Abstract
Background: While both public health entities and primary care play key roles in health promotion and prevention, complex challenges, such as lack of role clarity, gaps in governance and coordination, and resource constraints hinder health system integration efforts.
Approach: We aim to explore opportunities to facilitate integration across public health and primary care for health promotion and prevention initiatives in Alberta. The study aim was informed through consultation with public health and primary care staff, leadership, and providers. Patient Co-Investigators play an important role in carrying out the following objectives:. Examine the landscape of public health and primary care integration internationally through an environmental scan. We identified factors influencing integration efforts between public health and primary care for health promotion and prevention initiatives in the academic and grey literature.2. Identify policy, system, and individual-level barriers and facilitators for integrating efforts in Alberta through qualitative interviews with public health and primary care staff, leadership, and providers. Interviews were conducted with patients and caregivers to understand their experiences with receiving care and support for health promotion and prevention.
Results: This study is in progress, with Objectives and 2 underway. Preliminary findings from Objective include the identification of 72 initiatives across 6 countries, with two multi-country initiatives. System-level (macro) initiatives (e.g., pandemic response or national service coordination) accounted for 27% of initiatives. Organizational-level (meso) initiatives comprised 24% of initiatives (e.g., interdisciplinary care teams). Patient-provider-level (micro) initiatives were described in 49% of initiatives, including integrated behavioral health initiatives (e.g., health promotion education). To date, we interviewed 0 public health and primary care staff, leaders, and providers, and 5 patients and caregivers. Key factors influencing implementation of integration identified from Objectives and 2 include: shared vision/goals around health promotion and prevention, clarity around organizational and provider roles and responsibilities, differences in organizational/professional cultures, quality of relationships and partnerships (co-design as an important facilitator), financial compensation/reimbursement for integrated models, the need for governance, organizational structures, and processes for data sharing to support collaboration, and availability of staff. Patients and caregivers identified family doctors as a critical support for their health promotion and prevention goals, while other healthcare providers can also play an important role (e.g. pharmacists). Patients and caregivers emphasized the need for accessible, trusting, person-centred, and culturally sensitive care. Patients and caregivers reported needing to advocate for themselves; they want the system to provide accessible and reliable information.
Implications: Based on the findings from Objectives and 2, we will conduct a consensus workshop with public health and primary care leaders, healthcare providers, and patients to co-design solutions towards health system integration in Alberta. These solutions need to address patient and caregiver needs regarding health promotion and prevention, including addressing system-level gaps to address issues related to accessibility of information and coordination of services. This project aligns with ongoing provincial initiatives to improve patient experiences and outcomes, and can provide practical guidance for strengthening integration efforts between public health and primary care organizations in Alberta.