Primary Care’s Potential New Partner: Public Health

In the coming years, physicians might find themselves expanding their daily medical practice to further include elements of public health. 

A recent Institute of Medicine (IOM) report, “Primary Care and Public Health: Exploring Integration to Improve Population Health,” recommends further integration of primary care and public health as a way to improve healthcare as a whole.

Both entities “share a similar goal of health improvement and can build on this shared platform to catalyze intersectoral partnerships designed to bring sustained improvements in population health,” the report states. “In addition, they have strong ties at the community level and can leverage their positions to link communty organizations and resources.”

Also according to the report, now is the opportune time to begin further integrating primary care and public health. It notes multiple reasons for this, but the primary one it says, is the Affordable Care Act (ACA).

“While the ACA does not explicity address the integration of primary care and public health, it provides a menu of initiatives that agencies and communities can exploit to make gains in improving population health,” a summary of the report states.

The report outlines several of these initiatives, but a key one, and the one that would likely most impact physicians directly, is the development of new models of care like Patient-Centered Medical Homes (PCMH) and accountable care organizations (ACOs).

The ACO model for instance, already focuses on increasing care coordination between physicians of various specialties and across various healthcare systems. The report suggests that the Health Resources and Services Administration (HRSA) could further encourage the development of these models of care, and also encourage such models to partner up with local public health departments.

The PCMH model of care encourages physicans to take a more active, team-based role in their patients’ health and in their patients’ care throughout the healthcare system. The report recommends that the HRSA and the CDC collaborate to encourage further development of such models, and that they encourage these models to include local public health departments in their care.

The IOM is just part of a growing number of organizations and physicians who are advocating for further integration of primary care and public health.

In fact, some ACOs are already incorporating social workers into their care models. And a Pregnancy Medical Home model recenty unveiled in North Carolina, requires participating primary-care physicians to direct their Medicaid-eligible patients with high-risk pregnancies to case managers at the North Carolina Public Health Department who will help coordinate patient care.

Physicians are also getting on board. Just this week, Naheed Dosani, a family medicine resident co-wrote an article appearing on KevinMD in which he emphasized how important it is for physicians to screen patients for external factors that may be affecting their health such as poverty, in addition to screening patients for things like smoking and high cholesterol.

Dosani, also suggested that physicians work with patients to connect them to resources that will assist them when necessary, such as WIC, food stamps, and general relief programs; and he suggested the addition of social workers to healthcare teams.

“We know that families struggling to get by face considerable barriers in making healthy lifestyle choices, and people’s health is significantly affected by the quality of their homes, jobs and schools,” he wrote. “In Canada, where I am a resident physician in family medicine, low income has been shown to account for 24 percent of person years-of-life lost.”

What do you think of more further integrating public health into your daily practice? How would you do it? What would be the challenges and/or the opportunities?