Primary Care and Public Health Exploring Integration to Improve Population Health (2012) / Chapter Skim
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1 Introduction
1 Introduction
Pages 17-44
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From page 17... ...
At the same time, both health problems and community needs, resources, and circumstances vary among localities, so no single approach to combating health problems can be applied. Primary care and public health are uniquely positioned to play critical roles in tackling the complex health problems that exist both nationally and locally.
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As a result, the current health system is inadequately equipped to provide critical health promotion and preventive services. A number of relatively new developments have converged to create opportunities for improving the nation's health.
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health care services directed to individuals, and (3) public health activities operating at the population level to address health behaviors and exposures.
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Primary Care In 1996, the IOM Committee on the Future of Primary Care defined primary care as "the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community" (IOM, 1996, p.
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health system. In the United States, more individuals receive care in primary care settings than in any other setting of formal health care.
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The success of the Chronic Care Model in revitalizing the management of patients with chronic conditions by relying on an interdisciplinary primary care team with aligned objectives and methodology generated interest in redesigning the entire practice of primary care. This interest in reinventing primary care led in turn to interest in the "medical home," a model first proposed in the 1960s for providing care for children with special needs (Rosenthal, 2008)
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From page 23... ...
This community relationship is exemplified by health centers and other primary care delivery systems, particularly those that use a community-oriented approach. Thus, primary care is working in areas that largely overlap with public health and is strategically placed at the interface of people in communities and the rest of the health care system.
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. Although the report emphasizes the importance of government health agencies and argues that strengthening the role of health departments would be crucial in moving public health forward in the future, its overall conception of public health is much broader, involving the private sector, community organizations, public–private partnerships, and others.
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. These reports provide an opportunity to revisit public health in light of changes in health status in the United States since the IOM's 1988 report was published.
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Because health departments are legally tasked with providing the essential public health services, they are required to work with all sectors of the community.
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For example, some public health departments deliver primary care. This report, however, focuses on more formal integration efforts between local primary care and public health organizations.
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Finally, community participation, which could be facilitated through advisory boards, surveys, or community assessments undertaken by health departments, is critical to any integration efforts at the local level. In addition to primary care and public health entities, other groups working at the community level are striving for population health improvements.
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. At one end of this continuum is isolation, with primary care and public health entities working completely separately.
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For example, public health's ties to community resources can provide support in areas of patient care that are typically difficult for primary care to handle on its own, such as prevention, health promotion, and the management of chronic disease. A primary care practitioner caring for significant numbers of people with asthma can work with local public health agencies to identify geographic areas in the community where poor housing stock or environmental risks can be addressed through combined action with other local stakeholders to remove or reduce asthma risks and ultimately decrease unnecessary use and expense in the health care system.
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Each has knowledge, resources, and skills that can be used to assist the other in carrying out its roles. To quote the 1996 IOM report Primary Care: America's Health in a New Era, "the population-based functions of public health and the primary care services delivered to individuals are complementary functions, and strengthening the relationship should be the focus of action in both arenas" (pp.
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Challenges of Integration Aligning primary care and public health to work together and with other partners in pursuit of the shared goal of improved population health is challenging. A number of trends reinforce the fragmented nature of the current health system, including a history of segregation between primary care and public health, a lack of financial resources and incentives, and an inflexible regulatory system (Baker et al., 2005; IOM, 1988, 2002, 2003, 2011b)
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As public health professionals and educators argued for more independence from medicine in universities and government, public health became viewed by medical professionals as an economic competitor that was largely encroaching on matters believed to be best resolved through the care and treatment provided by medical professionals to individual patients (Brandt and Gardner, 2000)
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The call to better integrate primary care and public health is not new. The National Commission on Community Health Services, in a report known as "The Folsom Report" (1966)
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For example, efforts have been made in some areas within the United States to adopt COPC models. COPC has been defined as a continual process by which primary health care teams provide care to a defined community on the basis of its assessed health needs through the integration in practice of primary care and public health (IOM, 1984)
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, an examination of how organizational characteristics and market conditions contribute to collaborations between either community hospitals or community health centers and public health agencies (Halverson et al., 2000) , and the American Medical Association's analysis of effective clinical partnerships between primary care practices and public health agencies (Sloane et al., 2009)
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Four of the open meetings were focused on HRSA and CDC and their work in the areas of maternal and child health, cardiovascular disease prevention, and colorectal cancer screening. The agendas for the open meetings can be found in Appendix C
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a. This should include non-patient specific reporting of notifiable condi tions and health department notification of primary care providers regarding key community health challenges b.
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Promotion of integration for the goal of achieving high quality primary care and public health 3. How can HRSA and CDC use Affordable Care Act provisions (e.g., community transformation grants, prevention strategy, quality strategy, community health center expansion, National Health Services Corps, and other workforce pro grams)
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2002. Improving primary care for patients with chronic illness.
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2003. Integrating primary care and public health: Learning from the community oriented primary care model.
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Bethesda, MD: National Association of Community Health Centers. National Business Group on Health.
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2011. Strengthening primary health care through primary care and pub lic health collaboration: About the project.
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Key Terms
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