Primary Care Partnership Research Articles

Respect and reflexivity: international education partnerships in primary care

ABSTRACT The UK general practice model has been described as the ‘jewel in the crown’ of the National Health Service and is widely respected and emulated around the world. In recent years, there has been a particular interest in the UK approach to primary care medical education, including at undergraduate and postgraduate levels, leading to a number of international education partnerships designed to draw on the best of UK experience and expertise in this area. Drawing on the limited academic literature in this area, and the authors’ personal experiences of working across many international partnership projects with countries around the world, this article reflects on the central importance of respect and reflexivity when engaging in such work. A respectful approach relies on a genuine and deep curiosity for the local context, and a desire to empower partners to build their own solutions that are contextually authentic. A reflexive approach, meanwhile, relies on those engaging in partnerships to understand themselves as ‘invited guests’ and to remain mindful of current and historical power differentials and inequities when framing their engagement, looking both inwardly and outwardly as they conduct themselves. As primary care education around the world develops and expands, there may be a greater role for international partnerships and it is critically important that those engaging in such partnerships bring a thoughtful and scholarly lens to this work.

“They are dealing with people’s lives…”: Diagnostic and post-diagnostic healthcare experiences in primary progressive aphasia

Purpose The healthcare experience is a multifaceted and varied process, particularly for people living with complex conditions such as primary progressive aphasia (PPA). Different experiences influence pathways through the health system, impacting client outcomes. To our knowledge, no previous studies have directly explored the healthcare experiences of people with PPA and their families. This study aimed to explore the experiences of people living with PPA from the perspective of both the person with PPA and their families during diagnostic and post-diagnostic phases, and to identify factors influencing service access and perceptions of quality of care. Method The study followed an Interpretive Phenomenological Analysis (IPA) approach. In-depth, semi-structured interviews were completed with three people with PPA and their primary care partner, and two further care partners of people with PPA. Result Five superordinate themes were identified: characterising the assessment experience, getting a diagnosis, moving beyond the diagnosis, participant interactions with clinicians, and overall service provision. The five superordinate themes comprised 14 subthemes. Conclusion The study provides preliminary insights into the complexity of the PPA healthcare journey, and the need for increased accessibility of information and supports following diagnosis. The findings inform recommendations for improving quality of care and the development of a PPA service framework or care pathway.

Dissemination of Remote Patient Monitoring: An Academic-Community Primary Care Partnership in South Carolina.

Remote patient monitoring (RPM) for diabetes and hypertension may reduce barriers to patient care, leading to improved disease control and decreased morbidity and mortality. We describe the implementation of a community-academic partnership to improve diabetes and hypertension control for underserved populations using RPM. In 2014, our academic medical center (AMC) began working with community health centers (CHCs) to implement a centrally monitored RPM program for patients with diabetes. AMC nurses recruited, trained, and supported community partners through regular communication. Community sites were responsible for enrollment, follow-up visits, and all treatment adjustments. More than 1350 patients have been enrolled across 19 counties and 16 predominantly rural CHCs. The majority of patients reported low annual household income and African American or Hispanic background. It took about 6 to 9 months of planning at each CHC prior to first enrolled patient. More than 30% of patients utilizing the newer device continued to transmit glucose readings regularly at week 52 of enrollment. Hemoglobin A 1c data reporting was completed for more than 90% of patients at 6 and 12 months postenrollment. Partnering of our AMC with CHCs enabled dissemination of an effective, inexpensive tool that engaged underserved populations in rural South Carolina and improved chronic disease management. We supported implementation of clinically effective diabetes RPM programs at several CHCs, reaching a large number of historically underserved and underresourced rural CHC patients with diabetes. We summarize key steps to achieving a successful, collaborative RPM program through AMC-CHC partnerships.

The Impact of the COVID-19 Pandemic on Care Partners of People with Parkinson's Disease.

