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OCR for page 222
COPC ant! a State Health
Department: West
Virginia's Experience
~ Clark Hansbarger
The West Virginia Department of Health has become a strong advocate
of what we are today calling community oriented primary care (COPC).
The department has been influenced to move in this direction by a variety
of internal and external sources. Included in these sources are the two most
recent directors (of which I am one), the community "wants," community
health needs, federal community health programs, United Mine Workers
of America-supported clinics, community boards of directors, the state
legislature, and Governor John D. Rockefeller IV.
One major result of these influences was the law passed by the state
legislature in 1977 that reorganized the departments of Mental Health,
Hospitals and Public Health into a new State Department of Health. The
purpose of the law is "to develop and implement a coordinated and com-
prehensive continuum of health and mental health services to meet current
and future needs at reasonable costs; to promote the delivery of preventive
care by emphasis on primary care and community-based services; tO achieve
equal access tO all types of quality care for all citizens of the State; to
encourage the active participation of the citizens of this State in matters
relating tO the delivery of health and mental health services...." With this
visionary statement, the state legislature provided the State Department of
Health with a mandate for its emphasis on COPC. This set of inputs,
combined with the knowledge, dedication, and values that each employee
brings to the State Health Department, have resulted in an identifiable set
of values and management norms that this administration intends to pursue.
They are:
222
OCR for page 223
COPC and a State Health Department
223
1. Health services should be comprehensive, coordinated, and inte-
grated.
2. The least restrictive mode of care is the best. This norm is especially
applied to developmental disabilities and geriatric care, but covers the con-
tinuum of health services delivered and funded by the department.
3. Health care services should be community-based, and are best planned,
organized, and delivered at the community level.
4. Health services should be responsive to epidemiologically defined
community needs.
5. Community health services should emphasize prevention, wellness,
and the reduction of the risk factors that are linked to the three major
killers—cancer, heart diseases, and accidents.
6. The process used in helping communities and medical practices be-
come more responsive to broader health needs should be an educative/
.. . .
mediative process, not a coercive one.
The continuing role of the State Health Department is not so much to
actually provide COPC services as it is to create a positive climate conducive
to the provision of those services. Through direct communication to pro-
viders and consumers we affect the knowledge, attitudes, values, and per-
ceptions of both providers and health care consumers. Our work with liaison
groups from various health care sectors, public health education for con-
sumers, and our commitment to grass roots health planning help maintain
open channels of communication and help establish the department's values
and operating norms in the public mind.
Through training and community organization, the State Health De-
partment affects availability of resources, accessibility, referrals, and skills.
In this regard, West Virginia has recently demonstrated its commitment to
funding community-based health care programs by the state legislature's
providing more than $1 million in new matching funds for the Primary
Care Block Grant, which it expects to assume in October 1982. Statewide
training programs, technical assistance programs, and conferences are also
important activities in affecting these factors.
The department also promotes COPC by affecting the attitudes and
behavior of health personnel and employers. The importance of attitudes
and behavior of State Health Department staffs cannot be overemphasized,
and the formal and informal organizational structure can and does influence
those attitudes.
In looking for behavioral outcomes for the department's activities in
COPC we may assess utilization, preventive actions, consumptive patterns,
compliance, and self-care within the dimensions of earliness, frequency,
quality, range, and persistence. Defining the standards against which to
OCR for page 224
224
PART II: PRACTICAL APPLICATIONS
measure these indicators presents another challenge, but changes or ex-
ceptions from established patterns could be easily noted.
The outcome of these behaviors is, hopefully, an improvement in the
health problems facing our communities. Some of these problems are re-
flected in our current statistical reporting systems, and these systems could
be refined to indicate morbidity, mortality, fertility, and disability within
the dimensions of incidence, prevalence, distribution, intensity, and dura-
tion. Improvement in these areas, not just statistically but in the everyday
lives of people, makes for an improvement in the "quality of life." It is this
translation of health services into quality of life terms that is our most
important and perhaps difficult task.
In the future the West Virginia Department of Health hopes to hold the
line on the advances we have made so far. That in itself is a fairly large
order in these times of economic retrenchment. We will try to improve
and strengthen the incentives offered to providers who have practiced
COPC and support their efforts in practical ways. We can also offer high-
quality technical assistance in the epidemiology of community health prob-
lems that public and private health providers observe daily. By providing
relevant support and encouragement of COPC, we hope to make COPC
the standard of care for West Virginia.
Representative terms from entire chapter:
health department
