Community health

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Community health is a major field of study within the medical and clinical sciences which focuses on the maintenance, protection, and improvement of the health status of population groups and communities. It is a distinct field of study that may be taught within a separate school of [public health] or [environmental health]. The WHO defines community health as:

World Health Organization Specialised agency of the United Nations

The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organisation, was an agency of the League of Nations.

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environmental, social, and economic resources to sustain emotional and physical well being among people in ways that advance their aspirations and satisfy their needs in their unique environment. [1]

Community health tends to focus on a defined geographical community. The health characteristics of a community are often examined using geographic information system (GIS) software and public health datasets. Some projects, such as InfoShare or GEOPROJ combine GIS with existing datasets, allowing the general public to examine the characteristics of any given community in participating countries.

Community group of interacting living organisms sharing a populated environment; a social unit of human organisms who share common values

A community is a small or large social unit that has something in common, such as norms, religion, values, or identity. Communities often share a sense of place that is situated in a given geographical area or in virtual space through communication platforms. Durable relations that extend beyond immediate genealogical ties also define a sense of community. People tend to define those social ties as important to their identity, practice, and roles in social institutions. Although communities are usually small relative to personal social ties (micro-level), "community" may also refer to large group affiliations, such as national communities, international communities, and virtual communities.

A geographic information system (GIS) is a system designed to capture, store, manipulate, analyze, manage, and present spatial or geographic data. GIS applications are tools that allow users to create interactive queries, analyze spatial information, edit data in maps, and present the results of all these operations. GIS sometimes refers to geographic information science (GIScience), the science underlying geographic concepts, applications, and systems.

Public health preventing disease, prolonging life and promoting health through organized efforts and informed choices of society and individuals

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the health of a population and the threats it faces is the basis for public health. The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological and social well-being. As such, according to the World Health Organization, it is not merely the absence of disease or infirmity.

Medical interventions that occur in communities can be classified as three categories: primary healthcare, secondary healthcare, and tertiary healthcare. Each category focuses on a different level and approach towards the community or population group. In the United States, community health is rooted within primary healthcare achievements. [2] Primary healthcare programs aim to reduce risk factors and increase health promotion and prevention. Secondary healthcare is related to "hospital care" where acute care is administered in a hospital department setting. Tertiary healthcare refers to highly specialized care usually involving disease or disability management.

Primary Health Care, or PHC, refers to "essential health care" that is based on "scientifically sound and socially acceptable methods and technology, which make universal health care accessible to all individuals and families in a community. It is through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination". In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy. PHC includes all areas that play a role in health, such as access to health services, environment and lifestyle. Thus, primary healthcare and public health measures, taken together, may be considered as the cornerstones of universal health systems. The World Health Organization, or WHO, elaborates on the goals of PHC as defined by three major categories, "empowering people and communities, multisectoral policy and action; and primary care and essential public health functions as the core of integrated health services[1]." Based on these definitions, PHC can not only help an individual after being diagnosed with a disease or disorder, but actively prevent such issues by understanding the individual as a whole.

United States federal republic in North America

The United States of America (USA), commonly known as the United States or America, is a country composed of 50 states, a federal district, five major self-governing territories, and various possessions. At 3.8 million square miles, the United States is the world's third or fourth largest country by total area and is slightly smaller than the entire continent of Europe's 3.9 million square miles. With a population of over 327 million people, the U.S. is the third most populous country. The capital is Washington, D.C., and the largest city by population is New York City. Forty-eight states and the capital's federal district are contiguous in North America between Canada and Mexico. The State of Alaska is in the northwest corner of North America, bordered by Canada to the east and across the Bering Strait from Russia to the west. The State of Hawaii is an archipelago in the mid-Pacific Ocean. The U.S. territories are scattered about the Pacific Ocean and the Caribbean Sea, stretching across nine official time zones. The extremely diverse geography, climate, and wildlife of the United States make it one of the world's 17 megadiverse countries.

In epidemiology, a risk factor is a variable associated with an increased risk of disease or infection. When evidence is found the term determinant is used as a variable associated with either increased or decreased risk.

The success of community health programmes relies upon the transfer of information from health professionals to the general public using one-to-one or one to many communication (mass communication). The latest shift is towards health marketing.

