Community partnerships work.

This adult care program epitomizes the values most recently espoused in debates on health care reform. Public/private partnerships are strengthened by emphasizing unique contributions of all resources of health care: private physicians, private pharmacists, local government, local health departments, community hospitals, business leaders, volunteer free clinics and a private medical school. The success of this program is also contingent on a high degree of patient responsibility. Patients must demonstrate a willingness to share in their care through improved capabilities of self-management. They must share in the cost of their medications, and if there is a propensity to abuse the services (unnecessary ER usage, doctor hopping), they run the risk of termination of services. Expectations are high and patients are being taught how to meet them. The next step is an intensive evaluation of outcome measures. It is felt that this evaluation must extend over a minimum of 5 years in order to be valid and demonstrate trends. We are currently pursuing funding for such an evaluation.

The value of the preschool examination in screening for health problems.

The effectiveness of physicians in detecting abnormalities of height, weight, vision, hearing, blood pressure, and the presence of dental caries in 1,158 kindergarten pupils was compared with that of a separate screening program staffed by trained volunteers and public health nurses. The screening program was significantly more effective in identifying abnormalities in vision, hearing, blood pressure, and the presence of dental caries. Pediatricians were no more effective than other physicians in detecting abnormalities. We conclude that the preschool examination should be modified to emphasize screening tests. These screening tests can be effectively performed by paramedical personnel, resulting in increased detection of health problems and decreased demands on physicians' time.