A systems-based partnership learning model for strengthening primary healthcare

Abstract

BackgroundStrengthening primary healthcare systems is vital to improving health outcomes and reducing inequity. However, there are few tools and models available in published literature showing how primary care system strengthening can be achieved on a large scale. Challenges to strengthening primary healthcare (PHC) systems include the dispersion, diversity and relative independence of primary care providers; the scope and complexity of PHC; limited infrastructure available to support population health approaches; and the generally poor and fragmented state of PHC information systems.Drawing on concepts of comprehensive PHC, integrated quality improvement (IQI) methods, system-based research networks, and system-based participatory action research, we describe a learning model for strengthening PHC that addresses these challenges. We describe the evolution of this model within the Australian Aboriginal and Torres Strait Islander primary healthcare context, successes and challenges in its application, and key issues for further research.DiscussionIQI approaches combined with system-based participatory action research and system-based research networks offer potential to support program implementation and ongoing learning across a wide scope of primary healthcare practice and on a large scale. The Partnership Learning Model (PLM) can be seen as an integrated model for large-scale knowledge translation across the scope of priority aspects of PHC. With appropriate engagement of relevant stakeholders, the model may be applicable to a wide range of settings. In IQI, and in the PLM specifically, there is a clear role for research in contributing to refining and evaluating existing tools and processes, and in developing and trialling innovations. Achieving an appropriate balance between funding IQI activity as part of routine service delivery and funding IQI related research will be vital to developing and sustaining this type of PLM.SummaryThis paper draws together several different previously described concepts and extends the understanding of how PHC systems can be strengthened through systematic and partnership-based approaches. We describe a model developed from these concepts and its application in the Australian Indigenous primary healthcare context, and raise questions about sustainability and wider relevance of the model.

Rural and remote health research: Does the investment match the need?

“…Indeed, the significant proportion of rural research that is about Indigenous health is appropriate and very welcome. High‐quality, rurally focussed and located research helps to build the rural health sector's capacity and has been demonstrated to bring positive health service and cost outcomes 13, 14. Research that improves rural service delivery and that addresses the underlying causes of poor health can make a critical contribution to the reduction of rural health inequality, a key aim of the Australian Government.…”

Cardiovascular disease risk in young Indigenous Australians: a snapshot of current preventive health care

“…System‐wide quality improvement is an effective method to strengthen health systems and enhance provision of quality care 41 . Primary health care networks and partnership‐based approaches to quality improvement, such as the ABCD National Research Partnership, can be used to strengthen quality of primary health care to address inequitable levels of chronic disease experienced by Indigenous people 42,43 …”

Lessons from Initiating the First Veterans Health Administration (VA) Women's Health Practice-based Research Network (WH-PBRN) Study

“…Special challenges arise in systems-based research, including the need to navigate across the various layers of departments and disciplines and engage stakeholders at multiple levels in the organization. 24 As the largest integrated health care system in the United States, the VA has a particularly complex structure. This includes organizational levels (national, regional, and local leadership); settings (medical centers and community-based outpatient clinics); units (primary care, specialty outpatient, inpatient, rehabilitative); and disciplines (nursing, medicine, pharmacy, and others).…”