Advanced Primary Care in San Antonio: Linking Practice and Community Strategies to Improve Health

Abstract

Improving health among people living in poverty often transcends narrowly focused illness care. Meaningful success is unlikely without confronting the complex social origins of illness. We describe an emerging community of solution to improve health outcomes for a population of 6000 San Antonio, Texas, residents enrolled in a county health care program. The community of solution comprises a county health system, a family medicine residency program, a metropolitan public health department, and local nonprofit organizations and businesses. Community-based activities responding to the needs of individuals and their neighborhoods are driven by a cohort of promotores (community health workers) whose mission encompasses change at both the individual and community levels.

Taking action on the social determinants of health in clinical practice: a framework for health professionals

“…69 In a study involving a cohort of over 1000 disadvantaged patients in San Antonio, Texas, a community-oriented primary care approach using health promoters acting as cultural brokers between patients and physicians, as well as helping to map out, mobilize and connect patients with resources in the local community, resulted in a 24% decrease in admissions to hospital and a cost savings of over US$250 000 per year." 70 Community engagement, empowerment and changing social norms Engagement and empowerment of the local community is needed to tackle deeply rooted challenges that become engrained in the social norm. For instance, violence against women can often be quite widespread and can become the "new normal" in some contexts, particularly when the perpetrators themselves were abused and lack power in various domains of their life, which creates a cycle of harm.…”

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

“…46 Two pre-post studies did not indicate statistical significance; of these, one intervention resulted in a decrease in ED visits 47 and one in an increase in ED visits. 48 There were three cohort studies that examined ED use, two of which showed significant decreases in ED use in the intervention group. 49,50 Hospitalizations Seventeen studies (50%) assessed the effect of the CHW intervention on hospitalizations, primarily during the CHW intervention.…”

“…34,35,37,39,40,51 One showed a significant decrease relative to the control. 36 Of the seven pre-post studies that assessed hospitalization, all showed a decrease in hospitalizations, 41,[43][44][45][46][47][48] but only five indicated statistical significance. 41,[43][44][45][46] Three cohort studies assessed the effect of the intervention on hospitalizations.…”

Re: Journal of the American Board of Family Medicine Issue on Communities of Solution

“…Linkage programs such as those described by Ferrer et al 2 and Garney et al 3 have for the most part failed to be accompanied by rigorous evaluation to demonstrate health status or utilization outcomes. There is also a lack of evidence about how to build effective COSs across sectoral boundaries and a paucity of data about related population-level outcomes.…”

“…Throughout our work examining the Folsom Report, 2 we have noted many of the same pitfalls regarding current fledgling communities of solution (COSs): the lack of rigorous research, outcomes data, and nationwide or regional networks. Burns and Gottlieb's cogent suggestions to further the rigor of COSs and assess outcomes are critical next steps.…”