December 2009 - Hot Topic

Strengthening Primary Health Care through Primary Care and Public Health Collaboration: Is Ontario Ready?

A primary health care (PHC) based health system ensures universal coverage and access to services that are acceptable to the population and equity-enhancing.[1] Reports such as, WHO’s “Primary Health Care Now More than Ever” as well as Canadian researchers and policy makers[2-4] argue that PHC systems can be strengthened through stronger public health and primary care collaboration, which can ultimately lead to integrated systems and improved health outcomes. The WHO report specifically calls for reforms that “secure healthier communities, by integrating public health actions with primary care and by pursuing public health policies across sectors – public policy reforms.” (p. xvi)[4]

Why should we bother collaborating? Lasker, Weiss and Miller[5] argue that connective power of collaboration can strengthen and combine actions for communities to better identify and address health issues. Actions refer to strategies such as clinic services as well as activities that emphasize population interventions, such as community screening programs and public education campaigns.

Partnering population-based strategies with individual clinic services can also result in better access and tailoring of services to meet community needs as well as a stronger understanding and ability to manage underlying causes of health problems.[6] Partnering has also been found to strengthen health promotion and protection efforts through community campaigns. Weiss, Anderson and Lasker[7] believe that partnerships can create synergies that result in something valuable that is greater than the sum of its parts. Julio Frenk pushes us to think beyond collaboration and move towards systems integration[8]; we need to develop primary care networks that are “seamlessly integrated into the rest of the health system” and provide high quality services using proactive strategies, that support continuity of care and assure universal health protection. (p. 172)

Is Ontario in a position to meet these challenges to improve collaboration between public health and primary care systems?

Ontario’s Public Health Standards 2008 indicate that collaboration with community partners is necessary to promote the health of the population and reduce health inequities, and thereby achieve positive health outcomes.[9] The importance of working with community partners is threaded throughout the Standards. Partnerships and collaboration are noted in the Standards as core principles for program delivery and public health programs and services typically involve extensive partnerships. In addition, primary care reforms have moved to developing models with stronger interdisciplinary team structures. This environment can be more conducive for building external partnerships with health and social service sectors.

Community Health Centres, and to a lesser extent other primary care delivery models (FHTs), have had varying partnerships with public health in Ontario. Involvement has been often dependent on local initiatives, leadership and awareness of each other’s needs/capacities. However, significant challenges exist that need to be overcome and more research is required to explore how we can better collaborate and perhaps even move closer to integration.

Three Canadian programs of research which involve Ontario researchers and decision-makers are currently exploring research questions related to primary care and public health collaboration that are complimentary.

The first program of research, “Strengthening Primary Health Care through PC and PH Collaboration”(i) (2008- 2011; led by Ruta Valaitis, Penny Nelligan and Jack McCarthy) is exploring:

  1. structures and processes required to build successful collaborations between public health and primary care (at interactional, organizational and systemic levels);
  2. roles that nurses and other health care practitioners play in building local collaborations between PC and PH;
  3. factors that influence their capacity to foster such collaborations; and
  4. the extent of collaborative partnerships that currently exist in Nova Scotia, Ontario, and British Columbia.

The second program of research, “Renewing Public Health Systems” (ii) (2009-2013; led by Marjorie MacDonald and Trevor Hancock) will examine the processes of public health standards/core functions implementation of two core public health programs in Ontario and British Columbia (chronic disease prevention and sexually transmitted infection prevention). They will also examine how contextual variations within and between each province affect implementation processes. A question that will be integrated throughout the broader research questions is: what are the relationships between public health and primary care sectors within and across the implementation of the two core programs and what effects do these relationships have?

The third study, “Integrating Public Health and Family Health Teams” (iii) (2008- 2009; led by Michael Green) examined the integration of public health and Family Health Teams (FHTs) in Ontario. They have investigated areas in which there is overlap in service provision between local PH units and FHTs. The purpose of their research is to identify:

  1. public health services and models of delivery used by local public health units that would assist FHTs in meeting their objectives;
  2. FHT services and models of delivery that would assist local public health units in achieving their objectives;
  3. current or proposed areas of integration between public health units and FHTs; and
  4. key priority areas for integration between local public health units and FHTs.

In January 2010, these three research teams — which involve researchers, decision-makers, and policy makers from Nova Scotia, Ontario, and British Columbia — will meet at McMaster University. The meeting will implement an “integrated knowledge translation” approach as described by CIHR as “a way of doing research that is collaborative, action-oriented, and involves the co-production of knowledge with researchers engaging the stakeholders who are the end users.” This event will enable interaction among the research teams to optimize learning and gain insights that relate to active policy agendas. The purpose of this meeting is to:

  • build research capacity;
  • share and interpret early research results from completed studies related to primary care and public health collaboration;
  • refine research questions and methods for the programs of research; and
  • craft messages and strategies to move results into policy and practice.

The three teams plan to keep Ontarians posted on the results of this event and results of their respective research studies through future updates.

For more information visit: http://strengthenphc.mcmaster.ca/ and http://web.uvic.ca/~cphfri/research_projects/emerging_team_grant.htm

 

 

References

[1] Pan American Health Organization (PAHO) and World Health Organization. Regional declaration on the new orientations for primary health care (Declaration of Montevideo). 9-25-2005.

[2] Stevenson Rowan MS, Hogg W, Hussey T. Integrating Public Health and Primary Care. Healthcare Policy 2007;3:1-22.

[3] Health Canada. Canadian public health and primary health care workshop. 1-31. 9-18-2005. Health Canada.

[4] World Health Organization. The World health report: Primary health care now more than ever. World Health Organization . 2008. Geneva, World Health Organization.

[5] Lasker RD, Weiss ES, Miller R. Promoting collaborations that improve health. Educ.Health.(Abingdon) 2001;14:163-72.

[6] Lasker RD. Medicine & public health : the power of collaboration. New York, NY: New York Academy of Medicine, 1997.

[7] Weiss ES, Anderson RM, Lasker RD. Making the Most of Collaboration: Exploring the Relationship Between Partnership Synergy and Partnership Functioning. Health Educ.Behav. 2002;29:683-98.

[8] Frenk J. Reinventing primary health care: The need for systems integration. The Lancet 2009;170-2.

[9] Ministry of Health and Long-Term Care. Ontario Public Health Standards 2008. 1-49. 2008. Toronto, Queen's Printer of Ontario. 3-4-2009.