1. Point of Inquiry What makes a partnership between primary care medicine and public/community health effective? Objectives Gain specific knowledge on existing partnerships regarding: 1. Structure 2. Facilitators and barriers 3. Sustaining factors 4. Physician perspective Effective clinical partnerships between primary care medical practices and public health agencies: Lessons learned from a nationwide sample Jessica Bates, MPH 1, Margaret Gadon, MD MPH 2, Cheryl Irmiter, PhD 3, Philip D. Sloane, MD MPH 1 (1) University of North Carolina at Chapel Hill, CB 7590, Chapel Hill, NC 27599; jbb@unc.edu (2) Northwestern University Clinical and Translational Science Institute, 750 N Lake Shore Drive, 11th Floor, Chicago, IL 60611 (3) American Medical Association (AMA), 515 N. State Street, Chicago, IL 60654 Sample: A purposive convenience sample was used. The programs met our operational definition of clinical partnership. Programs were identified through Internet searches, a national survey of public health programs, an email targeting primary care physicians, and then via a snowball method. 48 programs were identified for brief interview, and then in-depth interviews were solicited from those that best fit our operational definition of partnership. In the end, our sample consisted of the following subjects: 15 public health personnel participating in clinical partnerships 9 physicians participating in clinical partnerships representing a total of 16 programs. Public health interviews lasted approximately an hour, and physician interviews lasted approximately 15 minutes. Physicians were offered $100 compensation for their time. Qualitative analysis was conducted using ATLAS.ti, and the project team established consensus on the codebook and inter-rater reliability. Methods Results Collaborations are logical and cost-effective (Lasker, 1997; Bazzoli et al, 1997) Partners can expand their capacity and expertise and better serve their goals of improving individual and population health (Halverson et al, 2000) Longstanding, self-sustaining partnerships remain rare Efforts are “Swimming upstream” against the strong current of fragmentation in our health care system and its financing Consider new and alternative ways of doing things Consider breaking down existing silos Develop a more integrated way of managing individual and community health problems The time is right, and there is optimism about future collaborations, but more needs to be done Conclusions and Recommendations Clinical Partnership: A program or activity that includes all three of the following components: 1. Involves personnel or a program of one or more of the following public health agencies (or one of their local affiliates): department of health cooperative extension Area Agency on Aging 2. Involves one or more primary care providers who are not directly employed by the public health agency, and 3. Provides direct service to clients/patients. Opportunities for Collaboration We have identified the following areas as particularly ripe for collaboration between public health agencies and medical practitioners: Disease surveillance Disaster preparedness Care of underserved Chronic disease management Health promotion/healthy lifestyle Children's obesity References: Bazzoli GJ, Stein R, Alexander JA, Conrad DA, Sofaer S, Shortell. Public-private collaboration in health and human service delivery: Evidence from community partnerships. Milbank Q. 1997;75:533-561. Halverson PK, Mays GP, Kaluzny AD. Working together? organizational and market determinants of collaboration between public health and medical care providers. Am J Public Health. 2000;90:1913-1916. Lasker R. Medicine and Public Health: The Power of Collaboration. New York: Academy of Medicine; 1997. http://www.nyam.org/pubhlth. Population Targeted Children (N=35, 73%) 18 to 64 (N=34, 71%) Older Adult (N=38, 78%) Total Programs Identified: 48 Total selected for extended interview: 16 Type of Services Preventive Services (24, 50%) Primary care –indigent or underserved population (N=22, 46%) Disease Surveillance (N=4, 8%) Disaster preparedness (N=2, 4%) Facility Type Primary Care (N=24, 50%) Public Health Agency (N=15, 31%) Health Department (N=41, 85%) Cooperative Extension Services (N=3, 6%) Area Agencies and Aging (N=6, 13%) Both Primary Care and Public Health (N=9, 19%) Structural Elements of Successful Partnerships Common mission Strong leadership Dedicated program manager Specific liaisons in each organization Physician champion Workgroups and committees Volunteer help Ongoing communication between partners Increased Effectiveness Cost savings Quality improvement Satisfaction of partners BarriersFacilitators Sustaining Factors Time constraintsFinancial supportBuy-in within each organization Budget constraints Multi-modal forms of communication A long-range vision and plan Poor inter-partner communication Creating “win- win” situations Acquisition of ongoing funding Staff turnoverLocal championEvidence of cost- effectiveness Lack of evidence of effectiveness Accommodation of physicians’ time pressures Clear benefits to the primary care organization