Identifying Barriers to Collaboration Between Primary Care and Public Health: Experiences at the Local Level

Enhancing interprofessional teamwork between youth care professionals using an electronic health record; a mixed methods intervention study

We aimed to investigate whether using a shared electronic patient record (EPR-Youth) strengthened interprofessional teamwork among professionals in youth care and child healthcare. Using a mixed-methods design, we compared two partly overlapping samples of professionals, who completed questionnaires before the introduction of EPR-Youth (n = 117) and 24 months thereafter (n = 127). Five components of interprofessional teamwork (interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on processes) were assessed for this study. Midway through the study period, focus groups were held with 12 professionals to examine how EPR-Youth contributed to interprofessional teamwork. Professionals reported significantly more flexibility after the introduction of EPR-Youth than before. Professionals scored slightly -but not significantly- more positively on the other components of teamwork. Focus group participants reported that using EPR-Youth strengthened their sense of interdependence and collective ownership of goals, and contributed to newly created professional activities. At baseline, levels of interprofessional teamwork differed between organizations. Focus group participants confirmed these differences and attributed them to differences in facilitation of interprofessional teamwork. Our findings suggest that using EPR-Youth can foster interprofessional teamwork. Organizational differences underline that implementing an EPR alone is inadequate: shared definitions of teamwork and organizational facilities are needed to strengthen interprofessional teamwork.

A Bibliometric Review of Constituents, Themes, and Trends in Online Medical Consultation Research

As an emerging form of health care with accelerated growth in recent years, online medical consultation (OMC) has received extensive attention worldwide. Although the number of studies on OMC has increased substantially, few provide a comprehensive and up-to-date review of OMC's research constituents, themes, and trends. This study, therefore, extracted 1,801 OMC-related articles published in English from the Web of Science (WoS) Core Collection database during the past 30 years and employed a bibliometric analysis of WoS and CiteSpace to examine major constituents' distribution, collaboration relationships, themes, and trends. The results indicate that the United States, England, and China contributed the most to the proliferation of OMC studies. The United States had the greatest academic influence and the most collaborative connections, while China demonstrated the sharpest increase and most active development in recent years. However, there is a lack of substantial and close collaboration between researchers worldwide. The main themes of OMC research were Internet hospitals, COVID-19, mixed methods, online health community, and information technology. Researchers have recently shifted their attention to social media, management, efficacy, word of mouth, mental health, and anxiety. This review paper provides researchers and practitioners with a holistic and clear understanding of the features and trends of OMC research. It also identifies potential areas for future OMC research and sheds light on OMC practices.

A mixed-methods evaluation: COVID Care in the Home, a public health response to the first omicron wave across the Torres and Cape region, Queensland

OBJECTIVE

The purpose of this article is to evaluate the COVID-19 Care in the Home (CCITH) program during the first COVID-19 omicron wave across Torres Strait and Cape York region of Far North Queensland in 2022.

METHODS

A mixed-method study: An online survey and semi-structured interviews of CCITH internal and external stakeholders and participants was utilised to develop a greater understanding of perspectives of the program.

RESULTS

Survey participants n=140. Most survey respondents did not attend hospital, emergency, or primary healthcare centre during isolation for medical assistance (82%, 115/140) and most strongly agreed/agreed (87%, 122/140) that the CCITH program cared for their health needs. Interview participants n=14. Thematic analysis of interviews verified survey responses and identified successes of this program including improved community relationships and primary healthcare centres and community members felt supported. Limitations included rapid changes to policies and roles and limited food availability during isolation.

CONCLUSIONS

The CCITH program highlights the resilience and self-determination of First Nations communities and primary health staff across the Torres Strait and Cape York throughout the first COVID-19 outbreak in the region.

IMPLICATIONS FOR PUBLIC HEALTH

This virtual model of care could be employed in similar settings to improve service provision in both primary and public health to increase community safety and achieve good health outcomes.

Primary care engagement in health system change: a scoping review of common barriers and effective strategies

BACKGROUND

The complexity of health systems necessitates coordination between a multitude of stakeholders to enact meaningful change. Primary care physicians are a crucial partner to engage, as their investment and participation are critical to the success of any system-level initiative. The aim of this scoping review is to identify common barriers and effective strategies when engaging primary care physicians in designing and implementing health system change.

METHODS

A scoping review was performed. A literature search was performed in March 2020 using five databases. 668 unique articles were identified and underwent a title and abstract review. 23 articles met criteria for full text review and 10 met final inclusion criteria. A backward citation analysis identified two articles. 12 articles underwent data extraction and thematic analysis.

