The following is a summary of “Doing primary care integration: a qualitative study of meso-level collaborative practices,” published in the July 2023 issue of Primary Care by Leslie, et al.

The goal of integrating Primary Care (PC) into broader health systems has been a focus in various jurisdictions worldwide. However, achieving integration at the meso-level (intermediate level between micro-level patient care and macro-level policy) remains challenging, and actionable recommendations for promoting a ‘pro-integration culture’ among government and PC governance bodies still need to be made. For a study, researchers presented pragmatic integration efforts undertaken by meso-level participants in Alberta, Canada, and explored their potential generalizability to other health systems.

Eleven semi-structured interviews were conducted with 9 key informants from meso-level organizations as part of a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. The interviews focused on participants’ experiences and efforts to promote integration while responding to Alberta’s first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify recurring themes in the integration context and pragmatic integration activities.

As the Omicron variant emerged in Alberta, tensions in integration and relations between meso-level PC and central health system participants were evident. Despite challenges, efforts were made to improve the situation successfully. Staffing changes in response to external shocks and political pressures clearly influenced integration. Additionally, participants engaged in specific behaviors that fostered a pro-integration culture. The behaviors included signaling the value of integration through staffing and resource choices, demonstrating personal and group commitments to collaboration, persevering in the face of challenges, and engaging in bi-directional communication through formal and informal channels.

Achieving PC integration involves reactive responses to external factors and proactive efforts to enact cultural, relationship, and communication behaviors. The behaviors may promote integration regardless of the shocks, staff turnover, and relational fluctuations experienced by any health system.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02104-7