Community Oriented Primary Care ( COPC ) : An Effective Paradigm for Preventive Care

Community-Oriented Primary Care (COPC) can be an effective paradigm for both the inclusion of preventive care in primary care practices, especially in rural Utah, and the effective teaching of preventive medicine and primary care. This article discusses the three major elements of COPC and suggests a five-step process to incorporate COPC into a health care professional’s practice that would be applicable for any Utah provider. In addition, the definition of primary care, which was approved by the Institute of Medicine and the World Health Organization, is briefly outlined. Introduction The purpose of this paper is to highlight the key ingredients of “Community-Oriented Primary Care” (COPC) and indicate how these can be effective in teaching preventive medicine and primary care to health care providers. Paul Frame, MD, a practicing family physician in rural New York State, has become a national leader in the area of preventive health by demonstrating his ability to fully incorporate these COPC principles into a busy primary care practice. Further, he has written how the broader principles espoused under the title COPC have positively impacted his practice, including the delivery of preventive health services (Frame, 1989). Other authors have written extensively about the importance of the COPC approach in reshaping health care delivery in this country (Garr, Rhyne, Kukulka, 1993; Wright, 1993; Smith, Anderson, Boumbulian, 1991). In a similar fashion, COPC can be an effective tool for the state of Utah, which already has a reputation as one of the more health conscious states in the nation. Mainstream medical practice has been slow to fully incorporate well accepted preventive health strategies, such as those found in the U.S. Preventive Health Services Task Force Report (U.S. Preventive Health Services Task Force, 1989), into their day–to-day care of patients. There are many theories for this problem. These include the “disease focus” of American medicine coupled with the high percentage (approximately 70%) of physicians practicing in the sub-specialties (American Board of Medical Specialties, 1995), the focus of the public on curative medicine, the economic pressures of medical practice, and the lack of training provided to current practitioners. Dr. Frame makes the case that the principles of COPC have value in practice. However, these principles must be incorporated into the training of health care professionals, early and often throughout their education, if the volume and frequency of effective preventive services provided to our nation’s citizens is to be expanded. Ivey Boufford, M.D. and Pat A. Shonubi, B.S.N. , R.N. , M.S., have written a book on the value of, and techniques for, teaching COPC for urban practitioners, which includes a chapter discussing preventive education. (Bouford, Shonubi, 1986). The Task Force on Residency Curriculum for the Future, sponsored by the Society of Teachers of Family Medicine, incorporated the teaching of COPC into its curriculum noting that it “provides an excellent system for teaching community health to family practice residents” (Merenstein, Schulte, 1990). Following the Institute of Medicine’s publication of their report on COPC (Institute of Medicine, 1984), the Bureau of Primary Health Care (of the Health Resources and Services Administration, Public Health Service, DHHS) adopted these principles of practice for their grantees, including; community health centers, migrant health