By Amanda Boundris
Many Canadians remember the frustration of standing in a long line for a flu shot during the H1N1 flu pandemic of 2009. There were no lineups, however, in one northern community where public health and primary care staff teamed up to build an integrated scheduling and immunization tracking system, while sharing staff and utilizing volunteers.
This is just one example that illustrates the power of successful collaboration. Exploring how public health and primary care can better work together to improve health and the quality and effectiveness of primary health care systems was the focus of a four-year program of research led by Ruta Valaitis, an associate professor of nursing at McMaster.
To that end, Valaitis and her large interdisciplinary team from across Ontario, British Columbia and Nova Scotia have released their final report for the Canadian Foundation for Healthcare Improvement (CFHI) (formerly the Canadian Health Services Research Foundation), entitled Strengthening Primary Health Care through Primary Care and Public Health Collaboration. The team includes the School of Nursing’s Linda O’Mara, Noori Akhtar-Danesh, Andrea Baumann, Maureen Dobbins, Anne Ehrlich and Donna Ciliska.
"Primary care and public health collaboration makes sense and working together is important in all health care systems to improve the delivery of services," said Valaitis, who is also the Dorothy C. Hall Chair in Primary Health Care Nursing. "It’s about building synergies between these two sectors for improvement of the overall health care system."
The CFHI report defines primary health care as "an approach to health policy and service provision to individuals and populations that includes health services provided by both primary care and public health." Primary care is the first point of entry to a health care system, often a doctor or a nurse. Public health is an organized activity to promote, protect, improve, and restore the health of individuals, specified groups, or the population.
The report details a series of five studies: a literature review; three provincial environmental scans; key informant interviews; viewpoints of stakeholders, gathered using Q-methodology; and 10 case studies from British Columbia, Ontario and Nova Scotia.
Findings indicate that the health issues most often addressed through collaborations in all provinces include communicable disease control, chronic disease prevention and management, parent-child programming, youth and health promotion programs, and women’s health programs.
As well, several factors at each level of collaboration are needed for a partnership’s sustainability. To name a few, policy and funding are needed at the systemic level; strong leadership, and strategic coordination and communication among partners at the organizational level; role clarity, and trusting and inclusive relationships at the interpersonal level; and at the intrapersonal level, personal values, beliefs and positive attitudes toward teamwork.
Barriers to successful collaboration include lack of funding, policy, and lack of an integrated information and communication infrastructure. Another dilemma, Valaitis noted, is that primary care is not mandated to collaborate, whereas public health is provincially mandated to work in partnerships with other organizations.
"Collaboration between primary care and public health can no longer be viewed as a nice to have, it must be seen as need to have," said Stephen Samis, Vice President, Programs, CFHI. "This report further validates the need for a closer relationship between public health and primary health care, and how important such a partnership can be to improving the overall health care system."
Valaitis said nurses will continue to play a key role in successful collaborations. "In a lot of cases it’s the public health nurses, primary care nurses and nurse practitioners that tend to be the glue in the partnership to make it work," she said.
This research was funded in large part by CFHI and the Michael Smith Foundation for Health Research HSPRN Partnership Program.