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The Conceptual Framework of
COPC
 Welcome to learning about community oriented primary care, COPC.
Before you see its applications and learn its methodology,
you will learn the principles and key features of
COPC. This session introduces you to some definitions,
the concepts of COPC, and a brief history so you can
better understand its unique qualities and potential
impact on the delivery of health services and health
status of a community.
This session includes several documents for you to
read and discussion questions for you to answer (as
assigned by your faculty member). You can find the
documents in the Lecture and File sections and your
activities under the Assignments section. Supplemental
materials on COPC applications are included in Session
7 following this. Your faculty adviser will give you
guidance and deadlines.
Session Objectives
By the end of this session, learners will be able
to:
- explain the conceptual framework of the COPC approach.
- define COPC.
- describe some of its principles.
- discuss its unique role in primary care.
Acknowledgments
The AHEC expresses its appreciation to Dr. Jaime Gofin
and Dr. Rosa Gofin of Hebrew University for their
enormous contributions to this curriculum and to Dr.
Fitzhugh Mullan and Dr. Cheryl Focht of GWU for their
contributions to teaching and implementing COPC in
local organizations. This online curriculum is a new
step in the partnership initiated several years ago
between the School of Public Health and Community
Medicine of Hadassah - Hebrew University in Jerusalem
and the School of Public Health and Health Services
of George Washington University, in the development
of innovative teaching programs on Community Oriented
Primary Care (COPC). This COPC module is an expression
of the experience shared by the two schools in the
practice and teaching of the COPC approach as initially
developed by SL Kark and his team.
Definitions
of COPC:
- Kark SL, Kark E, An alternative strategy in community
health care: community-oriented primary health care.
Isr J Med Sci 1983; 19: 707-713.
"Community oriented primary health care is
a way of practicing medicine and nursing, or of
providing primary care, which is focused on care
of the individual who is well or sick, or at risk
for illness or disease, while also focusing on promoting
the health of the community as a whole or any of
its subgroups."
- Institute of Medicine: Community Oriented Primary
Care, Vols 1 and 2. Washington DC: National Academy
Press, 1984.
"Integration of community medicine with the
primary health care of individuals."
- Community Oriented Primary Care: A Resource for
Developers. King Edward's Hospital Fund for London
and Department of Social Medicine of The Hebrew
University, London, 1994.
"...a continuous process by which primary health
care is provided to a defined community on the basis
of its assessed health needs by the planned integration
of public health with primary care practice."
- Dictionary of Epidemiology (4th Ed.) John M.
Last (editor); International Epidemiological Association,
Oxford University Press, 2001.
"The primary health care practitioner or health
team is responsible for health care both at individual
and at the community or population level."
| COPC Basics: |
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Some years ago, British and US researchers
asked 1000 people how they felt in the last
two weeks. They found that:
- 750 out of the 1000 people did not feel
well in the last two weeks.
- 250 of them sought medical help.
- 9 of them required hospitalization.
- 1 of them was treated in a teaching hospital.
Many health professionals and students are
trained to treat people by learning in teaching
hospitals. Yet primary care has the power to
reach the 999 people (well and ill) who do not
end up in a teaching hospital. In fact, primary
care has the potential to serve the vast majority
of health problems that arise in a general population
and to coordinate care among many services.
The community-oriented primary care
model combines clinical individual care with
public health to guide the planning and delivery
of health services on a community level. It
incorporates community participation in health
care decisions to determine health priorities
and interventions. It creates opportunities
for the public to participate in decision making
about health care, a major departure from the
typical practice of primary care based on demands.
Another fundamental feature involves focusing
on a defined community whose health
assets and needs have been assessed with quantitative
and qualitative data, a process that relies
heavily on epidemiological methods and
on an outreach approach.
COPC provides a road map for clinicians, practices,
health systems, and communities to move their
primary care programs into a more community
oriented format. It offers a template for teaching
community health that is data-based and replicable
across a wide variety of settings.
It is a powerful concept that has been substantiated
by the results of practice and evaluation!
Click here for Assignments due on COPC BASICS
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| The COPC Process:
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In this section, you will learn the process
of creating a COPC program. Each specific stage
of the process will be explained and illustrated
with real-life COPC programs conducted around
the world. Under the Assignments for The COPC
Process section, you will be given the opportunity
to practice each of these stages in a simulated
or real environment, depending on your own situation.
Your faculty will assign you work. You do not
have to complete every assignment unless instructed
to do so. Take your time to consider each stage
and how you may apply this to your practice.
Your faculty advisor will give you your assignment
deadlines.