Since the onset of the coronavirus disease 2019 pandemic, the caregiving routine for care partners of people with Parkinson's disease (PwPD) changed substantially. To understand the nature and severity of burden in care partners of PwPD during the ongoing pandemic. We also sought to describe care partners' perceived change in burden and factors associated with increased burden. Cross-sectional online questionnaire-based study among care partners of PwPD, registered in the Fox Insight study. The questionnaire consisted of the Modified Caregiver Strain Index, whether an aspect of strain had changed over the course of the pandemic and additional pandemic-specific infection and lifestyle-related items. Two hundred seventy-three non-paid primary care partners responded to the questionnaire, 73% female with a median age at enrollment of 64 years, 56% reporting a household income greater than 75,000 USD per year, and 61% retired. An increase in burden compared to before the pandemic was prevalent, ranging from 33% to 63% for individual items. Emotional strain increased most frequently (63%). Decreases in burden were uncommon; work adjustments (7%) and time demands (6%) decreased most frequently. PD-related factors and care partner roles in personal care of the PwPD were the factors that were associated with strain in multivariable analysis, whereas social and pandemic-related factors were not. In this affluent and mostly retired cohort, increases in emotional strain during the pandemic were prevalent. Despite this, caregiving roles in personal care and severity of symptoms in the PwPD were more strongly associated with strain than social and pandemic-related factors.

A Mixed-Methods Analysis of a Special Supplemental Nutrition Program for Women, Infants, and Children and Primary Care Partnership to Promote Responsive Feeding for Infants in Group Well-Child Care.

To evaluate the Healthy Eating through Group Well-Child Care (GWCC) intervention, a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and primary care partnership which seeks to promote responsive feeding practices among low-income caregivers, by examining its impact on infant growth and exploring the experiences of caregivers who participated in this intervention. Using a difference-in-differences approach, we examined change in weight-for-length among infants in GWCC before versus after implementation of the intervention compared with infants in individual well-child care (IWCC) over the same time-period. In parallel, we conducted semi-structured interviews in English and Spanish with caregivers who participated in the intervention to explore their perspectives and analyzed transcripts via the constant comparative method to identify salient themes. Using electronic health record data from 279 GWCC and 6134 IWCC participants, we found no significant difference in first-year weight-for-length trajectory associated with participation in the intervention. We reached thematic saturation after 19 interviews with 22 caregivers and identified four major themes around feeding: 1) structural barriers limit access to healthy foods through WIC, 2)conflicting sources of nutrition advice challenge parental decision making, 3) exposure to novel foods facilitated further experimentation with healthier foods, and 4) discussion of responsive feeding facilitated awareness and adoption. A primary care and WIC partnership to promote responsive feeding in the context of GWCC was well received by caregivers but was not associated with improved weight-for-length among infants. Structural barriers to implementing responsive feeding and healthy eating practices may have impacted lack of measurable results from the intervention.

Partnering for Integrated Care: A Learning Collaborative for Primary Care and Oral Health Teams.

The Teaming and Integrating for Smiles and Health (TISH) Learning Collaborative was developed to help health care organizations accelerate progress in integrating delivery of oral and primary care. By providing expert support and a structure for testing change, the project aimed to improve the early detection of hypertension in the dental setting and of gingivitis in the primary care setting, and to increase the rate of bidirectional referrals between oral and primary care partners. We report its outcomes. A total of 17 primary and oral health care teams were recruited to participate in biweekly virtual calls over 3 months. Participants tested changes to their models of care through Plan-Do-Study-Act cycles between calls. Sites tracked the percentages of patients screened and referred, completed the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) and Interprofessional Assessment questionnaires, and provided qualitative feedback and updates in storyboard presentations. On average, with implementation of the TISH Learning Collaborative, sites displayed a nonrandom improvement in the percentages of patients screened for hypertension, referred for hypertension, referred to primary care, and referred for gingivitis. Gingivitis screening and referral to oral health care were not markedly improved. Qualitative responses indicated that teams made progress in screening and referral workflows, improved communication between medical and dental partners, and furthered understanding of the connection between primary care and oral care among staff and patients. The TISH project is evidence that a virtual Learning Collaborative is an accessible and productive avenue to improve interprofessional education, further primary care and oral partnerships, and achieve practical progress in integrated care.