RESULTS

Several barriers to engagement were identified including a lack of trust between primary care physicians and decision-makers, strong professional physician identity, clinically irrelevant and complex proposals, and a lack of capacity and supports. Described strategies to overcome these barriers included building trust and relationships, contextual engagement strategies, working with physician leadership, enabling open and intentional communication channels, designing clinically relevant and straightforward initiatives, and considering financial incentives.

CONCLUSIONS

Barriers to primary care engagement should be addressed with contextually designed strategies and a focus on relationship building, collaborative efforts, and implementing relevant and feasible initiatives. Further research should explore how to best develop relationships with primary care, working with collective voices of primary care physicians, and to better understanding the impact of financial incentives on engagement.

Modernizing the United States' Public Health Infrastructure: A Position Paper From the American College of Physicians

The United States' public health sector plays a crucial role in preventing illness and promoting health. Public health drove massive gains in life expectancy during the 20th century by supporting vaccination campaigns, promoting motor vehicle safety, and preventing and treating tobacco use. However, public health is underfunded and underappreciated, forcing the field to do more with fewer resources. In this position paper, the American College of Physicians (ACP) updates its 2012 policy recommendations on strengthening the nation's public health infrastructure. ACP calls for effective coordination of public health activities, robust and stable year-to-year funding of public health services, a renewed and well-supported public health workforce, action to address health-related dis- and misinformation, modernized public health data systems, and greater coordination between public health and medical sectors.

Assessment of implementation barriers of blockchain technology in public healthcare: evidences from developing countries

The widespread use of Blockchain technology (BT) in nations that are developing remains in its early stages, necessitating a more comprehensive evaluation using efficient and adaptable approaches. The need for digitalization to boost operational effectiveness is growing in the healthcare sector. Despite BT's potential as a competitive option for the healthcare sector, insufficient research has prevented it being fully utilised. This study intends to identify the main sociological, economical, and infrastructure obstacles to BT adoption in developing nations' public health systems. To accomplish this goal, the study employs a multi-level analysis of blockchain hurdles using hybrid approach. The study's findings provide decision- makers with guidance on how to proceed, as well as insight into implementation challenges.

Barriers for Inter-Organisational Collaboration: What Matters for an Integrated Care Programme?

Introduction

Inter-organisational collaboration is challenging but essential in managing the complex and comprehensive needs of frail older people. Therefore, there is a need to investigate the influence of different barriers to inter-organisational collaboration when implementing an integrated care programme. The aim of this study was to investigate both inpatient and outpatient staff views on the factors they deemed to be influential to inter-organisational collaboration for an integrated care programme.

Methods

The study was a cross-sectional study and included staff from hospitals, primary care and municipal health and social care.

Results

There were no significant differences between staff from inpatient and outpatient care in measuring factors that may cause difficulties for inter-organisational collaboration. Staff views diverged significantly on all factors, such as educational level at long physical distances, laws and regulations, knowledge of each others work settings, experience from inter-organisational collaboration, different professions, variations in professional status and power, psychosocial factors such as positive work environment and interpersonal chemistry.

Discussion

A multidisciplinary team culture and avenues for inter-organisational collaboration need to be developed for improved care continuity.

Conclusion

The staffs' educational level influenced what was perceived as barriers to inter-organisational collaboration, and may guide future development of integrated care programmes.

Public health spending, primary care, and perceived risk promoted vaccination against H1N1

The purpose of this study is to examine factors affecting the intent to vaccinate during the 2009 H1N1 pandemic and to leverage the results to inform public health policy decisions aimed at increasing vaccine uptake during the COVID-19 pandemic. Using the National 2009 H1N1 Flu Survey data and state-level administrative data, we employ logistic regression and mediation models to estimate the association between vaccine uptake and state level public health spending, political ideology, and H1N1 case and death rates as well as a set of individual and household characteristics. We find that higher public health spending can significantly increase the intent to vaccinate, mainly through raising concerns about the pandemic and promoting vaccine relevant doctor patient interactions. We conclude that physicians, especially primary care physicians, should play more important roles in the ongoing vaccination efforts against the COVID-19 virus.

Working with communities: Meeting the health needs of those living in vulnerable communities when Primary Health Care and Universal Health Care are not available

RATIONALE, AIMS, AND OBJECTIVES

The health care delivery model in the United States does not work; it perpetuates unequal access to care, favours treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are low-income minorities (Native Americans, Hispanics, and African-Americans) who live in high risk and vulnerable communities. The historical lack of support in the United States for Universal Health Care (UHC) and Primary Health Care (PHC)-with their emphasis on health care for all, population health, and social determinants of health-requires community health scientists to develop innovative local solutions for addressing unmet community health needs.

