School of Public Policy, University of Calgary, 906 8 Ave SW 5th floor T2P 1H9, Calgary, AB, Canada.
Cumming School of Medicine, Department of Community Health Sciences. 3D10, University of Calgary, 3280 Hospital Drive NW Calgary, Calgary, Alberta, Alberta, T2N 4Z6, Canada.
BMC Prim Care. 2023 Jul 17;24(1):149. doi: 10.1186/s12875-023-02104-7.
The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a 'pro-integration culture' amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems.
11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants' experiences and efforts to 'do' integration as they responded to Alberta's first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities.
As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels.
Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.
将初级保健（PC）整合到更广泛的卫生系统中是世界各地的目标。在中观层面上实现整合的努力引起了特别关注，但对于如何在政府和 PC 治理机构中建立“有利于整合的文化”，几乎没有可行的建议。本文描述了加拿大艾伯塔省中观层面参与者所进行的务实整合活动，并提出了将这些活动推广到其他卫生系统的方法。
从一项更大的定性研究中选择了 9 名来自中观组织的关键信息提供者的 11 次半结构化访谈，该研究考察了 COVID-19 大流行期间医疗保健政策的制定和实施。选定的访谈重点关注参与者在 2021 年 9 月应对奥密克戎变异的艾伯塔省第一波疫情时的经验和整合努力。采用解释性描述方法来识别整合背景和务实整合活动中的重复周期。
随着奥密克戎抵达艾伯塔省，PC 的中观层面和中心卫生系统参与者之间的关系紧张，但改善这种情况的努力取得了成功。在这种关系循环的背景下，对外生冲击和政治压力做出的人员变动对整合产生了明显影响。然而，参与者也采取了具体的行为来推进有利于整合的文化。他们通过以下方式做到了这一点：通过人员配置和资源选择来表明价值；通过口头表达和采取个人和团体对合作的承诺；坚持不懈；并通过正式和非正式渠道进行双向沟通。
实现 PC 整合不仅涉及对外生因素做出反应的被动工作，还涉及采取文化、关系和沟通行为的主动工作。这些行为可能支持整合，而不论任何卫生系统经历的冲击、人员流动和关系冻结解冻周期如何。
