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Primary Care/ Family Medicine/ Community Medicine

Community Diagnosis—PPM

Conducting a Community Diagnosis*

“How can preventive, rehabilitative, or curative services be fully effective if one knows little or nothing about the cultural, educational, economic, or psychological factors that can create barriers to care, isolate groups, and increase personal health risks for community inhabitants? – Dr. David Rogers

One of the first experiences at the Keck School of Medicine is to conduct a “Community Diagnosis” as a curriculum assignment for the PPM course. There are three components to this assignment.  First, each small group (ICM group) in the MDL has been assigned to visit a clinic in a distinct neighborhood in the greater Los Angeles region. Your group will meet with a community clinic director to learn about the role of the community clinic, and to gain a better understanding of the prevalent urban health issues in the area.  Second, either before or after the pre-arranged visit with the Community Clinic Director, the student group will walk within a 2-3 mile radius of the local health care provider/clinic assessing the neighborhood.  Using a map to pin point the provider/community clinic, the student group’s goal is to study and encircle the target community. Working in groups of two or three, the students will visit and observe different parts of “the circle”, the target community.  The visits are scheduled the week of August 16th.

The small groups are to develop a comprehensive health profile or environmental scan of the target community.  Walk through the community with open eyes and open mind.  Keep in mind that the health of those who live in the community that you are profiling are affected by the characteristics of the community itself.  With that in mind, observe and note factors that could either promote or threaten the health of its residents:  recurrent themes, emblematic landmarks of socio-cultural, economic, and environmental significance, and structural factors that help define and characterize the health of the community area.  Additionally, each team will further assess community needs by conducting an interview(s) of several leaders in the community (i.e., health clinic manager, principal, grocer, police man, small business owner and/or librarian.  You could ask questions such as what kinds of (health) problems does this community face?  What are the schools like?  Where do people go for medical care?  What other kinds of problems do people in the community face (nutrition, gang violence, sanitation, unemployment, crime, etc.)?  Keep in mind, that for an acute illness or trauma, most of the people you see will come to LAC+USC Medical Center.  They will be your patients!

Record what you see, hear, smell, and feel. HAVE FUN! The list below gives you some idea of what to pay attention to.

Community characteristics to look for:

  • Biophysical: housing including type (apartments, single family homes), variety, availability, condition of housing and density.
  • Nutrition: grocery stores, availability of fresh fruits and vegetables (you may have to go in to observe the quality of the food. Types of restaurants.
  • Educational: schools,  libraries
  • Other infrastructure: such as police and fire stations, gas stations,
  • Religious and expressive: churches/synagogues/mosques/other places of worship
  • Political: county courthouse, city hall, city councilman’s office
  • Transportation: condition of roads, public transportation (buses, metro stops), traffic. It is important to note bus routes and bus stops in their proximity to health care providers for example.
  • Recreational: public parks and recreation centers, school playgrounds and are they open after school.  Is there a community pool? What recreational facilities are available, what are the hours they are open, and who participates; where are the places to exercise? Is there a vibrant shopping district; movie theaters?
  • Topography and geography: conditions of the sidewalks, conditions of the parks, presence of street lights, obstacles and physical barriers.
  • Economic: what kinds of businesses do you see? Are there signs of jobs available?  Are there signs of unemployment?
  • Interactive: where do people “hang out”? Are there neighborhood coffee shops, cafes?
  • Health and medical care needs: hospitals, pharmacies, nursing homes, clinics and doctors’ offices
  • People: ethnic groups, ages, gender mix, languages spoken, homelessness. Is there a police presence?

Record your impressions of the community. In analyzing your data ask yourselves: how might what we observe affect the health and health care of the people living here?  For example, congestion may increase the risk of communicable disease. A lack of parks or area to exercise increases the risk for cardiovascular disease.

The third component of the assignment is to create a Community Map and Profile presentation, highlighting important characteristics of the community that you visited.  Please be as creative as you wish in recording important features of your target community.  Photos and videos may be important additions to your profile as well as written observations.  The presentation that your group will create will be presented to your fellow MDL classmates.

***Students should bring their notes, photos and videos to present and discuss their findings with their large MDL group. ***

Quotes:

“Thank you for the opportunity to meet such fine, enthusiastic physician trainees.  It was a pleasure to share with them the pleasure and challenge of treating each individual in the context of their family and their community.”

–Judith Kraft, MD, CMO of Wilmington Community Clinic

“Primary care is on the cutting edge of health care reform-health care’s ground zero-and still the best place to make a meaningful difference in the lives of individuals and communities.”

–Jehni Robinson, MD, Saban Free Clinic

“Primary care and community medicine may not come with the same prestige or glamour as other fields of practice.  However, working in a community health center provides countless opportunities to inspire fundamental lifestyle changes for populations who need your help the most.  Specialists make a difference by treating those with life-threatening conditions; but as a physician in a community clinic, you could help prevent such illnesses from developing in the first place. We’re so appreciative to be a part of the project.  The students this year had very thoughtful questions and insightful observations after our Clinic tour.  They all had comments and input in the Q&A session, an active discussion where everyone was engaged.  We also appreciated that they were dressed professionally, despite having to walk around the neighborhood in the hot weather!  We would definitely like to be included in this project again next year.”

Kirby Van Amburgh, Project Manager of KHEIR Center

“This was a great experience!  Great group! Great questions.  Glad they did their local tour around the area prior to the visit helps to contextualize things. Community medicine is as much a needed service as it is a self-rewarding career, and these two points alone can help to stave off what one can view as the chronic combat fatigue that is medicine today.  It cures what ails ya’. 😉 ”

— Guillermo Diaz Jr. MD, Chief Medical Information Officer/Assistant Chief Medical Officer of QueensCare Family Clinics


* The “Community Diagnosis” is adapted from Eugenia E. Blanchard L. Action-oriented community diagnosis: a health education tool. International Quarterly of Community Health Education. 1991; 11(2): 93- 110 and Sloane P, et. al. eds. Essentials of Family Medicine, Baltimore: Lippincott Williams & Wilkins; 2002