Implementation of a patient centred medical home (PCMH) initiative in general practices in New South Wales, Australia

Christine Metusela,Bridget Dijkmans-Hadley,Andrew Bonney,Andrew Gow,Judy Mullan

doi:10.1186/s12875-021-01485-x

Christine Metusela, Bridget Dijkmans-Hadley + Show 3 more

Open Access

https://doi.org/10.1186/s12875-021-01485-x

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Abstract

BackgroundWith an ageing population and an increase in chronic disease burden in Australia, Patient Centred Medical Home (PCMH) models of care have been identified as potential options for primary care reform and improving health care outcomes. Adoption of PCMH models are not well described outside of North America. We examined the experiences of seven general practices in an Australian setting that implemented projects aligned with PCMH values and goals supported by their local Primary Health Network (PHN).MethodQualitative and quantitative data were collected over a twelve month period, including semi-structured interviews, participant observation, and practice data to present a detailed examination of a subject of study; the implementation of PCMH projects in seven general practices. We conducted 49 interviews (24 pre and 25 post) with general practitioners, practice managers, practice nurses and PHN staff. Framework analysis deploying the domains of a logic model was used to synthesis and analyse the data.ResultsFacilitators in implementing successful, sustainable change included the capacity and willingness of practices to undertake change; whole of practice engagement with a shared vision towards PCMH change; engaged leadership; training and support; and structures and processes required to provide team-based, data driven care. Barriers to implementation included change fatigue, challenges of continued engaged leadership and insufficient time to implement PCMH change.ConclusionsOur study examined the experiences of implementing PCMH initiatives in an Australian general practice setting, describing facilitators and barriers to PCMH change. Our findings provide guidance for PHNs and practices within Australia, as well as general practice settings internationally, that are interested in undertaking similar quality improvement projects.

Highlights

In Australia, as internationally, the ageing population and associated increase in the burden of chronic illness is well recognised [1,2,3]
Our study examined the experiences of implementing Patient Centred Medical Home (PCMH) initiatives in an Australian general practice setting, describing facilitators and barriers to PCMH change
Our findings provide guidance for Primary Health Network (PHN) and practices within Australia, as well as general practice settings internationally, that are interested in undertaking similar quality improvement projects

Summary

Introduction

In Australia, as internationally, the ageing population and associated increase in the burden of chronic illness is well recognised [1,2,3] This is reflected in general practice in the caseloads of practitioners where currently over 40% of all consultations address chronic illness [4, 5]. PCMH models are aligned to the Quadruple Aim [17]; enhancing patient and provider experience, improving the health of the population and reducing health related costs. With an ageing population and an increase in chronic disease burden in Australia, Patient Centred Medical Home (PCMH) models of care have been identified as potential options for primary care reform and improv‐ ing health care outcomes. We examined the experiences of seven general practices in an Australian setting that implemented projects aligned with PCMH values and goals supported by their local Primary Health Network (PHN)

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Conclusion