Supporting the Implementation of Integrated Primary Care and Social Care Services: A Qualitative Descriptive Study

Abstract

Background: Within the Ontario context, a recent shift towards integrated care has led to primary care reforms that have aimed to achieve the quadruple aim benchmarks. Particular focus has been placed on population health management, a key pillar of the quadruple aim metrics, which recognizes and aims to address the broader social, structural and institutional determinants that impact upon population health outcomes. As a result, this study aims to identify and describe the key characteristics of integrated primary care and social care models, programs, and initiatives in Ontario that aim to address the social determinants of health. It also aims to identify barriers and facilitators in the implementation of these integrated care initiatives to support future implementation efforts.

Methods: A qualitative descriptive study design was utilized and was conducted in two phases: 1) document analysis; and 2) 13 in-depth semi-structured interviews with policymakers, managers/ administrators, clinicians and service providers involved in leading integrated primary and social care initiatives in Ontario.

Results: Developing and implementing these initiatives had primarily required the introduction of new governance and delivery arrangements. This included the adoption of shared governance structures where equal decision-making authority was often established between health and social partners, and the introduction of a system navigator role who was commonly co-located within primary care. There were minimal insights in relation to the development of new financial arrangements aside from a few joint funding agreements, as almost all initiatives did not share financial resources and few modified staff or provider remuneration. Initiatives experienced barriers including a lack of permanent or long-term funding and technological infrastructure to support patient tracking, follow-up, and information sharing between health and social partners. However, the system navigator position was found to be an essential role in bridging communication gaps between sectors and delivering integrated care for clients. In addition, factors such as pre-existing informal and formal partnerships between primary care and social care organizations, communication and trust between health and social partners, and organizational leadership support for integration were viewed as enablers.

Discussion and Conclusions: The lessons learned from participants’ experiences in planning and implementing integrated primary care and social care models are timely and can inform future implementation and scale up as the province continues to move towards integrated care arrangements in efforts to achieve the quadruple aim benchmarks. Specific recommendations for policy and future research are proposed.