Mass communication is the study of how people exchange their information through mass media to large segments of the population at the same time with an amazing speed. In other words, mass communication refers to imparting and exchanging information on a large scale to a wide range of people. It is usually understood for relating newspaper, magazine, and book publishing, as well as radio, television and film, even via internet as these mediums are used for disseminating information, news and advertising. Mass communication differs from the studies of other forms of communication, such as interpersonal communication or organizational communication, in that it focuses on a single source transmitting information to a large number of receivers. The study of mass communication is chiefly concerned with how the content of mass communication persuades or otherwise affects the behavior, the attitude, opinion, or emotion of the person or people receiving the information.

Health marketing is a new, customer-centered, approach to public health promotion that applies traditional marketing principles and theories alongside science-based strategies to protect and promote the health of diverse populations.It involves creating, communicating, and delivering messages for the public on prevention, health promotion and health protection. Health marketing is one of the ways advancements in medicine and in health-protecting services, such as insurance, are made widely known. A good example is the current drive in Kenya to promote circumcision among communities that do not customarily circumcise. Medical researchers have recently documented that circumcision is 65% effective in preventing HIV infection among men.

Measuring community health

Community health is generally measured by geographical information systems and demographic data. Geographic information systems can be used to define sub-communities when neighborhood location data is not enough. [3] Traditionally community health has been measured using sampling data which was then compared to well-known data sets, like the National Health Interview Survey or National Health and Nutrition Examination Survey. [4] With technological development, information systems could store more data for small scale communities, cities, and towns; as opposed to census data that only generalizes information about small populations based on the overall population. Geographical information systems (GIS) can give more precise information of community resources, even at neighborhood levels. [5] The ease of use of geographic information systems (GIS), advances in multilevel statistics, and spatial analysis methods makes it easier for researchers to procure and generate data related to the built environment. [6]

The National Health Interview Survey (NHIS) is an annual, cross-sectional survey intended to provide nationally representative estimates on a wide range of health status and utilization measures among the nonmilitary, noninstitutionalized population of the United States. Each annual data set can be used to examine the disease burden and access to care that individuals and families are currently experiencing in the United States.

The National Health and Nutrition Examination Survey (NHANES) is a survey research program conducted by the National Center for Health Statistics (NCHS) to assess the health and nutritional status of adults and children in the United States, and to track changes over time. The survey combines interviews, physical examinations and laboratory tests.

Information systems (IS) are formal, sociotechnical, organizational systems designed to collect, process, store, and distribute information. In a sociotechnical perspective, information systems are composed by four components: task, people, structure, and technology.

Social media can also play a big role in health information analytics. [7] Studies have found social media being capable of influencing people to change their unhealthy behaviors and encourage interventions capable of improving health status. [7] Social media statistics combined with geographical information systems (GIS) may provide researchers with a more complete image of community standards for health and well being. [8] [9]

Categories of community health

Primary healthcare and primary prevention

Community based health promotion emphasizes primary prevention and population based perspective(traditional prevention). [10] It is the goal of community health to have individuals in a certain community improve their lifestyle or seek medical attention. Primary healthcare is provided by health professionals, specifically the ones a patient sees first that may refer them to secondary or tertiary care.

Primary prevention refers to the early avoidance and identification of risk factors that may lead to certain diseases and disabilities. Community focused efforts including immunizations, classroom teaching, and awareness campaigns are all good examples of how primary prevention techniques are utilized by communities to change certain health behaviors. Prevention programs, if carefully designed and drafted, can effectively prevent problems that children and adolescents face as they grow up. [11] This finding also applies to all groups and classes of people. Prevention programs are one of the most effective tools health professionals can use to greatly impact individual, population, and community health. [11]

Secondary healthcare and secondary prevention

Community health can also be improved with improvements in individuals' environments. Community health status is determined by the environmental characteristics, behavioral characteristics, social cohesion in the environment of that community. [12] Appropriate modifications in the environment can help to prevent unhealthy behaviors and negative health outcomes.