METHODS

We developed a model community health science approach for improving health in fragile communities, by combining community-oriented primary care (COPC), community-based participatory research (CBPR), asset-based community development, and service learning principles. During the past two decades, our team has collaborated with community residents, local leaders, and many different types of organizations, to address the health needs of vulnerable patients. The approach defines health as a social outcome, resulting from a combination of clinical science, collective responsibility, and informed social action.

RESULTS

From 2000 to 2020, we established a federally funded research programme for testing interventions to improve health outcomes in vulnerable communities, by working in partnership with community organizations and other stakeholders. The partnership goals were reducing chronic disease risk and multimorbidity, by stimulating lifestyle changes, increasing healthy behaviours and health knowledge, improving care seeking and patient self-management, and addressing the social determinants of health and population health. Our programmes have also provided structured community health science training in high-risk communities for hundreds of doctors in training.

CONCLUSION

Our community health science approach demonstrates that the factors contributing to health can only be addressed by working directly with and in affected communities to co-develop health care solutions across the broad range of causal factors. As the United States begins to consider expanding health care options consistent with PHC and UHC principles, our community health science experience provides useful lessons in how to engage communities to address the deficits of the current system. Perhaps the greatest assets US health care systems have for better addressing population health and the social determinants of health are the important health-related initiatives already underway in most local communities. Building partnerships based on local resources and ongoing social determinants of health initiatives is the key for medicine to meaningfully engage communities for improving health outcomes and reducing health disparities. This has been the greatest lesson we have learned the past two decades, has provided the foundation for our community health science approach, and accounts for whatever success we have achieved.

Nurse Support on Health Cadre Empowerment and the Influence on the Ability of Women’s Mentoring Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome

BACKGROUND: In the context of community empowerment, the role of nurses as health workers is very important to transform the knowledge and skills of cadres. However, the support of nurses in empowering human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) health cadres has not been widely explained. AIM: This study examines the effect of nurse support and empowerment on the ability of HIV/AIDS cadres to assist mothers with HIV/AIDS. METHODS: This study used a cross-sectional approach. We involved 119 HIV/AIDS cadres including local residents who care about AIDS (WPA, n = 90), facilitators of families of hope (PKH, n = 17), and peer support groups (KDS, n = 12). Data collection was carried out from February to April 2020, the sample was selected using multistage cluster sampling in Kudus Regency, Central Java, Indonesia. Multiple linear regression analysis was conducted to determine the support of nurses, empowerment of HIV/AIDS cadres, and its effect on the ability of cadres in assisting women with HIV/AIDS. RESULTS: We found that nurses’ support for the empowerment of HIV/AIDS cadres was low in almost all aspects (instrumental, informational, emotional, and affiliation). Nurse support and cadre empowerment affect the ability of HIV/AIDS cadres by 28%. Regression test formula Y = −97.080 + 0.738X1 + 1.944X2. CONCLUSION: The results showed that the four types of nurse social support may be interrelated and are generally still low in the process of empowering HIV/AIDS cadres. There is an effect of nurse support and empowerment of HIV/AIDS cadres on the ability of cadres to assist women with HIV/AIDS.

Web-Based Software Tools for Systematic Literature Review in Medicine: A Review and Feature Analysis (Preprint)

Background

Systematic reviews (SRs) are central to evaluating therapies but have high costs in terms of both time and money. Many software tools exist to assist with SRs, but most tools do not support the full process, and transparency and replicability of SR depend on performing and presenting evidence according to established best practices.

Objective

This study aims to provide a basis for comparing and selecting between web-based software tools that support SR, by conducting a feature-by-feature comparison of SR tools.

Methods

We searched for SR tools by reviewing any such tool listed in the SR Toolbox, previous reviews of SR tools, and qualitative Google searching. We included all SR tools that were currently functional and required no coding, and excluded reference managers, desktop applications, and statistical software. The list of features to assess was populated by combining all features assessed in 4 previous reviews of SR tools; we also added 5 features (manual addition, screening automation, dual extraction, living review, and public outputs) that were independently noted as best practices or enhancements of transparency and replicability. Then, 2 reviewers assigned binary present or absent assessments to all SR tools with respect to all features, and a third reviewer adjudicated all disagreements.

