One great resource for clinical providers looking to improve the health status of their patients at the population-level is the county health department. Health departments can share many skills and resources with doctors and other providers to help improve the patient’s health.
My work has allowed me to interact with Brian Hartl, the Kent County Health Department of Michigan’s chief epidemiologist. These contacts, and an introduction to epidemiology course have shown me that health departments excel at providing population-level health services. This contrasts with most clinical providers, who are skilled at communicating with patients face-to-face. Both the staff at physician offices and those in health departments care about the well-being of individuals and groups.
Most often, clinicians work with patients during face-to–face meetings. Each patient is treated individually. If a doctor is treating hypertension in a patient, she will plan the treatment for that individual. The physician will consider the impact of the treatment and instructions she gives on a population when she does her work. She might consider, for example, how effective she is at treating hypertension patients together.
Patients of a county’s health department are the residents of the county. In very rare cases, health departments only treat one person at a time. Many of their interventions would not be considered medical. Their work has an impact on the whole population. Health departments, for example, are responsible for ensuring that restaurants serve healthy food. To identify clusters and outbreaks of communicable diseases, health departments keep track of reports. This allows them to mobilize the community as well as physician groups to help prevent further transmission.
Are these two health organizations able to work together in improving the patient’s health? If so, how? Brian Hartl was kind enough to talk with me about his thoughts and offer some suggestions that could help clinicians do a better job. Hartl is an expert on population health and sees a lot of his work as preventive. It is crucial that physicians and other medical staff focus on prevention in the new world of population-level medicine. This includes preventing patients with diabetes from developing, as well as preventing teens from using alcohol and other drugs. Kent County Health Department is able to assist physicians in achieving their goals and would be happy to work with them. KCHD has a grant that can be used by patients to increase their chances of chronic disease prevention, risk management, or management via clinical and community links.
Mr. Hartl believes there is potential to work together with physicians to establish a system for prescribing healthy living activities and lifestyles as non-clinical interventions for the prevention/management of chronic disease. The Kent County Health Department, for example, is active in helping communities to develop walking trails in underserved areas of Grand Rapids. He believes that chronic disease patients can benefit greatly from walking more. He is happy to share information and maps about these paths with physicians so they can create a walking plan for patients and point them to the most convenient ones.
Kent County Health Department also works with community partners to provide fresh food to areas in the county that are not easily accessible. These areas are called ‘food deserts’. They often have no retail food stores and are limited to selling only packaged food. His group works with these retailers to remove barriers to fresh food. Dr. Hartl will share the location of fresh food sources with physician groups so that they can inform patients and improve their food habits.
These are two examples of information the health department will share with patients to help them live active, healthy lives. Health departments have contacts in the community that can be helpful, as well as information. The Kent County Health Department collaborates with the YMCA of Greater Grand Rapids to offer a nationally recognized program called the Diabetes Prevention Program. This helps prevent people with prediabetes becoming diabetics. The Grand Rapids Urban League, community educators, and prevention groups are also linked to the health department. These groups focus on preventing the misuse of alcohol.
You can see that there are many resources available from the health departments. These resources could be of benefit to clinicians. Accessing these resources will greatly benefit physicians and other clinicians, I believe. It will also improve the outcomes for patients at the population level. This is especially important for groups with risk-based contracts, such as those that work with Medicare patients. An article in Modern Healthcare dated January 16, 2015 states that 40% of private payer contracts are incentive-based. Those with such contracts should focus on the health of the population.