Linking primary care practice to community services: Where are we now?

Background: There is ample evidence for benefits of community-based programs in providing preventive care and improving chronic disease management. Leveraging community resources has become an important strategy in re-designing primary care delivery. However, ample empirical data on the use of community-based programs by patients seen in primary care practice is lacking.

Objective/purpose: To describe the prevalence of community health resources use by primary care patients in community health centers.

Methods: This was a cross-sectional survey study of 161 primary care patients in Washington Heights, New York City, from October to December of 2011. The study participants were recruited at three primary care practice sites serving predominantly Hispanic patients with Medicaid coverage. Both self-administered and face-to-face interviews were used.

Results: Among adult primary care patients surveyed, 24.2% of them reported knowing about any community- based programs for promoting health behavior and disease prevention. The majority of the patients (91.1%) believed community-based programs could be helpful in disease prevention, but only 16% reported to have used any community programs to address health issues. More than half of the patients (66.7%) would be interested in using community services to improve diet and physical activity, if referred by a health care provider. Only 23% patients reported their primary care providers referred them to a community-based program to address health issues. Most of the patients expressed interest in getting more information about community programs from the doctor's office or via mail. The major barriers preventing use of community programs include language fluency, lack of time and lack of transportation.

Discussion/conclusions: Patients had poor knowledge and low use of existing community-based programs. As only a small number of patients were referred to a community program by their provider, this study highlighted the urgent need to establish and implement effective linkages between primary care practices and community services to improve patient care outcomes. Various strategies need to be developed to facilitate integration of community resources into clinical care. While both government programs and private foundations have invested in the development of community programs such as public health programs and community health workers, further efforts are required to develop the functional linkages and collaborations between primary care practices and community organizations to address the needs of individual patients and improve the population's health.