Public-private partnership in primary health care: an experience from Iran.

The aim of this paper is to introduce the experience of applying public-private partnership (PPP) in providing primary health care (PHC) in East Azerbaijan Province (EAP), Iran. Moving toward the Universal Health Coverage (UHC) involves using of all health-related resources. Certainly, one of the key strategies for achieving UHC is PPP. Since 2015, a PPP in PHC policy has begun in EAP as a major strategy for strengthening the health system and achieving UHC. In this case study, data were collected through interviews with stakeholders, document analysis, reviewing of health indexes and published studies. The data were analyzed using content analysis. PPP in PHC policy was designed and implemented in EAP with the aim of social justice, strengthening the health system and achieving UHC in the framework of health complexes (HCs). HCs provide a defined service package according to the contract. The reimbursement method is a combination of per capita, fee for services and bonus methods. Part of the payments is fixed and the other part is based on the pay for quality system and paid according to the results of monitoring and evaluation. According to the study results, the most important strength of the plan is to improve access to services, especially in marginalized areas. The main weakness is not providing infrastructures before the implementation of the plan, and the most important challenges are financial, political and organizational unsustainability and, sometimes, poor cooperation by the other organizations. The findings show that PPP in PHC in EAP is an effective strategy to provide social justice, implement family practice and achieve UHC.

DEVELOPMENT OF A BEHAVIORAL FRAMEWORK FOR DEMENTIA CARE PARTNERS’ FALL RISK MANAGEMENT

Abstract Although older adults living with dementia (OLWD) are at high risk for falls, few strategies that effectively reduce falls among OLWD have been identified. Dementia care partners may have a critical role in fall risk management (FRM). However, little is known in what ways care partners behave that may be relevant to FRM and how to effectively engage them in FRM. Semi-structured, in-depth interviews were conducted with 14 primary care partners (Age: 48-87; 79% women; 50% spouses/partners; 64% college-educated; 21% people of color) of community-dwelling OLWD to ascertain their own behaviors and those of care partners who were secondary in the caring role. The analysis of interview data suggested a novel behavioral framework consisting of eight domains of FRM behaviors adopted across four stages. The domains were 1. functional mobility assistance, 2. assessing and addressing health conditions, 3. health promotion support, 4. safety supervision, 5. modification of the physical environment, 6. receiving, seeking, and coordinating care, 7. learning, and 8. self-adjustment. Four stages of FRM included 1. supporting before dementia onset, 2. preventing falls, 3. preparing to respond to falls, and 4. responding to falls. FRM behaviors varied by the care partners’ caring role. Primary care partners engaged in behaviors from all eight domains. Secondary care partners were reported to assist in health promotion support, safety supervision, modification of the physical environment, and receiving, seeking, and coordinating care. This multi-domain and multi-stage framework will inform intervention development to engage care partners in managing fall risk for community-dwelling OLWD.

STUDENT CARE PARTNERING AMONG STUDENTS AT A HBCU: EXPLORING THE POTENTIAL IMPACT ON STUDENT PERSISTENCE

Abstract The number of students enrolled in higher education who are taking care of older adults, many of whom may be suffering from an illness, is expanding. The numerous factors in care partnering can compromise student success and persistence towards graduation. While most care partners experience challenges, the care partnering experience of Black students is magnified because Historically Black Colleges and Universities (HBCUs) have a higher enrollment of nontraditional and first-generation college students. Students may be primary care partners who provide most of the care, or they may provide supportive care as secondary, tertiary, and auxiliary care partners within an extended family or kinship network. Aging in place, within the context of family and community, emerges from African culture and tradition deeply grounded in filial loyalty. Care partnering is nuanced in the interaction of race, ethnicity, gender, family relationships, and student status; however, little is known about the lived experience of Black student care partners and how to support them to facilitate their persistence towards graduation. This poster describes initial efforts to understand Black student experiences in care partnering in the context of a Mid-Atlantic HBCU and suggests the next steps in a multi-year research program.

