The Practical Playbook: Public Health and Primary Care Together, by J. L. Michener, D. Koo, B. C. Castrucci, J. B. Sprague, editors. de Beaumont Foundation, Centers for Disease Control and Prevention, Duke University Department of Community and Family Medicine. 2016. pp. 1-381, New York, NY: Oxford University Press.
The Practical Playbook: Public Health and Primary Care Together (Practical Playbook) is highly recommended for offering insight and guidance on bridging the gap between primary care and public health. This text developed by the Duke University Department of Community and Family Medicine, Centers for Disease Control and Prevention, and the de Beaumont Foundation provides tools, experience, and case examples that reduce the schism between public health and primary care. The book is a necessary and welcome follow-up to the 2012 report of the Institute of Medicine, Primary Care and Public Health: Exploring Integration to Improve Population Health. The Patient Protection and Affordable Care Act, which emphasizes primary care and targets population health outcomes, has provided further momentum for this volume.
The editors, J. Lloyd Michener, Denise Koo, Brian C. Castrucci, and James B Sprague, use the terms "practical" and "playbook" to characterize their work. By practical, they aim to deliver real-life guidance. Using the analogy to a sports playbook, they seek to outline the plays that will operationalize partnerships and initiatives that bring public health and primary care together to improve community health. The key target audience is public health and primary care practitioners.
The Practical Playbook succeeds in its action orientation going beyond simply restating principles and espousing the value of a relationship between the 2 disciplines. This handbook outlines steps for action on how to engage primary care and public health workers to work on the same team furthering population health initiatives. Strategies are accompanied by detailed easy-to follow instructions guiding those interested in improving community health including primary care providers, public health officials, community policy makers, and advocates.
Other audiences for this book include students of public health and resident physicians in primary care programs. The book is organized into 5 sections: fundamentals of partnerships between public health and primary care; working together; health and health care; working with data; and success stories. The content is well organized and is framed in a contemporary context offering insight when outlining probable future trends. The perspectives of various players are identified. Public health practitioners refer to population health in terms of health outcomes of geographically defined communities. Health care providers refer to population health as the health outcomes in terms of patients receiving clinical services. The Practical Playbook seeks to integrate the focus on individual care with efforts that address determinants of population health to realize gains in health in an era where chronic disease predominates.
Essays by the former executive directors and staff of the Association of State and Territorial Health Officials and the National Association of County & City Health Officials describe opportunities for collaboration between public health and primary care. A chapter by staff of the Association of State and Territorial Health Officials and the National Association of Medicaid Directors, "Partnering With Medicaid, Public Health and Primary Care to Improve Health Outcomes," outlines successful partnerships already underway linking public health, health care providers, community groups, schools, and others on health initiatives to improve care of asthma, pregnancy, and hypertension. Guidance is provided for creating these partnerships involving primary care providers, state and local health agencies, and other stakeholders.
Although there is a chapter, "The Changing Landscape of Primary Care," enunciating the aspirations of primary care for population as a goal, the Practical Playbook contains less content on ongoing activities of collaboration initiated by primary care practitioners themselves. The chapter does identify the fertile field for future initiatives at the level of the individual and groups of primary care providers. Efforts are described to transform primary care practices into Primary Care Medical Homes that can usher a new era of population health management. Of interest is the reference to the Primary Care Extension Program for practice transformation. This program is analogous to agricultural extension programs bringing innovations to farmers. Accountable Care Organizations are discussed in a different section of the handbook, with concrete content on the responsibility of groups of providers for health outcomes of defined patient populations.
A bonus for this reader is section IV of the Practical Playbook, "Working with Data," containing 6 chapters and 2 essays on extracting information relevant to public health from electronic health records (EHRs) and geographic information systems. Now that we are in the age of EHRs, their ubiquitous use in primary care creates a common ground for primary care and public health. The EHR is familiar to primary care providers, less so to students and practitioners of public health.
Jeffrey Engel, author of an essay in this section, "Data and the Future of Public Health," transports us on an imaginary journey to the year 2025 when we are able to work with data in an integrated world of clinical data sources and public health reporting. The clinician treating a patient with severe pneumonia after entering all the clinical data into the EHR will receive a public health alert to consider Legionnaires' disease because of the increased number of reports of this disease in the community. In another case, information from a pediatric office visit adds information for a community health assessment. Bidirectional information flow benefits both primary care and public health surveillance.
The book complements the already available online, The Practical Playbook: Public Health and Primary Care Together (https://practicalplaybook.org), facilitating the use of the Web by offering a more complete framework, involving other experts in primary care and public health practice, and recounting examples of success in melding these disciplines in greater detail.
-Lloyd F. Novick, MD, MPH
Editor