A national framework to improve health

Integrating primary and community care to promote prevention

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For the past decade, researchers at Virginia Commonwealth University have been leading a national effort to integrate primary care and community care to promote prevention and support health behavior change.

Clinical preventive services, such as screening tests, immunizations, health behavior counseling and preventive medications, can save lives. However, studies have shown that Americans receive only half of these recommended preventive services. The “prevention gap,” if closed, could substantially increase the quality and length of life.

On this topic, Alex Krist, M.D., associate professor, and Steven Woolf, M.D., professor, community-engaged research experts from the Department of Family Medicine and Population Health in the VCU School of Medicine, have released their most recent study, “Clinical and Community Delivery Systems for Preventive Care: An Integration Framework,” published in the October issue of the American Journal of Preventive Medicine.

The paper focuses on a framework to describe how clinicians and the community can work together to support preventive services, creating a healthier society.

According to Krist, opportunities to improve the delivery of coordinated clinical preventive services exist in both clinical and community settings, but these activities are rarely coordinated, resulting in inefficiencies and reduced benefits.

The current study is an example of one type of community-engaged research that links clinical care, often primary care, with resources where patients live, work and play.

“Helping patients to eat right, exercise, lose weight and quit smoking is difficult. Patients need more help than either primary care or the community can provide,” said Krist, who is also the director of the Community Engagement Core with the VCU Center for Clinical and Translational Research. “Together, though, we can create a better model to help patients. Doctors are good at motivating patients, but often struggle with providing intensive daily support for health behavior change. But many community resources specialize in providing this daily support. Integrating the two creates a natural synergy.”

“This type of integration was the subject of a recent Institute of Medicine report,” added Woolf, who is also the director of the VCU Center on Society and Health. “But the ingredients of success are not discussed in many blue-ribbon reports. Our article lays out a framework based on dozens of examples of successful integration across the country. These principles provide a formula for scalability – the implementation of the Institute of Medicine recommendations on a broad scale.”

A number of federal entities, academic institutions, specialty societies and foundations worked together, under VCU’s leadership, to create a framework that identifies the necessary participants, their role in care delivery, and the infrastructure, support and policies needed to ensure success.

“The paper is unique because we worked collaboratively with the Centers for Disease Control and Prevention for a year, did field observations and interviews with 53 successful clinical-community integrations nationally and led a stakeholder meeting with 33 national organizations to generate this framework,” Krist said. “It was a real national effort.”

Greater success in preventing disease through collaboration may not only save lives, but may also reduce disease burden and thereby help curb the rising costs of health care, according to the paper.

“Just as our society is committed to caring for acute and chronic illnesses, a similar commitment for prevention is important,” Krist said. “With national efforts to not only expand coverage of clinical preventive services, but to test innovations for promoting quality health care as well, developing and implementing new clinical-community integration models such as the framework we have created is of critical importance to improve the health of Americans.”

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