Integrating Public Health and Primary Care Systems

JAMA ◽  
2012 ◽  
Vol 308 (5) ◽  
pp. 461 ◽  
Author(s):  
Bruce E. Landon ◽  
Kevin Grumbach ◽  
Paul J. Wallace
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Care Systems

Integrating Primary Care and Public Health: Learning from the Community-Oriented Primary Care Model

2003 ◽  
Vol 33 (1) ◽  
pp. 85-98 ◽  
Author(s):  
Steve Iliffe ◽  
Penny Lenihan
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Underserved Populations ◽  
Health Care Systems ◽  
Target Population ◽  
Active Involvement ◽  
Socioeconomic Changes ◽  
Interdisciplinary Approaches ◽  
Care Systems ◽  
Health Objectives

Community-oriented primary care (COPC), a 50-year-old widely applied innovative approach to primary care development, seems to be the same combination of public health and general practice perspectives currently sought in the formation of primary care trusts in Britain's NHS. The article reviews the experience of implementing COPC methods, the outcomes, and the applicability to and implications for primary care policy, taking the current British reforms as an example. The COPC model has been developed mainly in underserved populations to integrate public health objectives and primary care through interdisciplinary approaches, with active involvement of the target population. COPC methods are time consuming, can create problems with professional boundaries, and are vulnerable to socioeconomic changes. They can also deliver complex packages of care for target populations, particularly in poor areas underserved by traditional medical services. British primary care reforms may be seen as an unplanned, uncontrolled, nationwide experiment in applying COPC methods. They differ from COPC as applied elsewhere because change has been introduced from above rather than below, into a well-developed primary care system rather than underserved communities. International experience suggests the need for attention to factors promoting and impeding success and to reliable outcome measures. If this experiment succeeds, COPC methodology may facilitate similar changes in other health care systems.

Primary Care and Public Health: A Vision for the Future

PsycCRITIQUES ◽  
2013 ◽  
Vol 58 (11) ◽  
Author(s):  
Patrick H. DeLeon ◽  
Michaela Shafer
Keyword(s):  
Public Health ◽  
Primary Care ◽  
The Future

Promoting respiratory infection control practices in primary care: Primary care/public health collaboration

2005 ◽  
Author(s):  
William Hogg ◽  
Patricia Houston ◽  
Carmel Martin ◽  
Raphael Saginur ◽  
Adriana Newbury ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Infection Control ◽  
Respiratory Infection

Public Health and Primary Care Collaboration: Interactional Factors Influencing Capacity Building

2011 ◽  
Author(s):  
Linda O'Mara ◽  
Ruta Valaitis ◽  
Nancy Murray ◽  
Donna Meagher-Stewart ◽  
Sabrina Wong ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Capacity Building ◽  
Factors Influencing

Public Health and Primary Care Collaboration: An Evolving Conceptual Framework

2011 ◽  
Author(s):  
Ruta Valaitis ◽  
Marjorie MacDonald ◽  
Sabrina Wong ◽  
Linda O'Mara ◽  
Donna Meagher-Stewart ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Conceptual Framework

17. Boundaries or overlap: An examination of the community-oriented clinical practice of community medicine specialists and family/general practitioners

2007 ◽  
Vol 30 (4) ◽  
pp. 36
Author(s):  
M. L. Russell ◽  
L. McIntyre
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Community Health ◽  
Royal College ◽  
Community Medicine ◽  
Work Setting ◽  
Public Health Medicine ◽  
Work Settings ◽  
Main Work

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP). We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded. CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes). There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada. Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6. Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8. Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.

scholarly journals Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045997
Author(s):  
Abhijit Pakhare ◽  
Ankur Joshi ◽  
Rasha Anwar ◽  
Khushbu Dubey ◽  
Sanjeev Kumar ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Multivariate Analysis ◽  
Urban Slum ◽  
Primary Care Providers ◽  
Health Facilities ◽  
Care Providers ◽  
Community Based ◽  
Public Health Facilities ◽  
Care Facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

scholarly journals Geospatial analysis of emergency services use for public health assessment and intervention

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Cassourret
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Unemployment Rate ◽  
Emergency Services ◽  
Health Interventions ◽  
Healthcare Provision ◽  
Socioeconomic Determinants ◽  
Primary Care Doctors ◽  
Use Of Emergency Services ◽  
Neighborhood Level

