Literature Collection

Existing models for the safe, timely and effective delivery of health and social care are challenged by an ageing population. Services and care pathways are often optimised for single-disease management, while many older people are presenting with multiple long-term conditions and frailty. Systems engineering describes a holistic, interdisciplinary approach to change that is focused on people, system understanding, design and risk management. These principles are the basis of many established quality improvement (QI) tools in health and social care, but implementation has often been limited to single services or condition areas. Newer engineering techniques may help reshape more complex systems. Systems thinking is an essential component of this mindset to understand the underlying relationships and characteristics of a working system. It promotes the use of tools that map, measure and interrogate the dynamics of complex systems. In this New Horizons piece, we describe the evolution of systems approaches while noting the challenges of small-scale QI efforts that fail to address whole-system problems. The opportunities for novel soft-systems approaches are described, along with a recent update to the Systems Engineering Initiative for Patient Safety model, which includes human-centred design. Systems modelling and simulation techniques harness routine data to understand the functioning of complex health and social care systems. These tools could support better-informed system change by allowing comparison of simulated approaches before implementation, but better effectiveness evidence is required. Modern systems engineering and systems thinking techniques have potential to inform the redesign of services appropriate for the complex needs of older people.

PURPOSE: The New Mexico P5 (Physician-Pharmacist-Patient-Payor Partnerships) Summit, held May 13-15, 2024, in Albuquerque, NM, sought to bring physicians, pharmacists, patients, and payors together to address the state's healthcare access crisis by advancing integration of advanced practice pharmacists (APPh) into team-based care. The summit sought to identify gaps in healthcare delivery, optimize pharmacists' clinical roles, and develop sustainable collaborative care models to improve outcomes, particularly in rural and underserved areas. SUMMARY: New Mexico has a long history of progressive pharmacy practice legislation, including the Pharmacist Prescriptive Authority Act (1993) and reimbursement parity for pharmacist-provided services (2020). The New Mexico P5 Summit convened 119 stakeholders-healthcare providers, payors, policymakers, employers, and patient advocates-to address primary care shortages, workforce gaps, and socioeconomic determinants of health. Keynote and panel sessions examined APPh models in New Mexico and other states, payment reform initiatives, and expanded pharmacist roles in chronic disease management, preventive care, and point-of-care testing. Breakout sessions identified 5 priority areas: (1) legislative and regulatory reform, (2) pharmacy workforce development, (3) health information exchange, (4) reimbursement/business models for clinical services, and (5) employer-based pharmacist demonstration projects. Workgroups were formed and are working to address these priorities. CONCLUSION: The New Mexico P5 Summit underscored the potential of APPh to mitigate primary care shortages and improve healthcare quality, access, and equity. The collaborative strategies and workgroup initiatives developed provide a framework for legislative, workforce, and payment reforms that leverage pharmacists' expertise. Ongoing stakeholder engagement will be essential to achieving sustainable innovations and transforming New Mexico's healthcare delivery system.