Background:
Within the Ontario context, a recent shift towards integrated care has led to primary care reforms that have aimed to achieve the quadruple aim benchmarks. Particular focus has been placed on population health management, a key pillar of the quadruple aim metrics, which recognizes and aims to address the broader social, structural and institutional determinants that impact upon population health outcomes. As a result, this study aims to identify and describe the key characteristics of integrated primary care and social care models, programs, and initiatives in Ontario that aim to address the social determinants of health. It also aims to identify barriers and facilitators in the implementation of these integrated care initiatives to support future implementation efforts.
Methods:
A qualitative descriptive study design was utilized and was conducted in two phases: 1) document analysis; and 2) 13 in-depth semi-structured interviews with policymakers, managers/ administrators, clinicians and service providers involved in leading integrated primary and social care initiatives in Ontario.
Results:
Developing and implementing these initiatives had primarily required the introduction of new governance and delivery arrangements. This included the adoption of shared governance structures where equal decision-making authority was often established between health and social partners, and the introduction of a system navigator role who was commonly co-located within primary care. There were minimal insights in relation to the development of new financial arrangements aside from a few joint funding agreements, as almost all initiatives did not share financial resources and few modified staff or provider remuneration. Initiatives experienced barriers including a lack of permanent or long-term funding and technological infrastructure to support patient tracking, follow-up, and information sharing between health and social partners. However, the system navigator position was found to be an essential role in bridging communication gaps between sectors and delivering integrated care for clients. In addition, factors such as pre-existing informal and formal partnerships between primary care and social care organizations, communication and trust between health and social partners, and organizational leadership support for integration were viewed as enablers.
Discussion and Conclusions:
The lessons learned from participants’ experiences in planning and implementing integrated primary care and social care models are timely and can inform future implementation and scale up as the province continues to move towards integrated care arrangements in efforts to achieve the quadruple aim benchmarks. Specific recommendations for policy and future research are proposed. / Thesis / Master of Public Health (MPH) / Health systems in Canada are positioned to treat symptoms of health issues instead of addressing the root causes of illness and disease, such as lack of housing, access to healthy and nutritious food, and stable employment opportunities. Recently, health system reforms in Ontario have shifted to population health-based approaches to care which recognize and aim to address these non-medical determinants of health outcomes. Primary care, which is often an individual's first point of contact with the health system, may be uniquely positioned to fulfill this mandate due to the capabilities of primary care providers to develop and sustain relationships with patients along the life course. Primary care practitioners may be more aware of patients' underlying social needs that result in adverse health outcomes. This study aimed to identify models of care in Ontario that coordinate care for patients between health and social services such as housing and employment support. It was conducted in two phases. Phase one included a targeted document search which used government policy documents, stakeholder websites, and journal databases to identify these integrated models of care in Ontario. In phase two, 13 stakeholders identified from existing models were interviewed to explore their experiences with models that integrate primary care and social care services and the barriers and facilitators to implementing such models. The study found that most initiatives had made modifications to governance and delivery arrangements to support implementation, including the adoption of shared governance approaches and a system navigator position responsible for coordinating care for clients. The initiatives primarily experienced barriers with funding insecurity, communication and information sharing between health and social partners, and technology. However, communication and trust between health and social partners and organizational leadership support were factors that supported the implementation of initiatives. The findings from this research may support future implementation and scale-up of these coordinated models of care in Ontario.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/27526 |
| Date | January 2022 |
| Creators | Rintjema, Jacqueline |
| Contributors | Wilson, Michael, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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