Effective clinical partnerships between primary care medical practices and public health agencies: Lessons learned from a nationwide sample

Objectives: To identify and describe successful collaborations between public health organizations and medical practices in terms of development, structure, barriers/facilitators, and keys to sustainability.

Methods: Programs were identified and sampled using a three-step approach: (1) search of peer reviewed and commercial literature and of internet sites; (2) a national email survey of public health agencies; and (3) an email to a national sample of physicians. We found and interviewed staff of 48 partnerships meeting our operational definition, and a subsample of 16 were purposively selected for in-depth interviews with both staff members and a participating physician. Interviews were transcribed and analyzed qualitatively using ATLAS.ti.

Results: Most programs were initiated and managed by a public health organization to meet a community or clinical need. Commonly identified barriers include time and budget constraints, poor communication, and staff turnover. Keys to overcoming barriers included including finding common ground, having champions, creating win-win situations that address clinical care provision as well as public health needs, using feasible communication methods, and obtaining funding. Physicians and public health officials alike identified accommodating physician time pressures as a key to success. Sustainability was attributed to committed leadership, organizational buy-in, multimodal communication, funding, evidence of cost-effectiveness, clear benefits to medical practices, and a long-range vision for expansion.

Conclusion: Greater integration of public health agencies with primary care providers would improve the coordination and delivery of preventive and chronic care services. Existing models provide many lessons as to how such partnerships can be initiated and sustained.