Community needs assessment in family medicine

Dr. Yonah YapheDepartment of Family Medicine

Rabin Medical Centre andSackler Faculty of MedicineTel Aviv University, Israel

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

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

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?

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

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

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

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.

Measuring success of needs assessment

Did we obtain useful data?

Did this allow us to design an intervention?

Did the intervention improve health?

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

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?

Conclusion The role of

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