Major Health Issues in Nova Scotia: An Environmental Scan

# Reference Brief Notes
Putting population health into practice
through primary health care. N.Z.Med.J.;
2009; 122(1290):98-104.
opportunities to take a population health approach to the planning
and delivery of primary health care. This paper takes the position that
the features of a population health approach (such as a concern for
equity, community participation, teamwork and attention to the
determinants of health) enhance general practice care rather than
undermine it. We conclude that the contribution of the health sector
towards population health goals can be achieved through
collaboration between GPs, nurses, other primary health care
workers, and communities, together with health promotion and
public health practitioners. Finding common language and
understanding is an important step towards improving that
11. Ploeg,J, Feightner,J, Hutchison,B, et al.
Effectiveness of preventive primary care
outreach interventions aimed at older
people: Meta-analysis of randomized
controlled trials. Can.Fam.Phys. 2005;
51:1244-1245.
12. Starfield,B, Shi,L and Macinko,J.
Contribution of primary care to health
systems and health. Milbank Q.; 2005;
83(3):457-502.
13. Thielke,S, Vannoy,S and Unutzer,J.
Integrating mental health and primary care.
Prim.Care; 2007; 34(3):571,92, vii.
collaboration.
Objective was to determine the effectiveness of preventive primary
care outreach interventions aimed at older people. We included
studies of preventive primary care interventions aimed at patients 65
years and older if the studies were randomized controlled trials and if
any of the following outcomes was reported: mortality, living in the
community, admission to acute care hospitals, and admission to longterm
care. We defined preventive primary care outreach as proactive,
provider-initiated care, which can be provided by nurses, physicians,
other professionals, or volunteers, that is in addition to usual care and
is provided in primary care settings. Such care can be provided
through home visits, office visits, telephone contacts, or a
combination of these methods. This review showed that studies of
preventive primary care outreach interventions aimed at older people
were associated with a 17% reduction of mortality and a 23%
increased likelihood of continuing to live in the community.
Evidence of the health-promoting influence of primary care has been
accumulating ever since researchers have been able to distinguish
primary care from other aspects of the health services delivery
system. This evidence shows that primary care helps prevent illness
and death, regardless of whether the care is characterized by supply of
primary care physicians, a relationship with a source of primary care,
or the receipt of important features of primary care. The evidence
also shows that primary care (in contrast to specialty care) is
associated with a more equitable distribution of health in populations,
a finding that holds in both cross-national and within-national
studies. The means by which primary care improves health have been
identified, thus suggesting ways to improve overall health and reduce
differences in health across major population subgroups.
Mental health and primary care delivery systems have evolved to
operate differently. For example, attention to multiple medical issues,
health maintenance, and structured diagnostic procedures are
standard elements of primary care rarely incorporated into mental
health care. A multidisciplinary treatment approach, group care, and
case management are common features of mental health treatment
settings only rarely used in primary care practices. Effective
integration of mental health care into primary care requires systematic
and pragmatic change that builds on the strengths of both mental
health and primary care.