Abstract
Introduction: Public health and primary care are often conceived as two entities providing complementary services within the health system. This scoping review aims to better understand how the two sectors interact by identifying their shared functions, and by identifying organizational models that could facilitate the interaction between the two domains. Methodology: We conducted a review of published literature using PubMed and CINAHL journal indices. Our search yielded 179 articles. We reviewed abstracts and retained 55 relevant articles. We developed an extraction grid, based on a conceptual framework of functions of public health and primary care, in order to evaluate the relevance of selected articles, classify the information according to their functional connection, and identify interactions between them. Results: Our search identified various activities through which public health can contribute to more effective primary care, and functions usually performed by primary care that seemed to support a population health approach. Most authors identified screening and immunization as actions that are carried out in primary care, but that can benefit from the support of public health. Health promotion and lifestyle modification are also shared responsibilities that can take the form of collective or individual intervention. The surveillance and protection function of public health, which actually takes place in primary care, consists of case identification for prevention or early treatment. Primary care is the setting where patients present, whereas public health has the role of investigation and of providing advice to clinical settings. Planning and evaluation are also emerging activities that concern both public health and primary care. Many authors recognized that public health provides tools that enhance the planning of primary care activities and are more aligned with the actual needs of populations. Others noted that public health is able to assess primary care in light of the changing health of populations, which may lead to better results for groups of patients. Conclusion: One of the routes to a better understanding of how public health and primary care organizations can better interact is to identify the different contexts in which they collaborate successfully. Our scoping review of the scientific and gray literature identified various ways by which public health and primary care either reinforce each other through their respective functions, or increasingly act in a collaborative manner to increase population health and improve health systems performance.
Highlights
Public health and primary care are often conceived as two entities providing complementary services within the health system
We developed an extraction grid, based on a conceptual framework of public health and primary care functions, in order to evaluate the relevance of selected articles, classify the information according to its link with public health or primary care responsibilities, and to identify interaction between public health and primary care
Our search identified various activities through which public health can contribute to more effective primary care (Table 1), as well as functions usually performed by primary care that seem to be related to a population health approach (Table 2)
Summary
Public health and primary care are often conceived as two entities providing complementary services within the health system. Public health and primary care are often understood to be two entities providing complementary services within the health system, given that both aim to address health problems that are common in communities.[1,2,3,4] Public health may be defined as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society”[1] and includes activities encompassing all organized efforts to promote, protect and improve, and when necessary, restore the health of individuals, specific groups, or populations.[2] Its functions mainly focus on population-based services and include surveillance and analysis of the population’s well-being, including health status and determinants; health protection and the control of risk factors and diseases; prevention of diseases, injuries and social problems; promotion of health and well-being; the development and implementation of regulations, legislation and public policies that have an impact on health; research and innovation, including production, dissemination and application of scientific knowledge; and development and maintenance of skills and competencies.[5] Other suggested functions include aid in the planning of services and evaluation of their impacts from a population perspective,[6,7] supporting community participation, and ensuring equity in access.[8]. A well-developed primary care system creates benefits in terms of population health, with the reduction of avoidable morbidities and mortality, and hospitalizations.[12]
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