MDNews - San Antonio

++++++++++++++++++++++++++ + +++ +CoMMuNiTy HEALTH +++ ++++++++++++++++++++++++++ 2013 Bexar county community health Assessment Provides insight, oPPortunities for AreA PhysiciAns C OmmUNITY HeALTH ASSeSSmeNTS have become an integral part of community health. The Bexar County Community Health Assessment (CHA), issued every three years by The Health Collaborative (THC), has become a tool for helping Bexar County think about community health in a different way. THC joined city and county leadership in releasing the 2013 CHA in October. This comprehensive report of local health guides the development of the Community Health Improvement Plan (CHIP). But what does the data mean to doctors? Anil T. Mangla, PhD, MPH, FRIPH, Assistant Director for the San Antonio Metropolitan Health District, and Robert Ferrer, MD, MPH, of the Department of Family and Community Medicine, UT Health Science Center at San Antonio, are board members of THC. Both serve on the data committee that produced the assessment and they also will be working on the CHIP. In the sections that follow, they share their views with MD News readers on what the Bexar County CHA brings to physicians. Anil T. mangla, PhD, mPH, fRIPH, Assistant Director for the San Antonio metropolitan Health District and THC Board member Health care in San Antonio needs to be data-driven, and the Bexar County Community Health Assessment is an important tool in supporting this effort. Data can help us make sure we are implementing the correct programs to impact the disease burden in Bexar County. When I look at the assessment, I break it into six areas: screening, scoping, assessment, recommendations, reporting and monitoring/ evaluation. Screening establishes where we are in the community and what we want to do. It gives us the global view of community health. Scoping helps us identify the populations affected by disease and determine where we have the greatest health need. Assessment is the baseline of where we are. Recommendation is determining what we can do to affect the population. Reporting is the interpretation of the data so that our leadership understands the disease burden at the local level. Monitoring and evaluation brings us back full circle to tell us if we implemented the right programs and whether they are working. Physicians as providers are at the front line of public health. What they see is real, so it's important that they understand the disease burden and current trends. Consider the current syphilis crisis. We have experienced an increase in syphilis cases over the last five years. Many in the medical community consider syphilis a disease of the past. However, it has not gone away. A physician who knows that we have a syphilis crisis is better able to identify the disease when patients come in for diagnosis. Too often patients with the disease are misdiagnosed. Another trend we are seeing is the skyrocketing number of diabetes-related amputations. Many patients don't know that they have diabetes, so by the time they come in for treatment, it's too 12 | San Antonio MD News ■ mDNewS.COm late. The result is often an amputation. If a physician is aware of the increase in diabetes-related amputations, patients with diabetes may be more accurately diagnosed and treated earlier, lessening the need for amputations. Currently we are experiencing a substantial increase in pertussis, also known as whooping cough, in children. Children aren't completing the series of vaccinations required. In 2011 the DTaP coverage was 90 percent and only 77 percent for the fourth dose, a decrease of 13 percent. If physicians know this, they can impress on families the importance of this final dose. In these and other instances, the CHA gives upfront knowledge that physicians need to consider in treating their patients. It can provide physicians with a context that means better treatment for the patient and an improvement in health status for the community. Robert ferrer, mD, mPH, of the Department of family and Community medicine for UT Health Science Center at San Antonio and THC Board member The Bexar County CHA highlights for physicians the most common problems in our community, some of which get a lot of public attention (like diabetes) and some of which don't (high rates of late or no prenatal care). One the major insights for all physicians is the high rate of mental health problems. A finding that jumped out for me was the fact that 9 percent of adolescents have attempted suicide. Another was that the leading cause for hospitalizations is mental health disorders. Because mental health affects the care of every condition, it's a reminder for all physicians to be considering mental health as they care for patients so they can appropriately connect those who are suffering to resources. Of course, the low availability of mental health resources is a larger policy and delivery issue.

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