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Engaging the community in primary health care reform, and other challenges

Some recent snippets related to primary health care that may be of interest, particularly given the recent announcement of the first Medicare Locals.

***

Universal themes

A major new report investigating the future of health care in Wales reached some conclusions that sound relevant to the Australian situation, indeed perhaps to all modern health care systems:

It says that NHS Wales has to strengthen its efforts to:

  • Reduce health inequalities and inequities;
  • Promote a “sea-change” in public attitudes towards NHS services, by involving the public in the complicated world of planning and prioritising services;
  • Drive out waste in the health system, through pursuing quality in healthcare services and integrating public services to maximise efficiencies;
  • Ensure effective partnerships between public health and local authorities, in health and social care and in other measures; and
  • Create a consensus across government that will seek solutions to health problems across all policy agendas.

(NHS Wales: Forging a better future, A report by the Bevan Commission 2008 – 2011)

***

Engaging patients and the community in primary care

Meanwhile, the Agency for Health Care Research and Quality in the US has released a new brief, The Patient-Centered Medical Home: Strategies to Put Patients at the Center of Primary Care (available here).

It examines involvement at three levels:

  • the engagement of patients and families in their own care,
  • in quality improvement activities in primary care practices,
  • and in the development and implementation of primary care policy and research.

It notes that efforts to engage patients in their own care, practice improvement, or policy are not common, and that barriers include traditional fee-for-service reimbursement, and that the infrastructure, time, resources, and culture change required are significant.

It says:

Practices need assistance with redesign to engage patients and families. Small primary care practices in particular need access to resources for and assistance with practice redesign to accomplish meaningful patient engagement. Health care providers and patients need new skills to support partnership in care, improvement, and policy design.

***

Building community capacity and health

On related themes, two stories that I have recently done for the online publication Inside Story may be of interest.

One is about a community-building project in southwestern Sydney, Understanding Miller.

The other is about a community health centre in a disadvantaged area in the US, Primary healthcare reform: learning from the tough suburbs of Philadelphia.

While they are obviously quite different projects and worlds apart, in a geographic sense at least, it struck me that there are some similar themes:

  • when working with disadvantaged communities, the importance of building trust and relationships, and having a long-term commitment and focus
  • the differing perspectives and priorities of professionals versus residents, and the need to really listen to and understand what the people want – simply building services doesn’t mean that people will use them
  • partnerships between professionals/services and communities can be sustained for the long haul, but it takes a lot of work and dedication
  • the pervasive impact of trauma and how this affects peoples’ health and wellbeing in multiple ways
  • building community health requires so much more than medical services.

***

Medicare Locals

This blog asks the question: Will they be able to share tools for understanding and addressing their local population health needs?