Challenges in Developing Community and Clinician Partnerships for Prevention

Developing links between primary care practices and community organizations to help manage patients with unhealthy behaviors has been proposed as a strategy to improve health care delivery. The objective of this study was to evaluate easily reproducible interventions to improve referral rates between primary care practices and community organizations to help manage tobacco use, poor diet, and physical inactivity. A 6-month, 3-group clinical trial involving 9 adult primary care practices was conducted beginning in February 2008. The 3 groups included usual care, a passive intervention in which practices received referral material, and an active intervention group in which practices also nominated a "champion" to support the project and had access to a Web site to assist in the development of links with community organizations. Charts were abstracted at baseline, at the midpoint of the project (3 months), and at the completion of the project (6 months). Field notes were collected from the project members during the intervention period. Over the course of the project, regardless of group, the rate of detection of the 3 unhealthy behaviors was lower than expected. Few of those identified with an unhealthy behavior were referred to a community organization. Barriers included concerns among the health care providers about costs to their patients, lack of time to facilitate referral, and staff turnover at the community organizations that precluded the development of partnerships. Thus, the interventions evaluated to develop links between primary care practices and community organizations were not successful.