Abstract
In recent years, there is growing interest internationally to implement patient-centered medical homes (PCMHs), and Singapore is no exception. However, studies understanding the influence of contextual policy factors on the implementation of PCMHs are limited. We conducted 10 semi-structured in-depth interviews with general practitioners working in seven out of the nine PCMHs. Audio recordings were transcribed and analyzed by two study team members in NVivo 12 Software using grounded theory techniques. Power dynamics between the stakeholders and lack of shared decision-making among them in selecting the locale of the PCMH and formulating the practice fee and pharmacy structure were the key factors which negatively affected the implementation of PCMHs on a larger scale. Over time, lack of funding to hire dedicated staff to transfer patients and misalignment of various stakeholders’ interest to other right-siting programs also resulted in low number of patients with chronic conditions and revenue. Countries seeking to implement a successful PCMH may benefit from building trust and relationship between stakeholders, engaging in shared decision-making, ongoing cost-efficiency efforts, and formulating a clear delineation of responsibilities between stakeholders. For a healthcare delivery model to succeed in the primary care landscape, policies should be developed keeping mind the realities of primary care practice.
Highlights
Patient-centered medical home (PCMH) is a healthcare delivery model active in the United States for more than a decade
Primary care in Singapore is provided through a combination of an island-wide network of polyclinics operated by the public sector and clinics run by private general practitioners (GPs) who primarily serve as solo practices
These themes were identified based on the definition of the contextual policy factors, which is mentioned in the Introduction section of this paper
Summary
Patient-centered medical home (PCMH) is a healthcare delivery model active in the United States for more than a decade. It is based on key attributes such as access to a primary care physician, patient-centeredness, comprehensive and coordinated care, accessible services, and a commitment to quality and safety [1]. PCMH is associated with not just positive health outcomes at the primary care level and reduced healthcare utilization at the tertiary level [2,3]. In 2011 Singapore’s Ministry of Health (MOH) introduced the Family Medicine Clinic (FMC) as its localized version of PCMH to enhance chronic disease management in the primary care level [4]. Polyclinics are multi-doctor clinics offering a comprehensive range of subsidized healthcare services [5]
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