Community partnership to improve access to care for the poor and underserved

Primary care and public health activities in select US health centers: documenting successes, barriers, and lessons learned

OBJECTIVES

We examined primary care and public health activities among federally funded health centers, to better understand their successes, the barriers encountered, and the lessons learned.

METHODS

We used qualitative and quantitative methods to collect data from 9 health centers, stratified by administrative division, urban-rural location, and race/ethnicity of patients served. Descriptive data on patient and institutional characteristics came from the Uniform Data System, which collects data from all health centers annually. We administered questionnaires and conducted phone interviews with key informants.

RESULTS

Health centers performed well on primary care coordination and community orientation scales and reported conducting many essential public health activities. We identified specific needs for integrating primary care and public health: (1) more funding for collaborations and for addressing the social determinants of health, (2) strong leadership to champion collaborations, (3) trust building among partners, with shared missions and clear expectations of responsibilities, and (4) alignment and standardization of data collection, analysis, and exchange.

CONCLUSIONS

Lessons learned from health centers should inform strategies to better integrate public health with primary care.

Primary care and public health activities in select U.S. health centers: documenting successes, barriers, and lessons learned

PURPOSE

The goal of the current study was to examine primary care and public health activities among federally funded health centers, to better understand their successes, barriers encountered, and lessons learned.

METHODS

Qualitative and quantitative methods were used to collect data from nine health centers, stratified by administrative division, urban-rural location, and race/ethnicity of patients served. Descriptive data on patient and institutional characteristics came from the Uniform Data System, which collects data from all health centers annually. Questionnaires were administered and phone interviews were conducted with key informants.

RESULTS

Health centers performed well on primary care coordination and community orientation scales and reported conducting many essential public health activities. Specific needs were identified for integrating primary care and public health: (1) more funding for collaborations and for addressing the social determinants of health, (2) strong leadership to champion collaborations, (3) trust-building among partners, with shared missions and clear expectations of responsibilities, and (4) alignment and standardization of data collection, analysis, and exchange.

CONCLUSIONS

Lessons learned from health centers should inform strategies to better integrate public health with primary care.

'Working at the margins' or 'leading from behind'? A Canadian study of hospital-community collaboration

Collaboration between hospitals and community organisations has been promoted over the past 20 years by various levels of government, hospital associations, health promotion advocates, and others at the state/province, national and international levels as a way to improve the 'efficiency of the system', reduce duplication, enhance effectiveness and service coordination, improve continuity of care, and enhance community capacity to address complex issues. Nevertheless, and despite a growing literature on interagency collaboration, systematic documentation and empirical analysis of hospital-community collaboration (HCC) is almost completely lacking in the literature, particularly as regards collaborations that address the determinants of health beyond the hospital walls. In this paper, we describe the methodology and key findings from a research study of HCC. The Hospital Involvement in Community Action (HICA) study undertook detailed qualitative case studies (in four urban, suburban, rural and northern locations) and a telephone survey (of 139 community organisations in a large urban centre) in order to learn about the range of collaborations and working relationships that exist between hospitals and community agencies in the province of Ontario (Canada), and the factors that influenced (enabled and/or hindered) HCC. Particular attention was paid to barriers and enablers at three nested levels of context (policy, hospital and community) and, drawing primarily on the qualitative case studies, it is this aspect that is the focus of this paper. That such collaborations continue to be widespread despite a generally unfavourable policy environment and hospital institutional culture that poses significant barriers, suggests that the extent to which HCC flourishes (or exists at all) crucially depends on the presence and ongoing enthusiasm/commitment of one or more 'champions' within the hospital, and the commitment of both parties to overcome the marked cultural differences between hospital and community. We conclude with a discussion of implications for policy and practice.

A pilot study of oncology staff perceptions of palliative care and psycho-oncology services in rural and community settings in Indiana

Although there has been an increased interest in health care delivery for rural community populations, concerns remain regarding the lack of access to primary health care and specialty services (such as palliative care), particularly in rural areas that are medically underserved (MU). This survey was conducted to examine the perceptions of palliative care services in rural communities and toward identifying perceived barriers that interfere with accessing palliative care services. In conducting the study, personnel from various disciplines throughout the Community Cancer Care (CCC) network (the largest private provider of oncology services in Indiana) completed a survey that assessed their perceptions of the strengths and weaknesses of the available palliative care services in their communities. These responses, which indicate discrepancies in perceptions among staff within sites, suggest problems of integration of palliative care in given locations. Results revealed three particularly problematic areas: accessing pain control, accessing psychological or psychiatric services or both, and overcoming barriers to hospice care. Although no significant differences were found for any variables between MU and adequately medically served (AMS) areas, in general palliative care is limited and unintegrated into oncology care. Confusion among staff at a particular oncology program likely contributes to the haphazard delivery and poor integration of palliative care. Conclusions are tempered by important study limitations but the results suggest the need for programs that improve delivery of palliative care in rural Indiana.

The contributions of business and civil society sectors to rural capacity to solve local health issues

The new health movement, which has emerged over the last decade, focuses decision making for program designs, interventions and health policies at the local level. This movement assumes that rural communities have the capacity to deal with local health issues. Local problem-solving capacity is based in local leadership patterns, relationships among different community sectors and the ability to select critical but feasible goals. In this research, 159 community leaders in 16 rural counties were interviewed regarding local health priorities, organizational interactions, and leadership roles in county health issues. Analysis of variance was used to identify differences among community sectors. The business and industry sector was found to interact with other organizations around health issues significantly less than all other sectors. Further, 69 percent of the business and industry sector compared with 32 percent of all other sectors thought that the business sector was a source of local leadership. The civil society sector, when compared with all other sectors, was significantly more likely to give priority to health services such as primary, specialty and auxiliary care goals. These findings suggest that rural communities need to find ways to more actively involve the business and industry sector in local health problem solving. In addition, the civil society sector brings to community problem solving a set of priorities that are often different from other sectors of the community.