Community Health Care

Abstract: Since the fall of 2007, the Island Institute's Public Health Fellow, Peter Levandoski, has been working as the community health-care coordinator (CHCC) at Vinalhaven's Federally Qualified Health Center, Islands Community Medical Services (ICMS). ICMS offers medical, dental and social services to all of the island's residents, regardless of the ability to pay. Recognizing that health care is neither efficient, affordable nor effective when practiced solely in the clinic, the leadership at ICMS applied for and received a Fellow to bring health care out to the community. Peter has been working to identify pressing health-care needs on the island and tailoring public- health interventions and outreach programs to meet them. This work, in partnership with the efforts of a dedicated clinical team, has helped ICMS move closer to achieving its mission of "...improving the health of the whole community".

Purpose: The impetus behind creating the CHCC position was to give community members the opportunity to become partners with their doctors in the care of their health. To that end, the CHCC has worked to provide Vinalhaven residents with opportunities to learn more about what they can be doing to manage and prevent health problems. To accompany this education, the CHCC has also started programs in which people can apply health knowledge to their lives. There is a chronic disease self-management course, for people to learn about what they can be doing outside of the clinic to manage their condition and to reduce its impact on their lives. There have been partnerships with the school to increase the number of opportunities for students to learn about healthy lifestyles. Finally, there are programs for people to put their health knowledge, into action: a running/walking group, a weight-loss group, and a Tai Chi exercise program just to name a few. Instead of getting only a 15-minute health message from ICMS during an annual trip to the doctor's office, Vinalhaven residents have had the health message brought to them. This has closed the patient-doctor gap, making each patient more of a partner and less of a bystander in the health-care process. Educating and empowering health-care consumers ultimately makes them healthier. The role of the CHCC is to empower people and to work with them as they attempt to achieve lifelong health.

Results: Over the past year and a half, the progress of CHCC programs has been measured in program attendance and survey feedback. To date, over 20% of the island's 1,250 year-round residents have attended at least one outreach program, with the majority of those attendees taking advantage of two or more different activities. A greater percentage of the population has been touched by public-health programs in the clinic that aid the provider care of patients, such as the integration of health-information technology and the increased availability of patient-education materials. Qualitatively, this shows an increased awareness of health issues among patients. However, this outcome - and any other health outcomes that might arise from these statistics - is difficult to quantify due to multiple confounds.

Measured Results: In the winter of 2008, ICMS worked with the Maine Primary Care Association (the advocacy group for Maine's community health centers) to run the Living Well chronic disease self-management course. Vinalhaven, with a limited population of 1,250, graduated 16 people from the class. This was one of the largest graduating classes in the state, in spite of our limited patient base and geographical isolation. Our goal is to get people involved and harness the passion and the sense of pride that people feel for their community, using it to help them make it healthier. Attendance figures like those from the Living Well class are not atypical. Attendance figures, measured by health- information technology and databases, are used to drive future programming, and to identify new needs and new at-risk sub-populations.