Development of a behavioural framework for dementia care partners’ fall risk management

BackgroundAlthough older adults living with dementia (OLWD) are at high risk for falls, few strategies that effectively reduce falls among OLWD have been identified. Dementia care partners (hereinafter referred to as “care partners”) may have a critical role in fall risk management (FRM). However, little is known about the ways care partners behave that may be relevant to FRM and how to effectively engage them in FRM.MethodsSemi-structured, in-depth interviews were conducted with 14 primary care partners (age: 48–87; 79% women; 50% spouses/partners; 64% completed college; 21% people of colour) of community-dwelling OLWD to examine their FRM behaviours, and their observations of behaviours adopted by other care partners who were secondary in the caring role.ResultsThe analysis of interview data suggested a novel behavioural framework that consisted of eight domains of FRM behaviours adopted across four stages. The domains of FRM behaviours were 1. functional mobility assistance, 2. assessing and addressing health conditions, 3. health promotion support, 4. safety supervision, 5. modification of the physical environment, 6. receiving, seeking, and coordinating care, 7. learning, and 8. self-adjustment. Four stages of FRM included 1. supporting before dementia onset, 2. preventing falls, 3. preparing to respond to falls, and 4. responding to falls. FRM behaviours varied by the care partners’ caring responsibilities. Primary care partners engaged in behaviours from all eight behavioural domains; they often provided functional mobility assistance, safety supervision, and modification of the physical environment for managing fall risk. They also adopted behaviours of assessing and addressing health conditions, health promotion support, and receiving, seeking and coordinating care without realizing their relevance to FRM. Secondary care partners were reported to assist in health promotion support, safety supervision, modification of the physical environment, and receiving, seeking, and coordinating care.ConclusionsThe multi-domain and multi-stage framework derived from this study can inform the development of tools and interventions to effectively engage care partners in managing fall risk for community-dwelling OLWD.

An Innovative Approach to Empowering Care Partners Living with A Loved One Diagnosed with Younger-Onset Alzheimer's.

An Innovative Approach to Empowering Care Partners Living with A Loved One Diagnosed with Younger-Onset Alzheimer's Our innovative approach at Lorenzo's House, a nonprofit in Chicago, empowers care partners living with a loved one with younger-onset Alzheimer's. Lorenzo's Angels is a proven model designed to create one-on-one mentor matches between care partners. This personalized match offers connection with someone who shares a similar profile and understands. Families living with a younger-onset diagnosis are often underserved and under-discussed in the Alzheimer's community. With this diagnosis comes a dramatic shift in a younger family's dynamic and they are often alienated from popular Alzheimers' resources geared towards people who are diagnosed later in life. These care partner spouses are in a uniquely important and difficult position as they are responsible for being the primary care partner to their spouse, breadwinner for the household, and for parenting independently - all while navigating the complexities of the diagnosis. A family culture changes after a younger-onset Alzheimer's diagnosis, and there is a need for innovative care and personal connection. We recognize that the best guidance and support for care partners often comes from people who have or are still walking the path. We empower families by cultivating a care partner-to-care partner mentor model, building an International network of care partners matches. Our framework emphasizes social emotional wellness, practical information and resourcefulness so that families turn isolation to connectedness and darkness to light, living this journey together - never alone. By creating this framework through digital and in-person platforms, we provide sustenance to care partners everywhere living with a loved one with younger-onset Alzheimer's.

An evaluation of the aged mental health and primary care partnership program.

