Improving Population Health Through Integration of Primary Care and Public Health: Providing Access to Physical Activity for Community Health Center Patients

Matthew Silva and Lucy M. Candib are with the Family Health Center of Worcester, Worcester MA. Matthew Silva is also with the Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Worcester. Suzanne Cashman and Parag Kunte are with the Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester.
American Journal of Public Health (Impact Factor: 4.55). 09/2012; 102(11):e56-61. DOI: 10.2105/AJPH.2012.300958
Source: PubMed


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.

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.

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.

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: 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).
    No preview · Article · Mar 2013 · American Journal of Public Health
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    ABSTRACT: Hopkins offers two reasonable suggestions to improve participation in an open model for exercise access. Establishing a gym-buddy system may facilitate healthy socialization and create a mutual support mechanism for physical activity goals and improved health. Gym-buddy networks could be created using group visits and organized by a coordinator who would suggest individual and group goals. Trainers or staff can be used to encourage personal goal setting and facilitate patient groups. Scheduled phone calls could also be used for coaching and follow-up when individuals miss sessions. These interventions may be scaled to fit the partnership and budget for this work. (Am J Public Health. Published online ahead of print April 18, 2013: e1. doi:10.2105/AJPH.2013.301364).
    No preview · Article · Apr 2013 · American Journal of Public Health
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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.
    No preview · Article · Feb 2014 · Academic medicine: journal of the Association of American Medical Colleges
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