Beyond checkboxes: A qualitative assessment of physicians' experiences providing care in a patient-centred medical home.

Autor: Sklar M; Department of Psychiatry, University of California San Diego, San Diego, California.; Child and Adolescent Services Research Center, University of California San Diego, San Diego, California., Seijo C; Department of Psychiatry, University of California San Diego, San Diego, California.; Child and Adolescent Services Research Center, University of California San Diego, San Diego, California., Goldman RE; Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.; Center for Primary Care and Prevention, Brown University, Pawtucket, Rhode Island., Eaton CB; Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.; Center for Primary Care and Prevention, Brown University, Pawtucket, Rhode Island.
Jazyk: angličtina
Zdroj: Journal of evaluation in clinical practice [J Eval Clin Pract] 2019 Dec; Vol. 25 (6), pp. 1142-1151. Date of Electronic Publication: 2019 Apr 17.
DOI: 10.1111/jep.13136
Abstrakt: Rationale, Aims, and Objectives: The patient-centred medical home (PCMH) is an innovative approach to health care reform. Despite a well-established process for recognizing PCMH practices, fidelity to, and/or adaptation of, the PCMH model can limit health care and population health improvements. This study explored the connection between fidelity/adaptation to the PCMH model with implementation successes and challenges through the experiences of family and internal medicine PCMH physicians.
Methods: Interviews were conducted at two academic PCMH clinics with faculty and resident physicians. Data were transcribed and coded on the basis of an a priori code list. Together, the authors reviewed text and furthered the analysis process to reach final interpretation of the data.
Results: Ten faculty and nine resident physicians from the Family Care Centre (FCC; n = 11) and the Internal Medicine Clinic (IMC; n = 8) were interviewed. Both FCC and IMC physicians spoke positively about their clinic's adherence to the PCMH model of enhanced access to care, coordinated/integrated care, and improvements in quality and safety through data collection and documentation. However, physicians highlighted inadequate staffing and clinic hours. FCC physicians also discussed the challenge of providing high-quality care amidst differences in coverage between payers.
Conclusion: There remains significant variability in PCMH characteristics across the United States and Canada. This qualitative analysis uncovered factors contributing to fidelity/adaptation to the PCMH model in two academic PCMH clinics. For the PCMH to achieve the Triple Aim promise of improved patient health and experience at a reduced cost, policy must support fidelity to core elements of the PCMH.
(© 2019 John Wiley & Sons, Ltd.)
Databáze: MEDLINE
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