Enablers
Despite the challenges of collaboration, systemic level strategies led by government can help to bridge silos and send a clear message that collaboration is valued, important, and expected. These enablers create potentially powerful mechanisms to support collaboration between public health and primary care at the systemic level, and provide leadership by modelling these efforts for those working at the organizational level.
Health service structures that can promote collaboration include:
- Access to surveillance data and databases;
- Availability of practice guidelines and standards;
- Creation of interbranch/divisional/departmental committees;
- Shared public health-primary care portfolios;
- Provincial initiatives that require or at least encourage collaboration between sectors (for example, STOP HIV – See stophivaids.ca);
- Models of service delivery that facilitate and support collaboration.
Access to Surveillance Data and Databases
Practitioners have identified that, to support and facilitate collaboration between public health and primary care, they need access to surveillance data to help them define the scope and extent of health issues with which both groups are concerned (for example, chronic disease prevention and management).
“When I was able to provide my physician colleagues with morbidity and mortality data relevant to each physicians’ patient population, it facilitated our discussion about important health issues from a population perspective and how we might work together to address them.”
Related to this, is the importance of developing provincial/territorial level linked databases to provide ready access to relevant data.
Related: Harmonized Information and Communication Infrastructure
Data access and service agreements can facilitate availability of data in support of collaboration. For example, in British Columbia, the new First Nations Health Authority and the Provincial Health Services Authority (both provincial level organizations) have data access and service agreements that facilitate the collaborative work of the First Nations Health Authority. Integration of public health and primary care is an important focus in the First Nations Health Authority.
Availability of Practice Guidelines and Standards
The availability of practice guidelines that can inform and support practice by both public health and primary care practitioners can also encourage collaboration. In Ontario, for example, the Registered Nurses Association of Ontario (RNAO) has developed best practice guidelines for nurses. Many of these are relevant to both public health and primary care nurses, including one entitled “Developing and Sustaining Interprofessional Health Care: Optimizing patient, organizational, and system outcomes.” (See rnao.ca/bpg/guidelines/interprofessional-team-work-healthcare).
Similarly, in British Columbia, the Ministry of Health has developed evidence reviews and model core program papers for 21 core public health programs. The intent of these is to guide health authorities in implementing best practices. These evidence reviews and model programs are relevant to both public health and primary care practitioners. They make clear the importance of partnerships and collaborations, not only between public health and primary care, but with other sectors. See health.gov.bc.ca/public-health/quickfinder.html. However, as with the RNAO best practice guidelines, there is very little in these reviews to provide information on how ‘to do’ collaboration.
Creation of Interbranch/Divisional/Departmental Committees
An excellent example of interbranch strategies is the creation of a joint committee to review clinical prevention services in British Columbia’s Ministry of Health. This committee was jointly chaired by leaders in each division responsible for public health and primary care reporting to the Assistant Deputy Ministers responsible for each division.
This co-leadership and shared responsibility provided a powerful demonstration of effective public health and primary care collaboration and helped ensure that public health and primary care perspectives were brought forward as reflected in the committee’s final report and the development of a Lifetime Prevention Schedule for the province. (British Columbia, Ministry of Health Services. The Report of the Clinical Prevention Policy Review Committee: A Lifetime of Prevention, 2009. See health.gov.bc.ca/library/publications/year/2009/CPPR_Lifetime_of_Prevention_Report.pdf)
Shared Public Health Primary Care Portfolios
A new position was created in the BC Ministry of Health titled Joint Director, Public Health and Primary Care Collaboration. This position sent a clear message to others in government about the importance of collaboration between sectors. In addition it ensured that concerns of both health care sectors are taken into account to support strategic directions of the province, which includes an emphasis on collaboration throughout the health care system.
This type of shared public health and primary care portfolio is being created at the local level in provinces that are regionalized. There may be challenges in other Canadian provinces where there is a limited role of primary care in organizations that are not integrated into the larger health system.
Provincial Initiatives that Require Collaboration between Sectors
Another enabler of collaboration at the systemic level is the implementation of broad province-wide initiatives that require public health and primary care sectors to collaborate. There are many examples of this type of initiative across the country.
One important initiative in British Columbia is the STOP HIV/AIDS project, which has moved beyond pilot testing in two regional health authorities to province-wide implementation. The goals of the project are to: Ensure timely access to high quality and safe HIV/AIDS care and treatment; reduce the number of new HIV/AIDS diagnoses; reduce the impact of HIV/AIDS through effective screening and early detection; improve the patient experience in every step of the HIV/AIDS journey; and demonstrate system and cost optimization.
The intent is that the process will be “highly collaborative” (British Columbia Centre for Excellence in HIV/AIDS, 2013) to allow people to learn from each other and translate knowledge into practice. An HIV Continuum of Care Collaborative has been developed to facilitate collaboration among all stakeholders, including clients and practitioners across different sectors of the health care system. More information can be obtained at the following websites:
Another excellent example of a province wide initiative that is currently taking place in at least two provinces is the Nurse-Family Partnership project. This program provides prenatal and infancy home visiting for young, socially disadvantaged, first-time mothers and has resulted in new opportunities for public health and primary care collaboration. For more information visit the following websites:
Models of Service Delivery
Provincial governments have a responsibility to develop, fund, and support models of service delivery that are effective, meet the needs of the population, and are cost-effective in their delivery. One model of service delivery that has had a long history in several provinces is the Community Health Centre. These organizations are generally funded either through a global budget, capitation, or a blended model of global funding or capitation and limited fee-for-service.
The funding mechanism provides support for collaboration between public health and primary care practitioners. This is realized from several sources as follows: Either through their co-location in the same building; their focus on particular marginalized and underserved populations with specific public health and primary care needs; and the absence of the fee-for-service which can act as an incentive for spending more time with patients.
As an example of provincial health and social services please view the Quebec site: msss.gouv.qc.ca/en/index.php. For further information, see: publications.msss.gouv.qc.ca/acrobat/f/documentation/2004/04-009-05.pdf [subject to change 2015].
Related: Funding Models and Financial Incentives Supporting Collaboration