To evaluate the Mental Health and Primary Care Partnership (MaP) pilot program which operated in a metropolitan Melbourne setting in 2020. Data collection included: surveys, interviews, file audits, and an evaluation of routinely collected data, with MaP consumers, their carers, GPs, Practice Managers and Nurses located in Boroondara, and MaP and Aged Person's Mental Health Service staff. Thirty-five consumers aged between 66 and 101 years old (of whom 63% were female) received support from the MaP program throughout its 12-month operation. Statistically significant improvements in outcome measures assessing for psychological distress and symptoms of mental illness were observed. Strengths of the program included the single referral pathway and the provision of services for those not meeting criteria to access tertiary mental health support. Consumers and clinicians made recommendations for service improvement including provision of a longer duration of care to consumers and greater integration of community and primary care. It is hoped that the learnings from the MaP pilot program can be used to guide future program development.

226 DUAL ANTI-PLATELET THERAPY: AUDIT OF COMMUNICATION OF DIAGNOSIS AND DURATION ACROSS PRIMARY AND SECONDARY CARE

Abstract Background Dual Anti-Platelet Therapy (DAPT) is indicated in vascular disease & duration of treatment depends on factors such as indication, age, bleeding risk, disease severity & co-morbidities. Inappropriately prolonged DAPT may increase the risk of major bleeding without a reduction in all-cause mortality and decisions for the duration of DAPT are best made by specialists in secondary care which should be communicated definitively to partners in primary care. Methods A retrospective search of patients prescribed Aspirin and a PY2 inhibitor from 01/01/2020 to 30/04/2022 was conducted. Patients were excluded if DAPT was not prescribed concurrently or if the patient deceased before the duration of DAPT had passed. Each record was evaluated to determine if: (1) Secondary care correspondence stated indication & duration of treatment; (2) Patients had stop dates for DAPT on their prescription; (3) Patients had been on DAPT for correct duration and (4) Any errors/improvements were identified. Results Number of patients met criteria = 81, Average Age = 69.7yrs, Male = 58%, Female = 42%. 12% of letters from Secondary Care did not specify a duration. 43% did not have a stop date on their prescriptions. 19% prescribed DAPT for the incorrect duration. 15% classified as having a serious medication error (DAPT >3yrs, No obvious indication for DAPT, DAPT & Antithrombotic therapy without review). 14.8% not prescribed a PPI & 4.9% admitted to hospital with a GI bleed. 24.7% Patients prescribed Esomeprazole/Omeprazole & Clopidogrel Conclusion DAPT is an important pharmacotherapy intervention in the treatment of vascular disease, but it's duration should be regularly assessed by specialists and clearly communicated to prescribers in Primary care to optimise treatment and reduce bleeding risk. Clinical system warnings have now been utilised to alert prescribers to well defined time limits of DAPT and patients on less appropriate PPI's have been switched. Secondary care colleagues have been reminded of the importance of clear and concise communication of clinical interventions and plans.

COVID-19 Vaccine Uptake in Southeastern Ontario, Canada: Monitoring and Addressing Health Inequities.

Context:Implementation of a population-based COVID-19 vaccine strategy, with a tailored approach to reduce inequities in 2-dose coverage, by a mid-sized local public health agency in southeastern Ontario, Canada.Program:Coverage maps and crude and age-standardized coverage rates by material and social deprivation, urban/rural status, and sex were calculated biweekly and reviewed by local public health planners. In collaboration with community partners, the results guided targeted strategies to enhance uptake for marginalized populations.Evaluation:The largest gaps in vaccine coverage were for those living in more materially deprived areas and rural residents—coverage was lower by 10.9% (95% confidence interval: −11.8 to −10.0) and 9.3% (95% confidence interval: −10.4 to −8.1) for these groups compared with living in less deprived areas and urban residents, respectively. The gaps for all health equity indicators decreased statistically significantly over time. Targeted strategies included expanding clinic operating hours and availability of walk-in appointments, mobile clinics targeted to marginalized populations, leveraging primary care partners to provide pop-up clinics in rural and materially and socially deprived areas, and collaborating with multiple partners to coordinate communication efforts, especially in rural areas.Discussion:The scale and scope of monitoring and improving local vaccine uptake are unprecedented. Regular review of health equity indicators provided critical situational awareness for decision makers, allowing partners to align and tailor strategies locally and in collaboration with one another. Health care providers and pharmacies/pharmacists are key partners who require innovative support to increase uptake in marginalized groups. Continued engagement of other community partners such as schools, municipalities, and local service groups is also crucial. A “hyper local” approach is needed along with commitment from partners in all sectors and at all levels to reduce barriers to vaccination that lie further upstream for marginalized groups.

