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

• Published in: BMC public health 2020-04, Vol.20 (1), p.507-16, Article 507
• Main Authors: Valaitis, Ruta K, Wong, Sabrina T, MacDonald, Marjorie, Martin-Misener, Ruth, O'Mara, Linda, Meagher-Stewart, Donna, Isaacs, Sandy, Murray, Nancy, Baumann, Andrea, Burge, Fred, Green, Michael, Kaczorowski, Janusz, Savage, Rachel
• Format: Article
• Language: English
• Subjects: Analysis; Attitude of Health Personnel; Barriers; Building management; Canada; Capacity Building - organization & administration; Case studies; Case study; Collaboration; Communication; Community; Cooperative Behavior; Coordination; Data collection; Delivery of Health Care - organization & administration; Fairness; Focus groups; Health care; Health care access; Health care costs; Health care expenditures; Health care policy; Health care reform; Health Care Reform - organization & administration; Health disparities; Health education; Health promotion; Humans; Immunization; Leadership; Mailing services; Nurse practitioners; Nurses; Organizational Case Studies; Population; Population health; Populations; Precipitators; Primary care; Primary health care; Primary Health Care - organization & administration; Public buildings; Public health; Public Health - methods; Qualitative research; Reforms; Research methodology; Researchers; Self-assessment; Triple aim; Vaccines
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-020-08610-y

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. 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. Ten 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. Aims 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. Primary 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 coll