Secondary prevention refers to improvements made in a patient's lifestyle or environment after the onset of disease or disability. This sort of prevention works to make life easier for the patient, since it's too late to prevent them from their current disease or disability. An example of secondary prevention is when those with occupational low back pain are provided with strategies to stop their health status from worsening; the prospects of secondary prevention may even hold more promise than primary prevention in this case. [13]

Chronic disease self management programs

Chronic diseases has been a growing phenomena within recent decades, affecting nearly 50% of adults within the US in 2012. [14] Such diseases include asthma, arthritis, diabetes, and hypertension. While they are not directly life-threatening, they place a significant burden on daily lives, affecting quality of life for the individual, their families, and the communities they live in, both socially and financially. Chronic diseases are responsible for an estimated 70% of healthcare expenditures within the US, spending nearly $650 billion per year.

With steadily growing numbers, many community healthcare providers have developed self-management programs to assist patients in properly managing their own behavior as well as making adequate decisions about their lifestyle. [15] Separate from clinical patient care, these programs are facilitated to further educate patients about their health conditions as a means to adopt health-promoting behaviors into their own lifestyle. [16] Characteristics of these programs include:

  • grouping patients with similar chronic diseases to discuss disease-related tasks and behaviors to improve overall health
  • improving patient responsibility through daily disease-monitoring
  • inexpensive and widely-known

Chronic Disease self-management programs are structured to help improve overall patient health and quality of life as well as utilize less healthcare resources, such as physician visits and emergency care. [17] Furthermore, better self-monitoring skills can help patients effectively and efficiently make better use of healthcare professionals' time, which can result in better care. [18] Many self-management programs either are conducted through a health professional or a peer diagnosed with a certain chronic disease trained by health professionals to conduct the program. No significant differences have been reported comparing the effectiveness of both peer-led versus professional led self-management programs. [17]

The distribution of rural CDSME program participantsvaried across the US. Analysis across rurality indicated that approximately 22.1% (using county-level rurality) to24.4% (using ZCTA/ZIP Code-level rurality) of CDSME programparticipants resided in rural areas. Distribution of the chronic-disease self-management program by ZIP Code and rurality.png
The distribution of rural CDSME program participantsvaried across the US. Analysis across rurality indicated that approximately 22.1% (using county-level rurality) to24.4% (using ZCTA/ZIP Code-level rurality) of CDSME programparticipants resided in rural areas.

There has been a lot of debate regarding the effectiveness of these programs and how well they influence patient behavior and understanding their own health conditions. Some studies argue that self-management programs are effective in improving patient quality of life and decreasing healthcare expenditures and hospital visits. A 2001 study assessed health statuses through healthcare resource utilizations and self-management outcomes after 1 and 2 years to determine the effectiveness of chronic disease self-management programs. After analyzing 800 patients diagnosed with various types of chronic conditions, including heart disease, stroke, and arthritis, the study found that after the 2 years, there was a significant improvement in health status and fewer emergency department and physician visits (also significant after 1 year). They concluded that these low-cost self-management programs allowed for less healthcare utilization as well as an improvement in overall patient health. [19] Another study in 2003 by the National Institute for Health Research analyzed a 7-week chronic disease self-management program in its cost-effectiveness and health efficacy within a population over 18 years of age experiencing one or more chronic diseases. They observed similar patterns, such as an improvement in health status, reduced number of visits to the emergency department and to physicians, shorter hospital visits. They also noticed that after measuring unit costs for both hospital stays ($1000) and emergency department visits ($100), the study found the overall savings after the self-management program resulted in nearly $489 per person. [20] Lastly, a meta-analysis study in 2005 analyzed multiple chronic disease self-management programs focusing specifically on hypertension, osteoarthritis, and diabetes mellitus, comparing and contrasting different intervention groups. They concluded that self-management programs for both diabetes and hypertension produced clinically significant benefits to overall health. [15]

On the other hand, there are a few studies measuring little significance of the effectiveness of chronic disease self-management programs. In the previous 2005 study in Australia, there was no clinical significance in the health benefits of osteoarthritis self-management programs and cost-effectiveness of all of these programs. [15] Furthermore, in a 2004 literature review analyzing the variability of chronic disease self-management education programs by disease and their overlapping similarities, researchers found "small to moderate effects for selected chronic diseases," recommending further research being conducted. [16]

Some programs are looking to integrate self-management programs into the traditional healthcare system, specifically primary care, as a way to incorporate behavioral improvements and decrease the increased patient visits with chronic diseases. [21] However, they have argued that severe limitations hinder these programs from acting its full potential. Possible limitations of chronic disease self-management education programs include the following: [18]

