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Doing primary care integration: a qualitative study of meso-level collaborative practices.

Myles Leslie1,2, Raad Fadaak3, Nicole Pinto3

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Primary Care (PC) integration requires proactive cultural and communication efforts, not just reactive responses to health system changes. These behaviors foster collaboration despite challenges like staffing shifts and external pressures.

Keywords:
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Area of Science:

  • Health Services Research
  • Public Health Policy
  • Organizational Behavior

Background:

  • Integrating Primary Care (PC) into wider health systems is a global objective.
  • Meso-level integration efforts lack actionable strategies for fostering a 'pro-integration culture'.
  • This study examines pragmatic integration activities in Alberta, Canada, for broader applicability.

Purpose of the Study:

  • To describe pragmatic integration activities at the meso-level in Alberta, Canada.
  • To identify actionable recommendations for cultivating a pro-integration culture within government and PC governance.
  • To explore the generalizability of these activities to other health systems.

Main Methods:

  • Utilized 11 semi-structured interviews with nine key informants from meso-level organizations.
  • Focused on experiences during Alberta's Omicron variant response (September 2021).
  • Employed an interpretive descriptive approach to analyze integration context and activities.

Main Results:

  • Despite initial tensions, efforts to improve PC and central health system relations were successful.
  • Staffing changes due to external shocks and political pressures influenced integration.
  • Pro-integration behaviors included signaling value, demonstrating commitment, persevering, and bi-directional communication.

Conclusions:

  • Successful PC integration necessitates proactive cultural, relational, and communication strategies.
  • These proactive behaviors support integration amidst system shocks, staff turnover, and relational fluctuations.
  • Findings offer generalizable insights for health system integration efforts globally.