Community needs assessment in family medicine

1
Community needs assessment in family medicine

• Dr. Yonah Yaphe
• Department of Family Medicine
• Rabin Medical Centre and
• Sackler Faculty of Medicine
• Tel Aviv University, Israel

2
Objectives

• At the end of this presentation the learner will
• Understand the concept of community needs
• Know how to assess these needs
• Value the importance of needs assessment

3
Definitions

• Community the context of the practice
• Effect of setting inner city, suburban, rural
• Effect of organization Fee for service,
  capitation, salary, fixed list, free choice
• Needs requirements of the population for good
  health well-being and function
• Needs vs. wants affordable, accessible, affable
  care

4
The nature of community needs

• Are community needs the sum of individual needs
  or is there something more?
• Is this a collective or an individual
  responsibilty?
• Who is responsible for the health effects of
  poverty, poor education, malnutrition, pollution,
  social alienation and violence?
• Who is responsible for the effects of lifestyle
  and habits like smoking, alcohol, drugs or unsafe
  driving?

5
Approaches to assessing needs

• Indicators of health quality of life, indicies
  of function
• Measures of diseases morbidity, mortality, life
  expectancy, incidence and prevalence of diseases
• Measures of use of services admission rates,
  clinic visiting rates

6
Methods of assessing needs

• Health survey community-wide, inclusive of all
  conditions or selective
• Case finding based on clinic visitors
• Use of existing data
• Epidemic surveillance
• Long interviews
• Focus groups

7
Examples of community needs assessment

• Kiryat Hayovel community health centre, Jerusalem
  Israel, 1963-1998
• Affiliated with the Department of Social Medicine
  of the Hadassah-Hebrew University Medical School
• CHAD Community syndrome of coronary artery
  disease, hypertension, and diabetes
• PROD Program for child development

8
Problems with needs assessment

• Community participation real or sham?
• Social engineering
• Conflict between individual and collective needs
  and rights
• Health surveys miss the point Experience with
  Ethiopian immigrants to Israel
• Labor intensive programs divert energies from
  real needs.

9
Measuring success of needs assessment

• Did we obtain useful data?
• Did this allow us to design an intervention?
• Did the intervention improve health?

10
Impact on the daily work of the family doctor or
trainee

• Keep a chronic disease register
• Perform visit registration
• Perform epidemic surveillance
• Audit your practice
• Do original research

11
Discussion

• The struggle is to use our limited resources
  (time, manpower, energy, money) in the most
  effective way possible.
• Will community needs assessment help us?
• It depends on how we see our practice and our
  objectives
• Reducing mortality or admissions?
• Change in behaviour?
• Improving quality of life or function?
• Change in health quality indicators?

12
Conclusion

• The role of community health needs assessment
  begins and ends with a clear understanding our
  profession, ourselves, our patients and our
  shared objectives.