Results

Of the 53 SR tools found, 55% (29/53) were excluded, leaving 45% (24/53) for assessment. In total, 30 features were assessed across 6 classes, and the interobserver agreement was 86.46%. DistillerSR (Evidence Partners; 26/30, 87%), Nested Knowledge (Nested Knowledge; 25/30, 83%), and EPPI-Reviewer Web (EPPI-Centre; 24/30, 80%) support the most features followed by Giotto Compliance (Giotto Compliance; 23/30, 77%), LitStream (ICF), and SRDB.PRO (VTS Software). Fewer than half of all the features assessed are supported by 7 tools: RobotAnalyst (National Centre for Text Mining), SRDR (Agency for Healthcare Research and Quality), SyRF (Systematic Review Facility), Data Abstraction Assistant (Center for Evidence Synthesis in Health), SR Accelerator (Institute for Evidence-Based Healthcare), RobotReviewer (RobotReviewer), and COVID-NMA (COVID-NMA). Notably, of the 24 tools, only 10 (42%) support direct search, only 7 (29%) offer dual extraction, and only 13 (54%) offer living/updatable reviews.

Conclusions

DistillerSR, Nested Knowledge, and EPPI-Reviewer Web each offer a high density of SR-focused web-based tools. By transparent comparison and discussion regarding SR tool functionality, the medical community can both choose among existing software offerings and note the areas of growth needed, most notably in the support of living reviews.

Collaboration of primary care and public health at the local level: observational descriptive study of French local health contracts

AIM

In this paper, we report on a study investigating the involvement of primary care providers in French local health contracts.

BACKGROUND

Worldwide actions are carried out to improve collaboration between primary care and public health to strengthen primary healthcare and consequently community health. In France, the local health contract is an instrument mobilising local stakeholders from different sectors to join in their actions to improve the health of the population.

METHODS

We developed an instrument to analyse the frequency and nature of involvement of primary care providers in 428 action plans extracted from a sample of 17 contracts (one per French region). The number of primary care actions were counted, and thematic analyses were conducted to identify the nature and level of involvement of the professionals.

FINDINGS

Primary care providers were involved in 20.1% (n = 86) of the action plans and were mostly described as a target of the action rather than leaders or partners. Within those action plans, 76.7% (n = 66) of these action plans aimed to improve access to care for local communities; an issue that appears as the main driver of collaboration between public health and primary care actors.

The role of registered nurses in primary care and public health collaboration: A scoping review

Aim

The purpose of this work was to examine the roles of Registered Nurses (RNs) in primary care (PC) and public health (PH) collaboration. Additionally, we aimed to explore whether the current scope of practice for RNs is adequate to support their roles in PC/PH collaboration.

Design

A scoping review of current literature relating to the RN's role in PC/PH collaboration was conducted using the PRISMA 2009 checklist.

Methods

The review used key terms: primary care, public health, collaboration, nursing and nurse role across six electronic databases; 23 articles that were included in the final review were published over a 7-year span.

Results

Four key RN roles relating to PC/PH collaboration were identified: relationship builder, outreach professional, programme facilitator and care coordinator. RNs supported transitions in chronic disease, communicable disease care and maternity care at various healthcare system levels including systemic, organizational, intrapersonal and interpersonal levels.

The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions

INTRODUCTION

Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV).

METHODS

HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance.

RESULTS

The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices.

CONCLUSION

Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.

Strengthening Linkages Between Public Health and Health Care in Nebraska

Introduction

Effective collaboration between public health and the health care system is essential for connecting medical and community health–related resources and improving population health. We investigated the linkages between local health departments and primary care clinics in Nebraska.

Methods

We conducted a mixed-method study by using semistructured in-person and telephone interviews and surveys in 2017 and 2018 with directors of 19 Nebraska local health departments. Interviews and surveys assessed activities and programs that health departments implemented or planned with clinics in their jurisdictions. Barriers, benefits, and opportunities for building the linkages were identified.

Results

Strong linkages existed between local health departments and primary care clinics. Linkages focused on the control and prevention of chronic diseases and on traditional public health programs, including screening for cancer and other chronic diseases, vaccinations, worksite wellness programs, home visits, clinic and medication assistance referrals, health message development, electronic health records data analyses, staff education, and improvements in policies and procedures. The most frequently reported barrier was funding, and the most frequently reported benefit was patient behavior change. The opportunity most frequently reported was chronic disease health coaching.

Conclusion

Extensive linkages exist between Nebraska local health departments and the health care systems in their areas. Additional funding, effective workforce management, community needs assessments, and program evaluation can support joint initiatives to address community health priorities.