Robert S. Lawrence

Among the participants in Workshop E there was general consensus that a narrow view of COPC (a strict Karkian interpretation) was not appropriate to the challenges of the United States. There are simply too many constraints governing the definition of service areas, the availability of surveillance data or the personnel to collect such data, the lack of coterminus boundaries for different categorical service programs in many cities and counties, and other features that vary from region to region. It was also agreed that encouraging nascent efforts at COPC is important. Even the most modest efforts to make a community diagnosis and intervention should be encouraged. There is a real value of the halo effect wherein a case-finding and treatment program tend to organize a practice or a health department in a direction that makes other COPC activities easier.

The group suggested that the curriculum of health professionals be expanded to sensitize students about several of the important themes in COPC. Among the more important ones are the distinction between community wants and community needs, the cultural and ethnic diversity of patient groups and the impact of this diversity on health behavior, the need to organize records to include basic epidemiologic data via color coding of charts or other techniques, and the teaching of policy analysis skills to help the health professional determine the scope of responsibility.

There was strong feeling that there should be a follow-up to the conference with the conferees forming a network of consultation and support, distributing phone numbers and references on papers describing their own COPC projects, etc. The suggestion was also made that descriptions of COPC projects, not previously published in refereed journals, might be presented as brief case studies and published as working papers in COPC. These case studies would essentially be the “materials and methods” portion of a scientific paper.

There was general agreement among the participants that, for the full development of COPC in the United States, the basic reimbursement mechanism for paying for health care had to be completely changed.

Finally, in response to the question how to do COPC, the response was that there are really many ways and that the approach should be eclectic. Private practice should be adapted to COPC, new practice systems should be developed, nonpractice settings such as the industrial medicine services of large corporations should be encouraged to develop COPC, and the remnants of HSA planning activities should be utilized especially at the town, city, and county level to develop appropriate surveillance data for COPC.