluation - only distribution of informational pamphlets
(6%),
ŠŠ Multiple quantitative surveys (2.5%), and
ŠŠ Other (6%)
• The target population of COPC projects were: adult men (3%),
adult women (13%), young children (14%), adult men and women
(44%), pre-teens and teens (14%), multiple ages (12%).
• Impact of the COPC based on project evaluations done by the M4
(fourth year) students were: had no impact (13%), some positive
impact (8%), clear positive impact (9%), substantial evidence
of impact (21%), qualitative description of impact (17%), no
information (32%).
Conclusion
• The COPC projects benefited the
students (such as acquiring new skills and
engaging with the rural community) and
also benefitted the community (such as
providing health education interventions or
wellness activities).
Impact of the COPC Project from Evaluations, 1997-2013
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COPC Project, Purpose, and Activities, 1997-2013
20
70
15
60
%
50
10
40
%
5
30
0
Other
Community
Group
Schools
Family Medicine
Clinic
Multiple
Community
Partners
Health
Department
Community
Hospital
Other Physician
Group
20
10
0
Figure 3. The two most common specific partners for projects were schools (18% and
family medicine clinics (17%). The other group included partners from many types of
agencies such as: nursing homes, senior centers, health department, 4-H, etc.
Target Population of COPC Project Participants, 1997-2013
50
40
35
30
25
20
15
10
5
0
en
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Adu
Education that Included
Participant Activity
Research Only
Both Research and
Education
Figure 7. 65% of the projects purposes focused on implementing an educational
intervention.
Discussion
45
%
Education Only
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Figure 4. About 44% of projects involved both adult men and women with 14% to 4%
of projects involving other participant age or gender combinations.
• RMED students completing COPC projects have benefited a
variety of groups within rural communities and have worked
effectively with local partners to improve health related knowledge,
attitudes, and/or behaviors.
• Evaluation design used has been stronger since 2007. It is
acknowledged that use of a control group would be ideal, but
that design is not easily implemented with educationally focused
projects. The idea of a control group not getting the COPC
educational intervention or activity is not easily accepted in rural
communities.
1. Abramson JH, Kark SL. Community-oriented primary
care: meaning and scope. In Connor E, Mullan F, editors.
Community-oriented primary care: new directions for health
services delivery: conference proceedings. Washington DC:
National Academy Press, 1983
2. Epstein L, Gofin J, Gofin R, Neumark Y. The Jerusalem
experience: three decades of service, research, and training
in community-oriented primary care. AmJ Public Health.
2002 Nov;92(11):1717-21.
3. Geiger HJ. Community-oriented primary care: a path
to community development. Am J Public Health. 2002
Nov;92(11):1713-6.
4. Gofin, J. On “A Practice of Social Medicine” by Sidney
and Emily Kark. Ejournal (www.socialmedicine.info) Social
Medicine 2006 Aug;1(2):107-115.
5. J. Gofin & R. Gofin. Essentials of Global Community Health.
Jones & Bartlett. Learning and APHA, Sudbury MA, 2011
6. Gofin J, Foz G. Training and application of communityoriented primary care (COPC) through family medicine in
Catalonia, Spain. Fam Med. 2008 Mar;40(3):196-202.
7. Longlett SK, Kruse JE, Wesley RM. Community-oriented
primary care: historical perspective. J Am Board Fam Pract.
2001 Jan-Feb;14(1):54-63.
8. Plescia M, Groblewski M. A community-oriented primary
care demonstration project: refining interventions for
cardiovascular disease and diabetes. Ann Fam Med. 2004
Mar-Apr;2(2):103-9.
9. Tollman S. Community oriented primary care: origins,
evolution, applications. Soc Sci Med. 1991;32(6):633-42.
Corresponding Author: Martin MacDowell, DrPH
email: [email protected]