Abstract The population is increasingly using emergency care services around the world. The underlying interrogation is whether this increase is a consequence from a dysfunction in healthcare provision, from a deterioration in the health status of the population or from socioeconomic determinants. We performed geospatial analyses with 3-year 1,081,026 Emergency Medical Services (EMS) responses in Paris and its suburbs. Incidence of calls per population and complaints were compared, at the neighborhood level, with demographic and socioeconomic determinants. Associations with characteristics of the health system such as the density of primary care doctors were also studied. Spatial autocorrelations were searched with Moran's I analyses. We found a positive correlation between the incidence of EMS calls by population for respiratory problems, and the level of poverty as well as the unemployment rate (p < 0.001). There was no significant correlation between psychiatric complaints and socioeconomic determinants. There was a strong correlation between calls for birth or imminent birth by woman of childbearing age and the unemployment rate among women, the unemployment rate overall and household median household income (p < 0.001). There was no correlation between the density of primary care providers and EMS activity by population. EMS data allowed us to powerfully identify specific socioeconomic determinants of health for a 7 million-inhabitant population at the district level. Results could be used to design and implement tailored public health interventions for maximum impact. The overuse of emergency services does not seem to stem solely from the decrease in the supply of primary care doctors. Innovatively, monitoring the actual use of emergency services could responsively inform policy makers and agencies responsible for prevention and health promotion about the specific needs of the population and the consequences of decisions on the organization of the provision of care. Key messages The use of emergency services is a valid metric to evaluate the health status of the population and identify socioeconomic determinants. It gives specific guidelines for public health interventions. Geospatial analyses can efficiently identify the specific needs of a population at the neighborhood level. It can participate to the evaluation of the organization of healthcare provision.

scholarly journals An innovative approach to improve the detection and treatment of risk factors in poor urban settings: a feasibility study in Argentina

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Poggio Rosana ◽  
Goodarz Danaei ◽  
Laura Gutierrez ◽  
Ana Cavallo ◽  
María Victoria Lopez ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Primary Care ◽  
Community Health ◽  
Community Health Workers ◽  
Feasibility Study ◽  
Health Workers ◽  
Health Coverage ◽  
Cvd Risk Factors ◽  
Cvd Risk

Abstract Background The effective management of cardiovascular (CVD) prevention among the population with exclusive public health coverage in Argentina is low since less than 30% of the individuals with predicted 10-year CVD risk ≥10% attend a clinical visit for CVD risk factors control in the primary care clinics (PCCs). Methods We conducted a non-controlled feasibility study using a mixed methods approach to evaluate acceptability, adoption and fidelity of a multi-component intervention implemented in the public healthcare system. The eligibility criteria were having exclusive public health coverage, age ≥ 40 years, residence in the PCC’s catchment area and 10-year CVD risk ≥10%. The multi-component intervention addressed (1) system barriers through task shifting among the PCC’s staff, protected medical appointments slots and a new CVD form and (2) Provider barriers through training for primary care physicians and CHW and individual barriers through a home-based intervention delivered by community health workers (CHWs). Results A total of 185 participants were included in the study. Of the total number of eligible participants, 82.2% attended at least one clinical visit for risk factor control. Physicians intensified drug treatment in 77% of participants with BP ≥140/90 mmHg and 79.5% of participants with diabetes, increased the proportion of participants treated according to GCP from 21 to 32.6% in hypertensive participants, 7.4 to 33.3% in high CVD risk and 1.4 to 8.7% in very high CVD risk groups. Mean systolic and diastolic blood pressure were lower at the end of follow up (156.9 to 145.4 mmHg and 92.9 to 88.9 mmHg, respectively) and control of hypertension (BP < 140/90 mmHg) increased from 20.3 to 35.5%. Conclusion The proposed CHWs-led intervention was feasible and well accepted to improve the detection and treatment of risk factors in the poor population with exclusive public health coverage and with moderate or high CVD risk at the primary care setting in Argentina. Task sharing activities with CHWs did not only stimulate teamwork among PCC staff, but it also improved quality of care. This study showed that community health workers could have a more active role in the detection and clinical management of CVD risk factors in low-income communities.

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