Developing integration among stakeholders in the primary care networks of Singapore: a qualitative study

BackgroundIntegrating healthcare services across and between the different health system levels can be achieved in a few ways; however, examining the social side of integration is essential and challenging. This paper explores the concept of integration perceived by general practitioners (GPs) and primary care network (PCN) representatives from the regional health systems (RHS) in a GP-RHS PCN and their perceived partnership success.MethodsIn this study, we explored three GP-RHS PCNs in Singapore. We used a qualitative research design and, overall, performed 17 semi-structured in-depth interviews with GPs (n = 11) and PCN representatives (n = 6) from the RHS. All interviews were audiotaped and transcribed verbatim. We conducted thematic analysis to inductively identify themes from the data. Singer's conceptual model of integration types was used as guiding principles to derive relevant and salient themes for integration.ResultsGPs and the RHS perceived the concept of integration through a series of interrelated strategies. Within the normative dimension, a sense of urgency motivated GPs to integrate improvements into their general practice. Participants perceived teamwork and relational climate as appropriate enablers for achieving interpersonal integration in a primary care partnership. While developing a trusted relationship was a perceived success of this partnership across the network, developing camaraderie and gaining knowledge in chronic disease management through the components of functional integration was a perceived success at an individual general practice level. The data also revealed some operational challenges within the structural dimension and some inabilities of the PCN to achieve complete process integration.ConclusionsOur study points to multi-faceted integration, comprising various forms that need to be manifested at all levels of care to achieve coordinated, seamless, and comprehensive care for patients suffering from chronic conditions. The present iteration of the PCN has been shown to offer integration at a level that warrants praise but still requires structural and process integration improvement.

Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO): process of adapting collaborative care for co-occurring opioid use and mental disorders

BackgroundOpioid use disorders (OUD), co-occurring with either depression and/or PTSD, are prevalent, burdensome, and often receive little or low-quality care. Collaborative care is a service delivery intervention that uses a team-based model to improve treatment access, quality, and outcomes in primary care patients, but has not been evaluated for co-occurring OUD and mental health disorders. To address this treatment and quality gap, we adapted collaborative care for co-occurring OUD and mental health disorders.MethodsOur adapted model is called Collaboration Leading to Addiction Treatment and Recovery from Other Stresses (CLARO). We used the five-step Map of Adaptation Process (McKleroy in AIDS Educ Prev 18:59–73, 2006) to develop the model. For each step, our stakeholder team of research and clinical experts, primary care partners, and patients provided input into adaptation processes (e.g., adaptation team meetings, clinic partner feedback, patient interviews and beta-testing). To document each adaptation and our decision-making process, we used the Framework for Reporting Adaptations and Modifications-Enhanced (Wiltsey Stirman in Implement Sci 14:1–10, 2019).ResultsWe documented 12 planned fidelity-consistent adaptations to collaborative care, including a mix of content, context, and training/evaluation modifications intended to improve fit with the patient population (co-occurring disorders) or the New Mexico setting (low-resource clinics in health professional shortage areas). Examples of documented adaptations include use of community health workers as care coordinators; an expanded consultant team to support task-shifting to community health workers; modified training protocols for Problem-Solving Therapy and Written Exposure Therapy to incorporate examples of treating patients for depression or PTSD with co-occurring OUD; and having care coordinators screen for patients’ social needs.ConclusionsWe completed the first three steps of the Map of Adaptation Process, resulting in a variety of adaptations that we believe will make collaborative care more acceptable and feasible in treating co-occurring OUD and mental health disorders. Future steps include evaluating the effectiveness of CLARO and documenting reactive and/or planned adaptations to the model that occur during its implementation and delivery.Trial registration NCT04559893, NCT04634279. Registered 08 September 2020, https://clinicaltrials.gov/ct2/show/NCT04559893

Hepatitis C diagnosis and management: a primary care and public health partnership approach.

