Implementing a COPC process in a Primary Care Center Puesta en marcha de un proceso APOC en un centro de salud

1. Montaner I, de la Iglesia R, Amoros N, Kret M, Ollero A, Colomer C. Members of the Primary Care Center El Carmel. Barcelona. Spain
COMMUNITY DIAGNOSIS
2005: Community diagnosis done in a
representative sample of children
between 6 to 10 years old.
All proffesionals of PCC agreed to
participate at different levels of
committment. A reorganization of the
daily clinical work was necessary
Epidemiological study confirmed the
problem and IT decided to plan a
community health program to address it.
Main Outcomes:
21.7% overweight + obesity
58.7% with sedentary life style
47.6% with inadequate nutrition
BAKGROUND
Community-Oriented Primary Care (COPC) is a methodology that integrates individual clinical care with community
care. It has been criticized for its difficulty to be applied at the Primary Health Care level. In our Primary Care Center
(PCC) we decided to use COPC methodology to approach the most important health problems of our community.
From 1994 until 2002 a Community Health Assessment was carried out annually as a teaching tool for residents in
family and community medicine
In 2003 a interdisciplinary team (IT) of the PCC (1 social worker + 5 nurses + 3 doctors + 2 administrative staff) was
constituted and received the approval of entire health team to continue the COPC process.
PRIORITIZATION
2004 : Internal discusion of IT and later
with representatives of the association
for district development “Carmel
Amunt”, concluded by consensus that
CHILD OBESITY was the first problem
to work on
CONCLUSIONS
It is feasible to carry out a COPC project at primary health care level under the given conditions: a) there is
agreement amongst the entire health care team, b) reorganization of daily clinical work and c) involvement
of different professionals and services of the community.
In our experience sensitization of health team has been slow but now is consolidated. Community involvement is not
optimal yet, but IT participates as technical assessor in the “Carmel Amunt District Project” , whose main objective is to
promote community iniciatives and involve the population to resolve their own problems.
Currently our COPC project is included as part of this District Project while still conserving the essence of the COPC
methodology.
COPC METHODOLOGY
COMMUNITY HEALTH ASSESSMENT
Quantitative data about health and its
determinants was collected and updated.
Qualitative data from professionals and the
community (focus groups) also provided
key information.
Assesment concluded with a list of the main
community problems related to health
PLANNING AND IMPLEMENTING
INTERVENTION
2005-2006 : Planning based on Preventing and
Promoting Healthful Feeding and Physical Exercise in
pediatric and teenager population. 3 levels of action:
Health Center (primary and secondary prevention),
Schools (primary prevention and health promotion),
and Community (health promotion activities)
Community and grupal activities progressively
implemented, currently : 3 schools involved, 1
workshop specific for parents, “ The health week in the
street” with several activities related to healthy
nutrition and physical exercise
RESULTS
COMMUNITY
INVOLVEMENT
* Qualitative information in 1st step
* Community representatives
participate in prioritization and
contribute to planify activities
at community level
Community assessment
Identify and
prioritize problems
Planning and
implementing
intervention
Evaluation Community
involvement
EVALUATION
2007: First evaluation will be done in
the same age group as the community
diagnosis
Qualitative evaluation: degree of
satisfaction of all human components
of the program
In depth study of the
problem: Community
Diagnosis