Patients and Community Together
A Family Medicine Community-Oriented Primary Care Project in an Urban Private Practice
William H. Bayer, MD;
Kevin Fiscella, MD, MPH
Arch Fam Med. 1999;8:546-549.
Background There has been considerable discussion in the literature regarding the value and feasibility of community-oriented primary care (COPC), but relatively few published real-world examples.
Objective To examine the effect of a practice-based COPC project on rates of preventive health interventions within an inner-city family medicine practice.
Methods A newly created community advisory board called Patients and Community Together (PACT) and the medical director of the practice in Rochester, NY, collaborated on all phases of the COPC project. Papanicolaou smear and mammography screening, childhood immunizations, diabetes control, and smoking cessation were targeted for intervention. A practice/community awareness campaign was instituted and individual and group incentives were developed. Progress was monitored through a computerized medical record that included all active patients in the practice.
Results Rates of annual Papanicolaou smears increased from 46% to 71%; annual mammography for women older than age 50 years, from 56% to 86%; completed childhood immunizations when younger than 6 years, from 78% to 97%; and performance of semiannual glycosylated hemoglobin, from 85% to 92%. Rates of patients with glycosylated hemoglobin values under 10% improved from 56% to 77%. There were 5 smokers who successfully quit.
Conclusion This project illustrates how practice-based COPC can be successfully implemented within a private practice setting. It also shows how COPC principles can be used to achieve the goals for Healthy People 2000 within inner-city practices.
From the Departments of Family Medicine (Drs Bayer and Fiscella) and Community and Preventive Medicine (Dr Fiscella), University of Rochester School of Medicine and Dentistry, Rochester, NY.
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