Family Medicine, Community, and Race: A Minneapolis Practice Reflects

In their commentary, Prasad, Wesby, and Crichlow posit, “Engaging directly with communities is one of the most effective ways to address social, structural, and political determinants of health. It should be the mainstay of the practice of family medicine, not a cute side-project” (1). We concur. The Chronic Care Model (CCM), which frames our work addressing racial disparities in diabetes care, establishes the critical role of community within its framework for understanding the system, relational, and individuals factors that influence patient outcomes (2). Community engagement enables more productive interactions with the patient as the team is able to contextualize the patient’s healthcare needs and resources within the community. Peek and colleagues argue that for the health system and community to fully integrate, the system cannot be “merely referring patients to existing community resources;” instead, clinical team members need to “actively collaborate” with community partners (3). We encourage clinicians to establish strong ties to the communities we serve. Our goal is to develop sustainable relationships within the community that move beyond the focus of a single condition and mature into long-term partnerships that address a range of factors that affect health. Community-engaged clinicians have a nuanced understanding of the patients and communities they serve. Engagement enables clinicians to observe firsthand the context of community factors such as food insecurity, housing instability, limited income, and other social determinants of health, which the American Diabetes Association stresses are critical to the management of diabetes.
As we all work toward successful community engagement, we need a shared understanding of how to measure that success. Although Pathman and colleagues developed a measure of clinician participation in health activities in the community (recognition of and intervention in the community’s health problems, awareness of local cultural health beliefs, coordination of community health resources, and assimilation into the community through participation in its organizations) more than two decades ago (4), it has been rarely used in family medicine research. Building on their work, we must continue to develop and utilize valid and reliable measures of community engagement to understand the community and individual patient outcomes that are associated with the work of community-engaged family physicians. We need measures that not only assess the power of community engagement, but also help us set goals to reach.

References
1. Prasad S, Westby A, Crichlow R. Family Medicine, Community, and Race: A Minneapolis Practice Reflects. Ann Fam Med. 2021;19(1):69-71.
2. Turner BJ, Parish-Johnson JA, Liang Y, Jeffers T, Arismendez SV, Poursani R. Implementation of the Chronic Care Model to Reduce Disparities in Hypertension Control: Benefits Take Time. J Gen Intern Med. 2018;33(9):1498-1503.
3. Peek ME, Ferguson M, Bergeron N, Maltby D, Chin MH. Integrated community-healthcare diabetes interventions to reduce disparities. Current diabetes reports. 2014;14(3):467.
4. Pathman DE, Steiner BD, Williams E, Riggins T. The four community dimensions of primary care practice. The Journal of family practice. 1998;46(4):293-303.