Patients and community together - A family medicine community-oriented primary care project in an urban private practice

Background: There has been considerable discussion in the literature regard ing the value and feasibility of community-oriented primary care (COPC), bu t 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 pra ctice. Methods: A newly created community advisory board called Patients and Commu nity 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 smok ing cessation were targeted for intervention. A practice/community awarenes s campaign was instituted and individual and group incentives were develope d. Progress was monitored through a computerized medical record that includ ed all active patients in the practice. Results: Rates of annual Papanicolaou smears increased from 46% to 71%; ann ual mammography for women older than age 50 years, from 56% to 86%; complet ed childhood immunizations when younger than 6 years, from 78% to 97%; and performance of semiannual glycosylated hemoglobin, from 85% to 92%. Rates o f 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 success fully 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.