Community Oriented Primary Care A Practical Assessment, Vol. 2: Case Studies (1984) / Chapter Skim
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Tarboro-Edgecombe Health Services System
Tarboro-Edgecombe Health Services System
Pages 163-184
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From page 163... ...
There is also a strong history of cooperation with the Edgecombe County Health Department. For many years the Tarboro Clinic physicians had off ice space in the Edgecombe County Hospital until 1961 when the original portion of their present off ice building was constructed ad jacent to the new hospital building .
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From page 164... ...
Until very recently, the only in-patient facility in Edgecombe County was operated by the county health department. The original hospital was constructed in 1901 and the current facility was built in 19 59.
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From page 165... ...
The education department, established the Edgecombe Hospi tal in 1969, became in 1972 the community medicine department, and began to consider ways in which the Tarboro Clinic, the hospital, and the resources of the county health department might be better coord inated to serve the health needs of all residents of Edgecombe County. By the 1960s, many of the solo practitioners in Edgecombe County had either ret ired or lef t the area.
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From page 166... ...
The county health department runs an extensive program employing a total of 55 people and includes a nursing program divided into three individual teams. The Child Health Team deals with issues in pediatrics and school leapt and constets of six public health nurses.
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From page 167... ...
The major current project involves a study examining the determinants of patient compliance with therapeutic reg imens for hype rtens ion . In 1975, CMF was awarded a primary care development grant to set up a low-cost data system to support the primary care services delivered in the satellite facilities.
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From page 168... ...
Through a contract, the Tarboro Clinic provides X-ray and ultrasound services to the mate real and child health program of the county. The mental health center, operated with state funds independent of the county health department, provides direct services using the psychiatr ist and the clinical psychologist of the Tarboro Clinic on a parttine salary basis.
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From page 169... ...
The Tarboro Clinic and the four satellite facilities accounted for over 100,000 patient visits in 1983. Medical Records There are several medical record systems for documenting patient care in Edgecon~be County, including the medical record at the Tarboro Clinic, the hospital, each of the four satellite clinics, and the direct services programs of the county health departments.
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From page 170... ...
For example, it is estimated that in the Whitakers community virtually all children have an immunization record, but the data system indicates only 35-40 percent immunized at the Oak City facility. There is no formal linkage between the data system maintained in the Tarboro Clinic and that developed and maintained by the Community Medicine Foundation for the four satellite facilities.
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From page 171... ...
The budget for the Edgecombe County Health Department for 1983 was just over S1.2 million and is shown in Table 9.
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From page 172... ...
2 Sources of Funding for the Community Medicine Foundation CY 1981 CY1982 l CY 1983 Hypertension Study S 68, 637 S 86, 000 S 87, 900 (Contract with UNC} RHI Grant 319,000 341,000 296,000 State Primary Care S4, 793 54, 000 54, 000 Grant Coon unity fund Raising 6, 500 TOTAI. GRANTS $448, 930 S481.000 S437, 900 Medicaid S207.
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From page 173... ...
173 TABLE 9.3 Source of Revenue for the Edgecombe County Bealth Department for 1983 Carry~over f r~ 1982 County Tax Appropr fat ion S tate Aid to County Othe r State Aid to Ind igent TOTAI COUNTY E1JNDS Th i rd-Party Payment f or Home Heslth Care State/Federal Grants Family Planning MCH Aging WIC Chronic Di sease Pr imary Care Cr ippled Ch ildren TOTAl, S 65, 000 311, 000 78, 000 3, 000 15,000 472, 000 ~ 221,000 8 176, 000 146, 000 37, 000 62,000 12,000 21, 000 54, 000 29,537 S S37, 300 S1, 230, 300 TABLE 9.4 Comparison of Projected Sourcen of Revenue for the Tarboro Clinic and the Co~unity Hedicine Foundation, CY 1983 Tarboro C1 inic Co~nunity Hedicine Foundation Total Medicaid S 410, 335 (11%)
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From page 174... ...
of E:dgecombe County. Edgecombe county lies in ' -- - an area that is Credos the coastal plains of Eastern Norton ~arol~nzz in minantly based on an agricultural economy with tobacco as the major cash crop.
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From page 175... ...
They assist in the recruitment of medical staff, in fund raising, and in a general set of activities forming a liaison with the larger community. Members of the individual advisory committees are also members of the Board of Directors of the Community Medicine Foundation.
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From page 176... ...
Thus, it was estimated that 45 percent of the total need for outpatient services in Edgecombe County was being met by the Tarboro-Edgecombe Health Services System. Subsequently, a satellite facility has been opened in Oak City and by the end of the current year, each of the satellite facilities will have a full-time resident physician.
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From page 177... ...
The individual surveys were directed pr imarily to the adult members of the household and obtained a substantial amount of data on health perceptions, sources of health care, and patterns of health behavior. Although emphasizing issues related to the hypertension research, the surveys also took the opportunity to gather additional information on the health status of the residents of Edgecombe County.
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From page 178... ...
The results suggested a generally low awareness of issues of sexuality and family planning. An intervention plan has been developed that includes a health team, organized from among the staff of the county health department, the schools, and the Community Medicine Foundation.
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From page 179... ...
Also program impact would be based on review of the vital data of the county looking for an anticipated reduction of birth rate among adolescents within the community. ANALYS IS OF TARBORO~EDGECOMBE HEAI TE SERVICES SYSTEM AS A COPC PROGRAM The Eunctions of COPC Def ining and Characterizing the Community There is no reliable mechanism for listing all individusIs within Edgecombe County, the community for which the program has accepted responsibility.
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From page 180... ...
This was addressed through the development and subsequent operation of four satellite facilities, which provide access on the periphery of the county to primary care services with established linkages into Tarboro for specialty care and hospitalization. Subsequent issues addressed more recently include hypertension and adolescent pregnancy, both of which are addressed with a strategy that involves a mix of primary care and community health efforts.
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From page 181... ...
Org an ization of Providers In the mid-1960s, the health care system of Edgecombe County consisted of the Tarboro Clinic, the county health department, and a general hospital operated by the county. In addition, a number of other solo physicians were in practice in the county, although their advancing age was accompanied by a rapid decline in their numbers.
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From page 182... ...
SUMMARY In order to gain the proper perspective on the COPC program of Edgecombe County, i t is necessary to focus on the integration of the several programs that exists within the county. The major components of thin system consist of the Tarboro Clinic, the Edgecombe County Health Department, the Community Medicine Foundation, the Area Health
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From page 183... ...
The county health depar~cment provides public health services and also of fere pr imary care services for maternal and child health. The Area Health Education Center contributes to the health care system, with the development, recruitment, and maintenance of the medical manpower pool.
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From page 184... ...
184 TABLE 9 .6 Co - ar ison of the Level of Development of the ~ jor Func ~ tonal Elenents of COPC in the Tarboro-Edgeca~be Health Services System ;— Identify Modify Def ine and Community the ~nitor Characterize Health Health Impact of the Conenunitsr Problems Program Modif ications STAGE O STAGE: ~ STAGE ~ I X ACCESS STA" II ~ ACCENTS ACCESS HIGH BP HIGH BP HIGH BE ~ P=G TEEN PIG DIN PI STA" IV ACCESS refers to the acti~rity that addressed the problem of decreased access to primary in the periphery of the county. HIGE BP refers to the activity that addressed the problem of hypertension.
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