Define COPC
COPC - Community-orientated primary care
- primary care where professionals from different disciplines and approaches work together with organisations and people in defined communities to identify and respond systematically to health and health-related needs to improve health
Primary care
- first point of contact of community with health care system
- epidemiology (stats, factors impact on disease)
- public health
- quality improvement
Work together
- team approach
- complex issues made easier with a team
- something meaningful id difficult to do alone
- collaboration, interdisciplinary{dr work on same pt and have same goal} vs multi disciplinary{different dr work on one pt with different goals}
Defined community
- In COPC the healthcare worker looks beyond the individual patient and assumes responsibility for the health of a specific community
- NB that the community should be a partner in every step of the COPC process
Systematic process
- COPC implementation requires that you follow certain steps in the process to address and improve health concerns within the community
Guiding principals of COPC
- Local health and institutional analysis
➡️Know the community
➡️ ensures that health care is provided specific to the community - Comprehensive care
➡️Health-disease continuum
➡️ promote, prevent, treat, rehabilitation, palliative - Equity
➡️Accessible, affordable, appropriate and relevant care - Practice with science
➡️Evidence-based and interdisciplinary care + systematic approach - Service integration around users
➡️Person-centred
➡️continuity of care
➡️partnership with community
Questions to ask when doing COPC
- What is the state of the community’s health?
- What are the factors responsible for this state of health?
- What is being done about it?
- What more can be done?
- What is the expected outcome?
Community-related factors that lead to dysfunction and disease
Social determinates of health
- poverty -> ill health -> further poverty
- overcrowding
- lack of education
- gang violence
- food insecurity
- accessibility
- violence
- sanitation
- pollution
Full list on phone
History of COPC
- Dr Sidney and Emily Kark (1940)
- Trained Health Assistants
- Visited families in their homes every 4 – 6 weeks:
➡️Built relationships
➡️Collected information on births, deaths, nutrition status, illness, employment, sanitation, water, food, work, education, etc.
➡️Socio-medical diagnosis
➡️Evidence-informedinterventionsprovided:
• Health advice & encouragement
• 1st aid & household treatment
• Smallpox vaccination
• Referral when needed
• Feedback at community meetings
COPC today
- Internationally recognized
➡️The Institute of Medicine adopted the approach in 1982 ➡️Integrated in medical training in USA and elsewhere
➡️Included in the Alma Ata Charter - In South Africa
➡️Renewed focus on Primary Health Care - Western Cape Government: Department of Health and Wellness ➡️Prioritized COPC as a critical element of service re-design
Slide 16
- holds people at its core (community at its core)
- equity
- brings care closer to where people live
- Primary health care component
- home and community based care
- collaboratively service
- defined population
- clearly demarcated geographical stable, long-term personal relationships with households that build understanding, empathy and trust
- potential of individuals for self-help
- range of curative and preventative
- optimally located to allow for easy access
Benefits of including COPC at pilot sites
- Increased appropriate referrals of children <5 to PHC facilities
- Increased
➡️cervical cancer screening
➡️antenatal visits before 20 weeks
➡️deworming dose
➡️vitamin A supplementation - Increased case findings of
➡️severe malnutrition
➡️Pneumonia
➡️children with diarrhea with dehydration
Why COPC?
- COPC can help you learn more about and reach those who are not attending health services (not all people in community come to health facility)
- Many factors that cause health problems can only be addressed on a community level (can only be solved outside of health care)
- COPC helps you to get to the root causes of illness
COPC process
- Define and Characterise the community
↕️ - Identify community’s health problems
↕️ - Develop & Implement intervention
↕️ - Monitor impact of intervention
- Not linear but can go back and forward
- centre: community (involve community in each step)
Define and characterize the community
Community definition: ‘a group of people living in the same place or having a particular characteristic in common’
Classification of different communities:
- Geographic community (living together)
- Health care coverage
- Users of a defined service (all people use the mobile clinic)
- Special population (all people working in mine)
Identify community’s health problems
Community diagnosis (Medical detective)
SOAP Approach
- S = subjective information
- O = objective information
- A = analyze information
- P = problem prioritization
Develop & Implement intervention
Things to consider when developing and implementing interventions:
- Time
- Resources
- Community assets
- Personnel – partners
- Tracking
- Impact
- Ethics
- Sustainability
Monitor impact of intervention
Very important step
Two important questions to ask:
- Was the intervention effective?
- What was the impact of the intervention?
The COPC team
Only examples
Healthcare workers
- Doctors, nurses, OTs, Physios, Speech therapists, Dieticians, Psychologists, Community care workers, etc.
Key stakeholders
- Community organisations, Police, Department of Education, Religious leaders, Non- governmental organisations, etc.
The community
- Work WITH the community and not just IN the community
Students
- Agency