  • underrepresentation of minority cultures within programs
  • lack of medical/health professional (particularly primary care) involvement in self-management programs
  • low profile of programs within community
  • lack of adequate funding from federal/state government
  • low participation of patients with chronic diseases in program
  • uncertainty of effectiveness/reliability of programs

Tertiary healthcare

In tertiary healthcare, community health can only be affected with professional medical care involving the entire population. Patients need to be referred to specialists and undergo advanced medical treatment. In some countries, there are more sub-specialties of medical professions than there are primary care specialists. [12] Health inequalities are directly related to social advantage and social resources. [12]

Aspects of care that distinguish conventional health care from people-centred primary care [22]
Conventional ambulatory medical care in clinics or outpatient departmentsDisease control programmesPeople-centred primary care
Focus on illness and cureFocus on priority diseasesFocus on health needs
Relationship limited to the moment of consultationRelationship limited to programme implementationEnduring personal relationship
Episodic curative careProgramme-defined disease control interventionsComprehensive, continuous and personcentred care
Responsibility limited to effective and safe advice to the patient at the moment of consultationResponsibility for disease-control targets among the target populationResponsibility for the health of all in the community along the life cycle; responsibility for tackling determinants of ill-health
Users are consumers of the care they purchasePopulation groups are targets of disease-control interventionsPeople are partners in managing their own health and that of their community

Challenges and difficulties with community health

Summary of Governance Issues, Strategies, and New/Lingering Problems Table 2 Summary of Governance Issues, Strategies, and Problems.tif
Summary of Governance Issues, Strategies, and New/Lingering Problems

The complexity of community health and its various problems can make it difficult for researchers to assess and identify solutions. Community-based participatory research (CBPR) is a unique alternative that combines community participation, inquiry, and action. [24] Community-based participatory research (CBPR) helps researchers address community issues with a broader lens and also works with the people in the community to find culturally sensitive, valid, and reliable methods and approaches. [24]

Other issues involve access and cost of medical care. A great majority of the world does not have adequate health insurance. [25] In low-income countries, less than 40% of total health expenditures are paid for by the public/government. [25] Community health, even population health, is not encouraged as health sectors in developing countries are not able to link the national authorities with the local government and community action. [25]

In the United States, the Affordable Care Act (ACA) changed the way community health centers operate and the policies that were in place, greatly influencing community health. [26] The ACA directly affected community health centers by increasing funding, expanding insurance coverage for Medicaid, reforming the Medicaid payment system, appropriating $1.5 billion to increase the workforce and promote training. [26] The impact, importance, and success of the Affordable Care Act is still being studied and will have a large impact on how ensuring health can affect community standards on health and also individual health.

