Back in March, the AAFP joined a diverse group of public and private organizations in helping to launch the Practical Playbook(practicalplaybook.org) initiative, which offers online resources to help primary care and public health professionals in their efforts to integrate with one another. Last month, the same team unveiled its next initiative -- the BUILD Health Challenge(www.buildhealthchallenge.org) -- that provided grant and loan funding to foster and expand meaningful partnerships among health systems, community-based organizations, local health departments and other organizations that affect community health.
Now, the Academy has stepped up its promotion of this synergistic idea by publishing its own position paper titled "Integration of Primary Care and Public Health."
AAFP member David O'Gurek, M.D., of Philadelphia, led the development of the paper, which he told AAFP News was the first such effort by the Academy on this topic. He said a Primary Care-Public Health Integration workgroup was established as part of the Commission on Health of the Public and Science to address the growing trends and push for integration of public health and primary care.
- The Academy's "Integration of Primary Care and Public Health" position paper is the first such document the AAFP has produced on this topic.
- The position paper defines population health as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group."
- The paper also outlines the family physician's role in these efforts, calling for action at the physician, practice, leadership and education levels.
"There have been a number of articles published in the Annals of Family Medicine on the subject matter, both previously and related to public health, and there have been other pushes in the past for this integration; however, none of these were Academy documents or Academy-driven efforts," O'Gurek said.
The position paper begins by urging AAFP members to become informed about the importance and value of, as well as the movement toward, integration of primary care and public health.
Quoting from a presentation delivered by Steven Woolf, M.D., M.P.H., a professor of family medicine at Virginia Commonwealth University in Richmond, during the 2011 AAFP National Conference of Family Medicine Residents and Medical Students, the paper says one of the first objectives for family physicians is to "understand the living conditions patients face when they leave our office or when they leave the hospital."
The paper goes on to explain that this is paralleled by a growing awareness of the social, environmental and community determinants of health. "However, for successful broad system change, family medicine within the primary care specialties must co-align with the public health sector -- two fields with a common interest, yet functioning independently for the last century," it adds.
According to O'Gurek, the concepts and ideals involved in the push to integrate primary care and public health are not new to family physicians.
"These are often the same concepts and ideals that first inspired many of us to pursue the specialty and work within a community context," he said. "The position paper and accompanying resource list accept the challenge of making this effort successful after several attempts in the past at integration that did not amount to much."
Focusing on population health -- defined in the position paper as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group" -- is an integral concept in this initiative. For most family physicians, this main group of individuals will be their patient panel.
"Delivering on the promise of population health demands that the public health sector be a part of the medical neighborhood, which the Academy formally recognizes; however, this cannot be in letters only and must be put into practice," said O'Gurek.
Although some concepts -- such as those established for years through the community health centers, "communities of solution," and community-oriented primary care -- are not new concepts, they are stabilized by including the public health sector into family physicians' daily lives in a much more real way than they currently do, he said.
"Furthermore, efforts looking at innovative models are exactly the practice transformation that the health system is yearning for and needs," O'Gurek added. "The challenge for practices is that no integration model should be exactly alike as it must meet the needs of the patients within the context of the community. There is not, and should never be, a series of check boxes that need to be obtained to say that integration is occurring."
Role of the Family Physician
The goal of fully integrating primary care and public health comes with a call to action for family physicians to support this effort by walking the walk in their daily practices.
"Integration efforts, the position paper, as well as external resources, provide a tool for family physicians to incorporate practice transformation to ensure that 'Health is Primary,'"(www.healthisprimary.org) said O'Gurek.
The position paper outlines the family physician's role in these efforts. It says that "in order to meet these needs, the AAFP calls for action in the following areas:
- Physician Level
- Understand the role public health has to play for you, your patients and the community you serve.
- Demonstrate awareness of integration efforts between primary care and public health.
- Practice Level
- Redefine population based on the public health definition as geographic as opposed to a practice patient panel.
- Recognize and incorporate the public health infrastructure into the medical neighborhood.
- Continuously collaborate and communicate with the public health infrastructure to operate as a continuous unit with a common goal.
- Leadership Level
- Facilitate collaboration and communication amongst health systems and public health organizations.
- Drive change within hospitals or health systems to partner with public health organizations.
- Educational Level
- Drive change within undergraduate and graduate medical education to ensure physicians of tomorrow are prepared for a more integrated system."
The paper states that "these leadership roles must start … at the individual physician level and move up to the practice level. Each physician has a part to play at a personal level, and being informed about integration, its importance, the value and the successes is the first step."
Additional Paper Highlights
The patient-centered medical home (PCMH) and medical education reform also are addressed in the position paper as important pieces of the integration puzzle.
Offering care that is patient-centered, comprehensive, team-based, coordinated, accessible and of high quality focused through the PCMH can include others in the community to help patients improve their health. According to the paper, subspecialty physicians, allied health workers, community resources, behavioral health workers and organizations, schools, educational organizations, volunteer organizations, governmental organizations, and notably, public health organizations all can play a role.
Then, as the system and delivery models change to emphasize population health with primary care and public health integration, pipeline and workforce issues must also be adapted, says the paper.
"This includes both changes to undergraduate and graduate medical curriculum, as well as faculty development programs to ensure faculty of medical schools and residency programs are able to provide students with the tools needed," it reads.
O'Gurek suggested members visit the Association of State and Territorial Health Officials (ASTHO) resource(www.astho.org) on the topic for additional information on related national strategic initiatives and direction on how to get involved. He said the ASTHO website explains how to participate in conference calls, receive newsletters on efforts occurring nationally, hear success stories and obtain information on the value proposition for individual institutions.
Related AAFP News Coverage
BUILD Health Challenge to Fund Community Health Collaborations
Team Behind Practical Playbook Backs Initiative