Primary Care Physicians and Public Health Agencies Need Shared Accountability to Improve Health Outcomes

Newswise — San Diego, CA, and Washington, DC, June 12, 2012 -- A first-time joint publication by the American Journal of Preventive Medicine and the American Journal of Public Health highlights how the two sectors of public health and primary medicine intersect and the work ahead to achieve true integration. This special supplement complements the recent Institute of Medicine (IOM) study released in late March, “Primary Care and Public Health: Exploring Integration to Improve Population Health.”

“Only by working together to create an integrated health system that leverages the complementary strengths of public health and health care will we truly be able to do our best job of caring for our communities and the U.S. population,” said Denise Koo, MD, MPH, with the Scientific Education and Professional Development Program Office of Centers for Disease Control and Prevention, along with her coauthors in an editorial entitled “A Call for Action on Primary Care and Public Health Integration.”

Four agencies of the U.S. Department of Health and Human Services, including the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Health Resources and Services Administration, and the National Institute on Minority Health and Health Disparities of the National Institutes of Health, sponsored this special supplement to showcase and support additional efforts in this critical area.

The supplement highlights examples of primary care and public health integration, showing how shared accountability can lead to improved community and population health outcomes. A joint referral system developed by a health care center and its local public health department eliminated duplication and competition. In Seattle-King County, Washington, a health department effort to promote influenza vaccination by all primary care providers – obstetricians and midwives as well as family practitioners – contributed to higher vaccination rates among pregnant and postpartum women. The Healthy Weight Collaborative has deployed 50 teams of primary care, public health, and community representatives to apply evidence-based interventions to prevent and treat obesity in children and families.

A fundamental challenge to realizing the vision of integration is that primary care and public health have evolved as distinct disciplines with different perspectives, goals, and skills. Physicians often remain unaware of health department resources and priorities. Both public health and primary care have limited resources, and integration can sometimes be an additional burden rather than an opportunity. Several articles recommend changes in financing to provide incentives.

According to Dr. Koo and her coauthors, increasing emphasis on healthy behaviors to reduce the burden of disease, as well as new developments in the reform of health care, including the passage of the Patient Protection and Affordable Care Act, offer powerful new opportunities to achieve the vision of an integrated health system in the U.S.

“Today, new opportunities, needs, and tools provide a platform to reintegrate public health and medicine—specifically primary care—in a way that improves population health outcomes and enhances quality of life in the United States,” conclude the authors of a commentary entitled “Are We There Yet? Seizing the Moment to Integrate Medicine and Public Health.”

The special joint supplement is freely available at www.ajph.org and www.ajpmonline.org as of June 12, after 4 PM (EDT).

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NOTES FOR EDITORSIntegration of Primary Care and Public HealthGuest Editors: Kaytura Felix, Denise Koo, Irene Dankwa-Mullan, Therese Miller, and Jill WaalenAmerican Journal of Preventive Medicine, 2012, Volume 42(6S2), published by ElsevierAmerican Journal of Public Health, 2012; Volume 6(Suppl 3), published by American Public Health Association

TABLE OF CONTENTS(Full text of articles is available to credentialed journalists upon request)

Introduction and CommentaryA Call for Action on Primary Care and Public Health IntegrationD Koo, K Felix, I Dankwa-Mullan, T Miller, J Waalen

Connecting Care Through the Clinic and Community for a Healthier AmericaHK Koh, M Tavenner

Integrating Primary Care and Public Health: A Strategic PriorityS Linde-Feucht, N Coulouris

Are We There Yet? Seizing the Moment to Integrate Medicine and Public HealthFD Scutchfield, JL Michener, SB Thacker

Education and TrainingIntegrating Public Health–Oriented e-Learning Into Graduate Medical EducationC Hemans-Henry, CM Greene, R Koppaka

Assessing Integration of Clinical and Public Health Skills in Preventive Medicine Residencies: Using Competency MappingEV Wells, AN Sarigiannis, ML Boulton

Integrating Clinical PracticeBeyond Prevention: Promoting Healthy Youth Development in Primary CareLA Taliaferro, IW Borowsky

Public Health Detailing of Primary Care Providers: New York City’s Experience, 2003–2010MG Dresser, L Short, L Wedemeyer, VL Bredow, R Sacks, K Larson, J Levy, LD Silver

Putting Public Health Into Practice: A Model for Assessing the Relationship Between Local Health Departments and Practicing PhysiciansHB Parton, SE Perlman, R Koppaka, CM Greene

Integrating Clinical Practice and Public Health Surveillance Using Electronic Medical Record SystemsM Klompas, J McVetta, R Lazarus, E Eggleston, G Haney, BA Kruskal, WK Yih, P Daly, P Oppedisano, B Beagan, M Lee, C Kirby, D Heisey-Grove, A DeMaria Jr, R Platt

Linkages Between Clinical Practices and Community Organizations for Prevention: A Literature Review and Environmental ScanDS Porterfield, LW Hinnant, H Kane, J Horne, K McAleer, A Roussel

2009 Pandemic Influenza A Vaccination of Pregnant Women: King County, Washington State, 2009–2010MK Kay, KG Koelemay, TS Kwan-Gett, BL Cadwell, JS Duchin

Policy IssuesThe Challenge of Attribution: Responsibility for Population Health in the Context of Accountable CareMN Gourevitch, T Cannell, JI Boufford, C Summers

A Re-emerging Political Space for Linking Person and Community Through Primary Health CareSA Sweeney, A Bazemore, RL Phillips Jr, RS Etz, KC Stange

Lessons LearnedPrimary Care and Public Health Activities in Select U.S. Health Centers: Documenting Successes, Barriers, and Lessons LearnedLA Lebrun, L Shi, J Chowdhury, A Sripipatana, J Zhu, R Sharma, AS Hayashi, CA Daly, N Tomoyasu, S Nair, Q Ngo-Metzger

ABOUT THE AMERICAN JOURNAL OF PREVENTIVE MEDICINEThe American Journal of Preventive Medicine (www.ajpm-online.net) is the official journal of The American College of Preventive Medicine (www.acpm.org) and the Association for Prevention Teaching and Research (www.aptrmweb.org). It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

Published by Elsevier (www.elsevier.com), the American Journal of Preventive Medicine, with an Impact Factor of 4.110, is ranked 10th out of 140 Public, Environmental and Occupational Health titles and 18th out of 151 General & Internal Medicine titles according to the 2010 Journal Citation Reports® published by Thomson Reuters.

ABOUT THE AMERICAN JOURNAL OF PUBLIC HEALTHThe American Journal of Public Health is the monthly journal of the American Public Health Association® (APHA), the oldest and most diverse organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at www.apha.org.

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