A doctor and a public-health nurse write about how their long collaboration was big help during the pandemic
Dr. Jamie L. Reedy, left, and Megan Avallone
As a public-health officer and a primary-care physician, we both know the value of understanding the communities we serve. In serving our communities, we engage with a range of individuals impacting public health — from school nurses to pediatricians and family physicians to mayors and council members. The Westfield Regional Health Department covers eight diverse municipalities in Union and Morris counties and a population of 110,000 people.
We know that public health, like politics, is local. Being boots-on-the-ground and building relationships is essential to promoting good policy around public health. Critical for public-health officers is to know your local health-care providers, especially those in primary care. Strong alignment between public-health and primary-care providers builds greater trust in public health and facilitates effective communication.
Through the past 16 years, we have worked together and have seen the value of our collaborative relationship as a public-health officer and a primary-care physician with expertise in public health. We communicate in-person two or three days each month, and by phone when urgent issues arise. Dr. Reedy and the public-health nurses she works closely with are available around the clock when provider input would be helpful.
We regularly discuss the latest public-health guidance that is then shared with the pediatricians, family physicians, and others advising their patients about everything from vaccines to communicable diseases to vaping and substance-use disorders.
During the pandemic, nationally, we saw how the lack of alignment and communication between public-health and local health-care providers could create or exacerbate mistrust in public-health messages. In our community, even with our strong history of collaboration, we saw some parents become frustrated and even angry when their children’s physician provided information that did not align with public-health guidance.
A boost to communication efforts
In parts of New Jersey, we received reports of a few pediatricians misinforming patients that the COVID-19 vaccine was not safe for children. Such situations are frustrating and cause unnecessary concerns for parents, their children, and the public at large.
Better relationships and communication between public health and primary care can lead to aligned public-health messaging, organized information campaigns and can result in greater overall understanding and trust in suggested actions to protect individuals and the community.
Having existing relationships between primary care and public health before a crisis is key. In our communities, we provide information to members of the medical community who may not, for instance, be up to date on the latest guidance on safe lead levels. (Today, we believe there is no safe level of lead for a child).
Our local hospital recognized that medical schools teach little about public health, and they reached out to us to remedy this, resulting in a partnership where third-year family-practice residents shadow us for a time to learn about the role of public-health departments. They may assist with a restaurant inspection or environmental complaint, and they also shadow Dr. Reedy and the public-health nurses in the child health clinic. The medical residents almost always leave, saying, “I had no idea this medical and public-health infrastructure existed!”
In public health, perhaps our highest-profile role surrounds communicable diseases, especially during the past two years. We found our existing partnership eased some of the challenges public-health officials faced during the pandemic. Collaboration between Dr. Reedy’s extensive physician network of contacts, including one of the largest pediatric practices in the state, and Ms. Avallone’s connections to the state Department of Health allowed for timely sharing of the latest COVID-19 public-health policies. From return-to-school guidance to vaccination updates, we worked closely to ensure local providers were regularly informed.
Information was shared quickly, and busy physicians did not have to spend time researching the latest information. The relationship was mutually beneficial. After the COVID-19 vaccines were approved, Dr. Reedy assembled a team to assist Ms. Avallone in obtaining supplies that might be needed for vaccine storage and distribution. Once vaccines began being widely distributed, Ms. Avallone was able to provide practitioners with vaccination rates in the communities they served.
The New Jersey Health Care Quality Institute, in Emerging From COVID-19: An Action Plan for a Healthier State, found that during the pandemic, local public-health departments and local health-care providers often did not work together — or even know one another. The action plan includes recommendations to address that disconnect that we highly support:
- Establish formalized, closer ties between local public-health departments and community-based primary-care providers, for example through their professional associations, local school-based or sports programs, or social-service organizations.
- Invite local providers and public-health officials to present at each others’ professional association meetings about priorities, challenges and updated clinical guidance.
- Hold regular forums to foster these new relationships.
- Encourage medical schools and medical residency programs to collaborate with local health departments.
We need to be ready for a future crisis, but also for the non-COVID-19 issues that did not go away during the pandemic. We’re still facing a crisis of social isolation, substance-use disorder and mental-health needs, as well as vaping and tobacco use. Public-health officers and primary-care providers must tackle these problems together — focusing on both individuals and the community.
Public-health and primary-care professionals can learn from the challenges we faced during the pandemic and move forward stronger together.