By Christopher Cheney
During the coronavirus pandemic, the failure to elevate the role of primary care providers on the frontline alongside public health officials has resulted in several missed opportunities to respond to the crisis, a recent study found.
The pandemic has highlighted weaknesses and vulnerabilities in the country’s healthcare and public health systems. For example, primary care and public health have been underfunded in the United States, limiting their ability to react to the pandemic. The United States allocates about 6% of national healthcare spending on primary care, which is less than half of the average expenditure on primary care in other high-income countries.
The recent study, which was published by The Johns Hopkins Center for Health Security, is based on 32 semi-structured interviews with subject matter experts and a review of 50 articles.
Weak integration of primary care and public health is a tragic lesson from the pandemic, the study’s co-authors wrote. “From its acute onset and throughout its extended duration, the COVID-19 pandemic has illuminated and exploited major vulnerabilities within the U.S. healthcare system, the most egregious of which were deficiencies in communication, collaboration, and coordination between primary care and public health. COVID-19 must be used as a catalyst for change.”
This lack of integration limited several key responses to the pandemic, the study’s co-authors wrote. “The failure to bring primary care providers into a frontline role as responders, alongside public health, resulted in many missed opportunities to provide better quality care, faster testing, more effective contact tracing, greater acceptance of vaccination, and better communication with patients. Participants in this study further indicated that better integration of primary care, public health, and community-based organizations could have provided greater support for the public health response, thereby easing the burden on overstretched public health personnel; and could have accessed primary care’s reach to amplify public health messaging.”
Elements of successful collaboration
The study’s literature review identified three primary components of effective collaboration between primary care and public health.
1. Strong relationships with community partners and organizations: “Strong ties with community partners and organizations are necessary to enhance the reach of any public health-primary care collaborative initiative outside of the capabilities of public health and primary care alone. Several articles emphasized the importance of relationships with mental health, social services, and community-based organizations and stakeholders that can leverage their community ties to bring more people into contact with public health and primary care initiatives,” the study’s co-authors wrote.
2. Established interprofessional relationships at the personal and institutional level between public health and primary care partners: “At the personal level, preexisting working relationships between public health and primary care representatives prior to the inception of the joint program contributed to more effective and regular communication. Previous connections between organizations, but not necessarily between the personnel involved, also provided a stronger foundation upon which the new collaboration could be built,” the study’s co-authors wrote.
3. Formal arrangements that specify the duties and expectations of public health and primary care partners: “When each partner is clear on their responsibilities and how those responsibilities contribute to the programmatic goals, there is less risk of duplicating efforts or gaps in program delivery. Additionally, identifying common goals and synergizing workplace culture between public health and primary care partners can help streamline collaborative processes and make the program more sustainable in the long term,” the study’s co-authors wrote.
The study includes four key recommendations:
1. Co-locate primary care and public health services to benefit population-level health and support active collaboration.
2. Primary care societies must align their efforts with public health in a unified voice to drive congressional action to ensure that the disastrous response to the COVID-19 pandemic is not repeated.
3. Craft efforts to support, protect, and sustain the primary care and public health workforces to drive integration across disciplines.
4. Public health “moves at the speed of trust” and people trust their primary care providers and community-based organizations; therefore, primary care and public health partnerships with strong ties to their community organizations should enhance health systems’ surge capacity, extend public health disease containment interventions, and position the United States for improved response to future pandemics.
Christopher Cheney is the senior clinical care editor at HealthLeaders.