出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : “El Carmel” health center is located in a social deprived area in Barcelona city with around 20000 inhabitants. Since the Spanish reform of the primary health care in 1984, Primary Healthcare Centers (PHC) have to provide healthcare services for individuals, families and the community assigned. However the reality is that the majority of PHC focus their practice into individuals, and community care is frequently left in oblivion. Here we present the strategy to progressively orient our practice to the community. Description of practice change implemented : Our project aim is to improve the health of the community as a whole, empowering citizens to face their own problems, beating against health inequities and creating a healthier neighborhood. Goals are : to achieve a community health diagnosis and to implement community health programs based on priorities agreed We identified three eligible situations: 1. In the medical/nurse consultation, using the patient-centered clinical method, contextualizing the health demands and looking for a salutogenic approach when possible. 2. At the PHC level we conducted a health diagnosis, and established priorities of action. 3. In the PHC outreach activity, we collaborate with the Neighborhood-Community-Project (NCP) in which are represented the main local citizen associations, the local government and other public and private services included social services. Key findings : In 1994 the PHC team began a community orientation in a very slow pace, facing internal and external constraints. a) In 2000 we finished a community health diagnosis (quantitative and qualitative). The document was updated in 2004 with a list of priorities b) In 2000 the NCP invited us to participate to developing a strong social network and promoting the community engagement. From 2004 until 2014 the NCP has developed a wide range of activities in which the PHC has participated, especially when related to health promotion. This process follows the "community plans" methodology.
关键词：community-oriented-primary-care ; health inequities ; community health diagnosis
