The interface between primary health care and population health: Challenges and opportunities for prevention

Abstract

Primary health care has the potential to contribute to population health at the individual and population levels. The '5As' (ask, assess, advise/agree, assist and arrange) provide a framework to realise this potential, especially for disadvantaged and vulnerable populations, not only by better organising multidisciplinary preventive interventions within primary health care, but also by linking these interventions with more intensive community and population programs and services, especially for patients with low health literacy. This requires changes to information systems to prompt and record preventive care, work with practices to engage a range of disciplines, including practice nurses, and development of effective linkages with other services in the local community. This has important implications for the newly established Primary Health Networks in supporting improvement within primary care, and creating linkages and partnerships with a range of organisations involved in delivering preventive interventions in the community. However, prevention in primary health care needs to be underpinned by funding systems that support multidisciplinary and preventive care for a population, rather than simply reactive, episode-based care. Background The prevalence of long-term conditions in Australia places an increasing demand on health services, as well as a burden on individuals and society. These conditions share a number of modifable behavioural and physiological risk factors-more than 90% of Australian adults have at least one risk factor, and 64% have three or more risk factors.1 They are amenable to intervention at both the population level and the individual level. Although populations are a key focus of public health and primary health care, services are focused on individuals, but they both have the potential to contribute to improved population health and wellbeing. The key role of primary health care is related to its population reach-the opportunities for prevention and early intervention that arise in interactions with patients, and the acceptance of this role by the community. More than 80% of the population visit a general practitioner (GP) at least once a year, and GPs have connections (both locational and cultural) with the communities they serve.2 Patients attending GPs frequently have one or more risk factors for chronic disease. For example, two-thirds of patients presenting in general practice are overweight or obese, 14% smoke, and one-quarter have at-risk levels of drinking.