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

Ruta K Valaitis,Sandy Isaacs,Linda O’Mara,Donna Meagher-Stewart,Michael Green,Ruth Martin-Misener,Fred Burge,Sabrina T Wong,Rachel Savage,Janusz Kaczorowski,Marjorie Macdonald,Nancy Murray,Andrea Baumann

doi:10.1186/s12889-020-08610-y

Abstract

BackgroundHealth 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.MethodsTen 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.ResultsAims 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.ConclusionsPrimary care and public health collaborations can strengthen community-based primary health care while addressing the Quadruple Aims with an emphasis on reducing health inequities but requires attention to collaboration barriers and enablers.

Highlights

Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures
Primary care (PC) and public health (PH) collaboration has been touted as a strategy to overcome such challenges [3,4,5,6] and is a core feature of the World Health Organization’s vision of primary health care in the twenty-first century
primary care (PC) is the first point of entry to a health care system that provides episodic, comprehensive, personfocused care over time, coordinates care by others, and includes health promotion [7]

Summary

Introduction

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. Health systems reforms in Canada are influenced by escalating health care costs, demands of an aging population, increasing prevalence of multiple chronic health and social conditions, and increasing health inequities [1, 2]. A community health centre is a model of primary care delivery in Canada that generally serves vulnerable clients, such as the poor and new immigrants, in geographically defined neighbourhoods. The interdisciplinary team emphasizes population-based and community development approaches to address the social determinants of health of the clients they serve [9] and physicians are salaried

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