Hepatitis C diagnosis and management: a primary care and public health partnership approach.

Leveraging Primary Health Care Corporation partnerships in preparation for the 2022 FIFA World Cup Qatar: A position paper

Background: Hosting 2022 FIFA World Cup (WC2022) in Qatar is a mega event that can shape a country's development1. Partnerships as preparedness efforts for mass gatherings within the health system can ensure a safe and efficient practice in hosting countries2,3. This work aims to provide an analysis of the existing literature around partnership frameworks to inform the development of an innovative partnership framework for Primary Health Care Corporation (PHCC). In addition, it also discusses the preparedness plan at PHCC for the WC2022 to promote staff and national resilience. Methods: Various databases such as Academic Search Complete, Education Research Complete, Medline and Web of Science were used to search for relevant studies from 2010 to 2021. The search strategy consisted of search terms including partnership, framework and health. Moreover, searching was conducted by title, abstract, and full texts, and was limited to studies in English language. The content analysis was performed to analyze the relevant publications. Results: A total of 18 studies were considered. The related literatures were analyzed to present the emerging themes which revealed four major themes: collaboration, engagement, transformation, and risk mitigation. Leveraging the current primary care partnership framework will influence the ability of healthcare professionals to adapt and respond to the upcoming mass gathering. National and international partners must recognize and embrace the need for diverse training programs during the WC2022. The preparedness for the WC2022 calls upon clear assessments from various stakeholders at PHCC that are tied to the needs for emerging roles and services. Conclusion: This work offers a new perspective on the current PHCC partnership framework and provides some recommendations for infrastructure, commissioning, and engagement pathways among future public and private partners. Leveraging PHCC partnership framework and transforming it into a holistic framework of national resilience during mass gathering is of significance.F0001 F0002a F0002b F0002e F0002d F0002e

Formative Exploration of the Feasibility of Embedding Community Assets Into Primary Health Care: Barbershop and Place of Worship Readiness in Guyana.

Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community-primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community-primary care partnership. Lack of previous collaborations with the formal health system was common to both. The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability.

Helping Public Health Decision-Makers Refine Community Coronavirus Disease-2019 Vaccination Efforts--Association between Confirmed Coronavirus Disease-2019 Cases and Vaccinations

Introduction The response to the coronavirus disease-2019 (COVID-19) epidemic included biomedical and vaccine research as well as identification of COVID-19 cases, contact tracing, community health promotion and disease prevention and community vaccination. The COVID-19 vaccinations remind public health professionals and non-professionals alike of this essential public health intervention for controlling infectious diseases. Actions that seek to improve existing vaccination efforts are equally important for effective public health programming. Methods Secondary data analysis uses an ecological study design to examine any possible associations between the number of COVID-19 cases identified at medical facilities (facility names not identified) within a healthcare system and the number of COVID-19 vaccinations administered within the system and reflect upon the findings for public health action. A loess curve was plotted to help to identify if a curvature pattern was present in a scatter plot. Results The statistical algorithm for the loess curve identified a curvature pattern. All plots showed that values became more separated in moving from left to right. Discussion This aggregate pattern in number of COVID-19 cases and number of vaccinations administered might be present in other public health settings or healthcare systems. Four refinements were proposed to help public health decision-makers to improve vaccination efforts: explore the reasons for differences in COVID vaccination given the number of confirmed COVID cases between facilities; provide vaccination outside traditional settings; facilitate public health and primary care partnerships for community vaccination; and address vaccine knowledge-gaps in the community and other barriers to vaccination.