Section Objectives
By the end of this section, you will be able
to:
- explain the development of a COPC program
- describe each stage in the process
- exercise skills in planning each stage
- discuss the opportunities and difficulties
of locating and analyzing data needed for
the COPC process.
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| The COPC Process:
Stages: |
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The following outlines the stages in the
COPC Process.
For more detailed explanations, click
here for the lectures.
Overview of the Stages of Development of
a COPC Practice
The six-step process on which this course is
based has been developed by the faculties at
the Hebrew University in Jerusalem and the George
Washington University in Washington, D.C. for
the purpose of teaching a practical approach
to applied COPC.
The six sequential steps of COPC are as follows:
1) Community Definition
The first stage of developing a new COPC
practice is defining the community served
by the practice. The community can be a geographically
defined area, a health plan, a neighborhood,
a school or a group of individuals registered
to receive care at a certain clinic. In each
of these settings, all members of the population
(and not only the sick or the users) will
be part of the COPC practice. Clarity in community
definition is key to all the subsequent stages
in the COPC process.
2) Community Characterization
Characterizing the defined community is the
next stage in the COPC process and is crucial
in establishing a clear understanding of the
geography and demography of the community
and the health status of its population. The
characterization should include information
on the geography of the community; the demographic
and social features of its population; health,
social, and other services available to members
of the community; and their health status.
Additionally, opinion should be gathered about
health issues in the community from individuals
who live and work there. This should be done
systematically by using methods, such as focus
groups and key informants. This information
will help the COPC team identify the main
health problems and issues of the community.
This stage is usually based on existing and
available data.
3) Prioritization
Given the competing demands of different
health problems and the restricted resources
available at the primary care level in most
health systems, the planning process must
include a comparative assessment of the different
health problems afflicting the community.
An objective selection of a health condition
or problem (or set of conditions/problems)
then must be made, with the goal of initiating
an intervention program. The participation
of both community members and staff members
from the COPC practice will assist the prioritization
process and provide substantial commitment
from individuals other than the COPC team.
Semi-quantitative techniques are available
for performing this prioritization process.
4) Detailed Assessment of the Selected Health
Problem
This stage involves the collection of additional
data about the selected health condition and
factors related to it. This exercise should
provide the team with information about the
distribution and the determinants of the selected
condition in the specific population. It will
be important to assess the past efforts of
the practice and the members of the community
in regard to this health condition. Additionally,
the COPC team will perform a literature search
and general exploration on how this selected
condition has been assessed elsewhere.
5) Intervention
According to the results of the detailed
assessment at the local level, the COPC team
will select a single intervention from among
the several candidate interventions that have
proved useful in combating a specific problem.
This process must keep practicality foremost
at all times so that the intervention selected
is feasible within the resources of the practice.
The precise nature of the problem chosen for
the intervention will, of course, determine
the specifics of the intervention, such as
its duration, location, and resources required.
Intervention planning entails adapting a proposed,
systematic intervention to the realities of
the problem in the specific community and
the realities of the COPC practice. This includes
choosing the objectives of the intervention,
allocating resources, promoting community
involvement in the activity, and planning
the timeline for the intervention. The role
of the community and clinical staff is very
important in both planning and carrying out
the intervention and should be given thoughtful
consideration.
6) Evaluation
The nature of the evaluation of the COPC
practice is, likewise, determined by the nature
of the intervention. This step cannot be well
performed as an afterthought. Evaluation is
an essential step in the COPC process to determine
the utility of the intervention and to help
in the process of considering future interventions.
It is important to develop the evaluation
plan in conjunction with the intervention
itself. What will the data needs of the evaluation
be before, during, and after the intervention?
Who will collect them? Where will they be
maintained? And who will analyze them? Decisions
on these questions need to be made prior to
initiating the intervention.
The evaluation of the COPC care produces
new data generated by the health intervention.
It constitutes a re-assessment of the situation
that existed at the initiation of the COPC
practice. Thus, the re-assessment produces
the necessary feedback for the continuing
process of COPC.
The Ongoing COPC Cycle
For a committed COPC practice, the process
does not stop with a single intervention, but
rather is seen as a continuing cycle of carefully
planned, data-based consensus projects for community
health improvement. Although updating may be
required from time to time, the definition and
characterization of the community should remain
valid for some period of time. Choosing a new
problem for the intervention at the end of the
process will, however, require reviewing the
prioritization of health problems, selecting
a new one, assessing it carefully, planning
the intervention and evaluation, and carrying
it out, as with the initial cycle.
Click
here for Assignments for the COPC Process
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Web
Based Public Health data
Lectures
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