One model of healthcare delivery that integrates primary care with public health is known as community oriented primary care. The benefits of such a model have been seen in researched evidence that this type of primary care delivery, with a community orientation, is associated with more effective and efficient healthcare services that are also more equitable in nature. What is community oriented primary care?
In the US, there is a growing demand for population health management, driven in part by various provisions of the Affordable Care Act (ACA). To respond to that growing need, there is also a need for enabling changes in healthcare delivery that will address the health priorities in a population, in particular considering individual care management in the context of population health for a defined population.
Community oriented primary care is focused on providing care to a defined population. The care is based on specific assessed needs with a goal of improving health status and using an approach that combines primary care and population health. The framework for community oriented primary care is based on these five principles:
- Responsibility for comprehensive care of a defined population
- Care based on health needs and its determinants
- Prioritization of those needs to implement health programs
- Programs that integrate promotion, prevention, and treatment
- Community participation.
The process to develop community oriented primary care requires:
- Defining (geographically, members registered in a practice or as a sociological construct) and characterizing the community to determine health needs, their determinants and assets
- Prioritization of identified health problems
- Detailed assessment of the prioritized condition
- Development and performance of intervention program
- Surveillance and evaluation
- Reassessment of health needs.
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The focus of community oriented primary care is aligned with the Triple Aim Initiative, which pursues the initiatives of:
- Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of health care.
Essential steps to developing a community oriented primary care initiative include:
Defining the community. The target population must be identified by a process that includes collecting demographic, economic, and historical data.
Identifying the health problem. This step involves identifying the health needs of the target population by reviewing available databases for demographic, socioeconomic, mortality, and morbidity rates. Any health issues out of proportion to the national distribution should then be benchmarked.
Prioritizing health needs. Surveys and focus groups can enable and encourage community participation in prioritizing the health issues that need to be addressed.
Implementing interventions to address those community health needs. Such interventions might include healthier school lunch menus, community garden development, or workplace injury prevention programs.
Evaluating the impact of the interventions. Ongoing evaluations and assessments of the community oriented primary care program should be conducted to determine the impact of those efforts. Community members should be included in the evaluation and assessment efforts.
Modifying future interventions. Using the information from the evaluations and assessments, it may be necessary to make adjustments to ensure that efforts are meeting the needs of the community.