Improving population health through integration of primary care and public health: providing access to physical activity for community health center patients.
ABSTRACT Objectives. Our community health center attempted to meet public health goals for encouraging exercise in adult patients vulnerable to obesity, diabetes, hypertension, and other chronic diseases by partnering with a local YMCA. Methods. During routine office visits, providers referred individual patients to the YMCA at no cost to the patient. After 2 years, the YMCA instituted a $10 per month patient copay for new and previously engaged health center patients. Results. The copay policy change led to discontinuation of participation at the YMCA by 80% of patients. Patients who persisted at the YMCA increased their visits by 50%; however, more men than women became frequent users after institution of the copay. New users after the copay were also more likely to be younger men. Thus the copay skewed the population toward a younger group of men who exercised more frequently. Instituting a fee appeared to discourage more tentative users, specifically women and older patients who may be less physically active. Conclusions. Free access to exercise facilities (rather than self-paid memberships) may be a more appropriate approach for clinicians to begin engaging inexperienced or uncertain patients in regular fitness activities to improve health.
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ABSTRACT: Purpose Obesity is a significant public health problem in women's health. This study examined relationship between body esteem, exercise motivations, depression, and social support among female free clinic patients. Low-income women who are at risk for obesity and other health concerns would benefit from health education efforts. Methods We compared 299 female and 164 male free clinic patients 18 years or older using assessments for body esteem, motivation to exercise, depression, and social support. Results Although female participants reported lower levels of body esteem and higher levels of depression compared with male participants (p < .01), female participants were more motivated to exercise for weight-related reasons than male participants (p < .05). U.S.-born female participants reported lower exercise motivations compared with non–U.S.-born female participants (p < .01). Social support might be an important factor to increase exercise motivation among female free clinic patients (p < .05); depression lowers levels of body esteem (p < .01). Conclusions The results of this study suggest that female free clinic patients should receive gender-specific interventions to promote positive body image and physical activity. It is important for health educators to engage a myriad of physical activity motives to increase the likelihood that clients will experience enjoyment and sustained adoption of exercise into their lifestyle. Future practice and research should warrant the implementation of body image and physical activity programs and the potential impact of using exercise to reducing depression among female patients at free clinics.Women s Health Issues 10/2014; DOI:10.1016/j.whi.2014.05.007 · 1.61 Impact Factor
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ABSTRACT: Optimizing the health of populations, whether defined as persons receiving care from a health care delivery system or more broadly as persons in a region, is emerging as a core focus in the era of health care reform. To achieve this goal requires an approach in which preventive care is valued and "nonmedical" determinants of patients' health are engaged. For large, multimission systems such as academic medical centers, navigating the evolution to a population-oriented paradigm across the domains of patient care, education, and research poses real challenges but also offers tremendous opportunities, as important objectives across each mission begin to align with external trends and incentives. In clinical care, opportunities exist to improve capacity for assuming risk, optimize community benefit, and make innovative use of advances in health information technology. Education must equip the next generation of leaders to understand and address population-level goals in addition to patient-level needs. And the prospects for research to define strategies for measuring and optimizing the health of populations have never been stronger. A remarkable convergence of trends has created compelling opportunities for academic medical centers to advance their core goals by endorsing and committing to advancing the health of populations.Academic medicine: journal of the Association of American Medical Colleges 02/2014; 89(4). DOI:10.1097/ACM.0000000000000171 · 3.47 Impact Factor
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ABSTRACT: I commend Silva et al. for their work toward integrating primary care and public health to promote exercise participation and healthy lifestyle change among low-income ethnic minority populations.(1) Establishing strategic partnerships with institutions such as the YMCA extends low-income individuals access to high-quality, community-centered wellness facilities that might otherwise be unaffordable. (Am J Public Health. Published online ahead of print March 14, 2013: e1. doi:10.2105/AJPH.2013.301216).American Journal of Public Health 03/2013; DOI:10.2105/AJPH.2013.301216 · 4.23 Impact Factor