Academic resources

See also

Notes

  1. "A discussion document on the concept and principles of health promotion". Health Promotion. 1 (1): 73–76. May 1986. doi:10.1093/heapro/1.1.73. PMID   10286854.
  2. Goodman RA, Bunnell R, Posner SF (October 2014). "What is "community health"? Examining the meaning of an evolving field in public health". Preventive Medicine. 67 Suppl 1: S58–61. doi:10.1016/j.ypmed.2014.07.028. PMC   5771402 . PMID   25069043.
  3. Elias Mpofu, PhD (2014-12-08). Community-oriented health services : practices across disciplines. Mpofu, Elias. New York, NY. ISBN   9780826198181. OCLC   897378689.
  4. "Chapter 36. Introduction to Evaluation | Community Tool Box". ctb.ku.edu. Retrieved 2018-03-05.
  5. Pearce J, Witten K, Bartie P (May 2006). "Neighbourhoods and health: a GIS approach to measuring community resource accessibility". Journal of Epidemiology and Community Health. 60 (5): 389–95. doi:10.1136/jech.2005.043281. PMC   2563982 . PMID   16614327.
  6. Thornton LE, Pearce JR, Kavanagh AM (July 2011). "Using Geographic Information Systems (GIS) to assess the role of the built environment in influencing obesity: a glossary". The International Journal of Behavioral Nutrition and Physical Activity. 8: 71. doi:10.1186/1479-5868-8-71. PMC   3141619 . PMID   21722367.
  7. 1 2 Korda H, Itani Z (January 2013). "Harnessing social media for health promotion and behavior change". Health Promotion Practice. 14 (1): 15–23. doi:10.1177/1524839911405850. PMID   21558472.
  8. Stefanidis A, Crooks A, Radzikowski J (2013-04-01). "Harvesting ambient geospatial information from social media feeds". GeoJournal. 78 (2): 319–338. CiteSeerX   10.1.1.452.3726 . doi:10.1007/s10708-011-9438-2. ISSN   0343-2521.
  9. Ghosh DD, Guha R (2013). "What are we 'tweeting' about obesity? Mapping tweets with Topic Modeling and Geographic Information System". Cartography and Geographic Information Science. 40 (2): 90–102. doi:10.1080/15230406.2013.776210. PMC   4128420 . PMID   25126022.
  10. Merzel C, D'Afflitti J (April 2003). "Reconsidering community-based health promotion: promise, performance, and potential". American Journal of Public Health. 93 (4): 557–74. doi:10.2105/AJPH.93.4.557. PMC   1447790 . PMID   12660197.
  11. 1 2 Nation M, Crusto C, Wandersman A, Kumpfer KL, Seybolt D, Morrissey-Kane E, Davino K (2003). "What works in prevention. Principles of effective prevention programs". The American Psychologist. 58 (6–7): 449–56. CiteSeerX   10.1.1.468.7226 . doi:10.1037/0003-066x.58.6-7.449. PMID   12971191.
  12. 1 2 3 Barbara S (1998). Primary care : balancing health needs, services, and technology (Rev. ed.). New York: Oxford University Press. ISBN   9780195125436. OCLC   38216563.
  13. Frank JW, Brooker AS, DeMaio SE, Kerr MS, Maetzel A, Shannon HS, Sullivan TJ, Norman RW, Wells RP (December 1996). "Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins". Spine. 21 (24): 2918–29. doi:10.1097/00007632-199612150-00025. PMID   9112717.
  14. "Chronic Disease Overview | Publications | Chronic Disease Prevention and Health Promotion | CDC". www.cdc.gov. 2017-10-02. Retrieved 2018-03-14.
  15. 1 2 3 Chodosh, Joshua; Morton, Sally C.; Mojica, Walter; Maglione, Margaret; Suttorp, Marika J.; Hilton, Lara; Rhodes, Shannon; Shekelle, Paul (2005-09-20). "Meta-Analysis: Chronic Disease Self-Management Programs for Older Adults". Annals of Internal Medicine. 143 (6): 427–38. doi:10.7326/0003-4819-143-6-200509200-00007. ISSN   0003-4819. PMID   16172441.
  16. 1 2 Warsi, Asra; Wang, Philip S.; LaValley, Michael P.; Avorn, Jerry; Solomon, Daniel H. (2004-08-09). "Self-management Education Programs in Chronic Disease". Archives of Internal Medicine. 164 (15): 1641–9. doi:10.1001/archinte.164.15.1641. ISSN   0003-9926. PMID   15302634.
  17. 1 2 Lorig, Kate R.; Sobel, David S.; Stewart, Anita L.; Brown, Byron William; Bandura, Albert; Ritter, Philip; Gonzalez, Virginia M.; Laurent, Diana D.; Holman, Halsted R. (1999). "Evidence Suggesting That a Chronic Disease Self-Management Program Can Improve Health Status While Reducing Hospitalization: A Randomized Trial". Medical Care. 37 (1): 5–14. doi:10.1097/00005650-199901000-00003. JSTOR   3767202. PMID   10413387.
  18. 1 2 Jordan, Joanne (November 15, 2006). "Chronic disease self-management education programs: challenges ahead" (PDF). Medical Journal of Australia. 186: 84–87.
  19. Lorig, Kate R.; Ritter, Philip; Stewart, Anita L.; Sobel, David S.; Brown, Byron William; Bandura, Albert; Gonzalez, Virginia M.; Laurent, Diana D.; Holman, Halsted R. (2001). "Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes". Medical Care. 39 (11): 1217–1223. doi:10.1097/00005650-200111000-00008. JSTOR   3767514.
  20. Lorig, K. R.; Sobel, D. S.; Ritter, P. L.; Laurent, D.; Hobbs, M. (November 2001). "Effect of a self-management program on patients with chronic disease". Effective Clinical Practice: ECP. 4 (6): 256–262. ISSN   1099-8128. PMID   11769298.
  21. Leppin, Aaron (2018). "Integrating community-based health promotion programs and primary care: a mixed methods analysis of feasibility". BMC Health Services Research. 18. doi:10.1186/s12913-018-2866-7. PMID   29386034.
  22. "Chapter 3: Primary care: putting people first". www.who.int. Retrieved 2018-03-05.
  23. Weiner, B. J.; Alexander, J. A. (1998). "The challenges of governing public-private community health partnerships". Health Care Management Review. 23 (2): 39–55. doi:10.1097/00004010-199804000-00005. ISSN   0361-6274. PMID   9595309.
  24. 1 2 Minkler, Meredith (2005-06-01). "Community-based research partnerships: Challenges and opportunities". Journal of Urban Health. 82 (2): ii3–ii12. doi:10.1093/jurban/jti034. ISSN   1099-3460. PMC   3456439 . PMID   15888635.
  25. 1 2 3 Organization, World Health (2016-06-08). World health statistics. 2016, Monitoring health for the SDGs, Sustainable Development Goals. World Health Organization. Geneva, Switzerland. ISBN   978-9241565264. OCLC   968482612.
  26. 1 2 J., Rosenbaum, Sara; Peter, Shin; Emily, Jones; Jennifer, Tolbert (2010). "Community Health Centers: Opportunities and Challenges of Health Reform". Health Sciences Research Commons.

