title: Improving population health through integration of primary care and public health: providing access to physical activity for community health center patients.
abstract: OBJECTIVE
  Our community health center attempted to meet public health goals for encouraging exercise in adult patients vulnerable to obesity, diabetes, hypertension, and other chronic diseases by partnering with a local YMCA.
  
  
  METHODS
  During routine office visits, providers referred individual patients to the YMCA at no cost to the patient. After 2 years, the YMCA instituted a $10 per month patient copay for new and previously engaged health center patients.
  
  
  RESULTS
  The copay policy change led to discontinuation of participation at the YMCA by 80% of patients. Patients who persisted at the YMCA increased their visits by 50%; however, more men than women became frequent users after institution of the copay. New users after the copay were also more likely to be younger men. Thus the copay skewed the population toward a younger group of men who exercised more frequently. Instituting a fee appeared to discourage more tentative users, specifically women and older patients who may be less physically active.
  
  
  CONCLUSIONS
  Free access to exercise facilities (rather than self-paid memberships) may be a more appropriate approach for clinicians to begin engaging inexperienced or uncertain patients in regular fitness activities to improve health.
authors.affiliation: Health Center of Worcester, Worcester MA, USA. msilva@mcphs.edu
authors.forename: Matthew
authors.initials: M
authors.lastname: Silva
authors.forename: Suzanne
authors.initials: S
authors.lastname: Cashman
authors.forename: Parag
authors.initials: P
authors.lastname: Kunte
authors.forename: Lucy M
authors.initials: LM
authors.lastname: Candib
mesh_terms: D000328:Adult; D000367:Age Factors; D003151:Community Health Centers / Q000458:organization & administration; D015444:Exercise; D005249:Fees and Charges; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D009043:Motor Activity; D011320:Primary Health Care; D011634:Public Health; D012737:Sex Factors