Addressing quadruple aims through primary care and public health collaboration: ten Canadian case studies

Abstract

Background: Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures. The Quadruple Aim advocates for: improving patient experience, reducing cost, advancing population health and improving the provider experience. It is at the forefront of Canadian reform debates aimed to improve a complex and often-fragmented health care system. Concurrently, collaboration between primary care and public health has been the focus of current research, looking for integrated community-based primary health care models that best suit the health needs of communities and address health equity. This study aimed to explore the nature of Canadian primary care-public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes. Methods: Ten case studies were conducted in three provinces (Nova Scotia, Ontario, and British Columbia) to elucidate experiences of primary care and public health collaboration in different settings, contexts, populations and forms. Data sources included a survey using the Partnership Self-Assessment Tool, focus groups, and document analysis. This provided an opportunity to explore how primary care and public health collaboration could serve in transforming community-based primary health care with the potential to address the Quadruple Aims. Results: Aims of collaborations included: provider capacity building, regional vaccine/immunization management, community-based health promotion programming, and, outreach to increase access to care. Common precipitators were having a shared vision and/or community concern. Barriers and enablers differed among cases. Perceived barriers included ineffective communication processes, inadequate time for collaboration, geographic challenges, lack of resources, and varying organizational goals and mandates. Enablers included clear goals, trusting and inclusive relationships, role clarity, strong leadership, strong coordination and communication, and optimal use of resources. Cases achieved outcomes addressing the Q-Aims such as improving access to services, addressing population health through outreach to at-risk populations, reducing costs through efficiencies, and improving provider experience through capacity building.

Surveys conducted pre‐ and post‐implementation of a synergy tool: Giving voice to emergency teams

“…Relational coordination among nurses is associated with improved quality and safety outcomes for patients, greater workplace engagement and decreased burnout (Havens et al., 2019). The need to improve provider relationships, by improving the care provider experience and subsequently improving patient care provision, is described as the fourth aim in the Quadruple Aim framework that has been prominently featured in our Canadian health care reform debates (Valaitis et al, 2020).…”

The Primary Care COVID-19 Integrated Pathway: A Rapid Response to Health and Social Impacts of COVID-19

“…Speci cally, collaborations between primary care and public health sectors have gained interest over the years, with the pandemic emphasizing their importance in Canadian contexts 18,19 . Within Canada, primary care is often the rst point of entry to the healthcare system, providing tailored and patient-centered care, whereas public health supports societal conditions that promote better health 20 . Though during the pandemic, public health has played a crucial role in COVID-19 identi cation, contact tracing, and information sharing 21 , and can thus facilitate primary care follow-up for illness management within the community 22 .…”

“…Though during the pandemic, public health has played a crucial role in COVID-19 identi cation, contact tracing, and information sharing 21 , and can thus facilitate primary care follow-up for illness management within the community 22 . Together, primary care and public health collaborations provide an integrated approach to improving both individual and population health 20 . Literature reports that successful collaborations are bene cial for community members and those involved in the collaboration 20 .…”

“…Together, primary care and public health collaborations provide an integrated approach to improving both individual and population health 20 . Literature reports that successful collaborations are bene cial for community members and those involved in the collaboration 20 .…”

Influences on the uptake of a population health approach to sexual health programs in Ontario public health units: a qualitative descriptive study

“…Partnerships with external organizations are necessary for a strong public health system that can reduce health inequities (Region of Peel 2019 ). Community partnerships are an effective strategy for implementing interventions (e.g., health behaviours) aimed at marginalized groups, as they have closer connections with these groups (O’Mara-Eves et al 2015 ; Valaitis et al 2020 ). As well, research shows that public health alone is insufficient to improve population health and that partnerships ensure a coordinated effort in working toward the goal of improved health in the community (Estacio et al 2017 ; Littlecott et al 2017 ).…”