Further reading

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Connected health is a socio-technical model for healthcare management and delivery by using technology to provide healthcare services remotely. Connected health, also known as technology enabled care (TEC) aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses readily available consumer technologies to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care and disease and lifestyle management, often leverages existing technologies such as connected devices using cellular networks and is associated with efforts to improve chronic care. However, there is an increasing blur between software capabilities and healthcare needs whereby technologists are now providing the solutions to support consumer wellness and provide the connectivity between patient data, information and decisions. This calls for new techniques to guide Connected Health solutions such as Design Thinking to a) support software developers in clearly identifying healthcare requirements and b) extend and enrich traditional software requirements gathering techniques.

Health communication is the study and practice of communicating promotional health information, such as in public health campaigns, health education, and between doctor and patient. The purpose of disseminating health information is to influence personal health choices by improving health literacy.

Primary Care Behavioral Health Consultation model (PCBH) is a psychological approach to population-based clinical health care that is simultaneously co-located, collaborative, and integrated within the primary care clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in primary care. Primary Care practice has traditionally adopted a generalist approach whereby physicians are trained in the medical model and solutions to problems typically involve medications, procedures, and advice. Appointment times are short, with the goal of seeing a large number of patients in a day. Many patients present with mental health care needs whose symptomology may overlap with medical disorders and which may exacerbate, complicate, or masquerade as physical symptoms. In addition, many medical problems present with associated psychological sequelae, that are amenable to change, through behavioral intervention, that can improve outcomes for these health problems. Over 50% of medical visits to primary care clinics today are related to chronic medical conditions. As we learn more and more about the contributing factors to the development and maintenance of these medical problems, there is growing evidence that the PCBH model affords us the opportunity for early identification and behavioral/medical intervention that can prevent some acute problems from becoming chronic health care problems. Behavioral Health Consultants (BHCs) work side-by-side with all members of the clinical care team to enhance preventive and clinical care for mental health problems that have traditionally been treated solely by physicians. The role of the BHC is to facilitate systemic change within primary care that facilitates a multidisciplinary approach both from a treatment and reimbursement standpoint. BHCs typically collaborate with physicians to develop treatment plans, monitor patient progress, and flexibly provide care to meet patients’ changing needs In this review the terms Primary Care Behavioral Health Consultation and Behavioral Health Consultation will be used interchangeably.

Chronic disease in Northern Ontario is a population health problem. The population in Northern Ontario experiences worse outcomes on a number of important health indicators, including higher rates of chronic disease compared to the population in the rest of Ontario.

The Patient Activation Measure (PAM) is a commercial product which assesses an individual's knowledge, skill, and confidence for managing one's health and healthcare. Individuals who measure high on this assessment typically understand the importance of taking a pro-active role in managing their health and have the skills and confidence to do so.