A Population Health Framework: Assessing Its Applicability for Primary Care Physicians

Abstract

Population health is concerned with analyzing the factors that determine the uneven distribution of health in a population and it also proposes interventions to narrow health inequalities. Kindig has proposed a population health management strategy that would engage the health and other sectors on population health improvement through a financial incentive linked to health outcomes. Proposed elements of a population health approach in health care at the patient encounter level include paying attention to health determinants for the patient and ensuring interprofessional collaboration; at the system level the approach includes developing and advocating for interventions that address health inequalities, such as delivering services to under-serviced areas and vulnerable populations. There has been virtually no research among frontline clinicians on the awareness and salience of a population health approach. In order to address this gap an exploratory study was conducted among family physicians in Primary Care Networks (PCNs) in Alberta, Canada. PCNs include capitation funding that is used to purchase services such as nursing, pharmacy and dietetics. The physicians were able to describe their patient populations in terms of a full range of social determinants and the health status inequalities they produce. They emphasized the importance of preventive screening and counseling in contributing to the health of their patients, and cited the key contributions of other team members to these activities, as well as the electronic medical record (EMR). They reported ambivalence toward the effectiveness of financial incentives for population health improvement, and while there was some collaboration with schools, inter-sectoral collaboration has yet to develop outside the health sector. This thesis has demonstrated the potential for primary care physicians to adopt a population health approach. However, there is a considerable distance to go in introducing an incentive approach for outcome-based population health management, as envisioned by Kindig.