Primary care and public health encouraged to work together

The nation’s health probably would improve if primary care and public health were better integrated, says an Institute of Medicine report.

Such integration should include health professionals sharing and collaboratively using data, asking the community to help define its medical needs and pursuing a shared goal of improving the population’s health, said the report, issued on March 28 (link).

“While integrating fields that have long operated separately may seem like a daunting endeavor, our nation has undertaken many major initiatives. ... It’s time we did the same for primary care and public health, which together form the foundation of our population’s overall well-being,” said IOM committee Chair Paul J. Wallace, MD. He is senior vice president and director of the Center for Comparative Effectiveness Research, which works to improve patient health outcomes and health care delivery.

Chronic disease prevention and treatment, which increasingly are becoming the focus of primary care and public health, is a key area where collaboration could improve the health of communities across the county, Dr. Wallace said. Primary care physicians often are overwhelmed by the broad spectrum of care that is needed for chronic conditions, he said.

Public health professionals feel burdened when the patients they educate about preventing chronic illnesses don’t have a primary care doctor to help manage their health, Dr. Wallace said. To resolve that issue, he has a simple message for primary care doctors and public health workers: “When you feel overwhelmed, call the other people up.”

Health professionals in primary care and public health think about chronic disease prevention and management in ways that complement one another, he said.

The aim of the IOM report was to offer recommendations on how the Centers for Disease Control and Prevention and the Health Resources and Services Administration could work collectively to improve health through the integration of primary care and public health. HRSA is the primary federal agency for improving access to health care services for the uninsured, isolated and medically vulnerable.

The 17-member IOM committee, which included experts in primary health care, public health and health care finance, examined published reports on integration and studies of three cities where integration efforts have taken place. The studied cities were Durham, N.C., New York and San Francisco.

Successful collaboration key

Committee members found that successful integration of the two sectors requires community engagement to define and tackle local population health needs, and leadership that bridges disciplines and jurisdictions and provides support and accountability. Also important are sharing data and analyses and a sustained focus on the goal of integration.

The report recommends that the CDC and HRSA create opportunities for staff to build relationships with each other. The agencies also are encouraged to assess their databases to create a consolidated platform for sharing and displaying local population health data that could be used by the community.

IOM committee members say the time is right to integrate primary care and public health due, in part, to the rising price of health care, which is leading many people to explore ways to reduce costs and improve health.

“This is not about creating something that hasn’t been done before,” said committee member J. Lloyd Michener, MD, professor and chair of the Dept. of Community and Family Medicine at Duke University Medical Center in Durham, N.C. “It’s about learning how we can bring ourselves and agencies together and have healthier communities.”