Primary Care Delivery Research Articles

A systematic literature review of patient self-assessment instruments concerning quality of primary care in multiprofessional clinics.

BackgroundQuality of care remains a priority issue and is correlated with patient experience. Measuring multidimensional patient primary care experiences in multiprofessional clinics requires a robust instrument. Although many exist, little is known about their quality.ObjectiveTo identify patient perception instruments in multiprofessional primary care and evaluate their quality.MethodsSystematic review using Medline, Pascal, PsycINFO, Google Scholar, Cochrane, Scopus, and CAIRN. Eligible articles developed, evaluated, or validated 1 or more self-assessment instruments. The instruments had to measure primary care delivery, patient primary care experiences and assess at least 3 quality-of-care dimensions. The COnsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) checklist was used to assess methodological quality of included studies. Instrument measurement properties were appraised using 3 possible quality scores. Data were combined to provide best-evidence synthesis based on the number of studies, their methodological quality, measurement property appraisal, and result consistency. Subscales used to capture patient primary care experiences were extracted and grouped into the 9 Institute of Medicine dimensions.ResultsTwenty-nine articles were found. The included instruments captured many subscales illustrating the diverse conceptualization of patient primary care experiences. No included instrument demonstrated adequate validity and the lack of scientific methodology for assessing reliability made interpreting validity questionable. No study evaluated instrument responsiveness.ConclusionNumerous patient self-assessment instruments were identified capturing a wide range of patient experiences, but their measurement properties were weak. Research is required to develop and validate a generic instrument for assessing quality of multiprofessional primary care.Trial registrationNot applicable.

Virtual care in Ontario community health centres: a cross-sectional study to understand changes in care delivery.

There has been a large-scale adoption of virtual delivery of primary care as a result of the COVID-19 pandemic. In this descriptive study, an equity lens is used to explore the impact of transitioning to greater use of virtual care in community health centres (CHCs) across Ontario, Canada. A cross-sectional survey was administered and electronic medical record (EMR) data were extracted from 36 CHCs. The survey captured CHCs' experiences with the increased adoption of virtual care. A longitudinal analysis of the EMR data was conducted to evaluate changes in health service delivery. EMR data were extracted monthly for a period of time before the pandemic (April 2019-February 2020) and during (April 2020-February 2021). In comparison with the pre-pandemic period, CHCs experienced a moderate decline in visits made (11%), patients seen (9%), issues addressed (9%), and services provided (15%). During the pandemic period, an average of 54% of visits were conducted virtually, with telephone as the leading virtual modality (96%). Drops in service types ranged from 28%-82%. The distribution of virtual modalities varied according to the provider type. Access to in-person and virtual care did not vary across patient characteristics. The results demonstrate a large shift towards virtual delivery while maintaining in-person care. No meaningful differences were found in virtual versus in-person care related to patient characteristics or rurality of centres. Future studies are needed to explore how to best select the appropriate modality for patients and service types.

Recruitment and retention of primary care nurse practitioners in underserved areas: A scoping review

BackgroundThe growing nurse practitioner (NP) workforce plays a critical role in primary care delivery in the United States. However, better recruitment and retention of the robust NP workforce in underserved areas are needed; evidence to inform such effort is limited. PurposeThis scoping review aimed to examine the findings, scope, and knowledge gaps of available literature on factors associated with NP recruitment and retention in underserved areas. MethodsThis review was guided by Joanna Briggs’ Scoping Review Methodology and PRISMA-SCR reporting standards. Literature search for peer-reviewed and gray literature was conducted in six databases. FindingsA total of 22 studies met inclusion criteria. Factors associated with NP recruitment and retention in underserved areas were mapped into five themes, including factors related to: the individual NP, NP education programs/financial aid, organizations employing NPs, the communities NPs work in, and autonomous practice. Majority of the included studies were published before 2010; few used rigorous study designs and analysis methods; and few exclusively studied NPs and unique challenges facing the NP workforce. DiscussionAvailable studies demonstrate that NP recruitment and retention can be addressed by various stakeholders (e.g., educators, policy makers); however, up-to-date, methodologically rigorous, and NP-focused studies are needed.

The performance based budgeting as a catalyst for effective delivery of primary health care

The main aim of this article is to explore how performance-based budgeting has an effect on primary health care service delivery in the Eastern Cape. This article assessed the performance-based budgeting system in the Eastern Cape Department of Health in an attempt to advocate for effective and efficient health service delivery. The Eastern Cape Province is succumbing to insufficient funding at the provincial level and this has a clear-cut reflection on the administration of services within respective departments. The article is premised on a constructivist paradigm that adopts a qualitative approach where document analysis was employed for collecting data. The Eastern Cape Province is succumbing to insufficient funding at the provincial level and this has a clear-cut reflection on the administration of services within respective departments. The article employed the Public Choice Theory and the Concept of New Public Management. Three main findings emerged from the article of the crippled funds in the province, the human resources crisis, poor public finance management, and shortage of health equipment. Data were analyzed using thematic analysis to examine the distinctive themes and sub-themes identified from within the reviewed literature. Recommendations were thus given based on the discussed and derived themes to ensure that there is an appropriate budgeting system to ensure efficient and effective provision of health care services in the Eastern Cape Department of Health.

Exploring consumer perspectives about the Health Care Home model of primary care provision: A qualitative study.

Australia's health system faces challenges in the management and prevention of chronic disease. Models of primary care delivery, such as the Health Care Home (HCH) model, have been proposed to help meet these challenges. The aim of this study was to explore pre-implementation consumer perspectives of the HCH model. Qualitative data were collected from focus groups and semi-structured interviews with 38 general practice patients diversified across rural and urbanareas and patient demographics. The qualitative findings revealed that consumers were confused about the name of the model. They were sceptical about potential hidden costs associated with the model and concerned about hidden agendas and where things in general practice are headed. The findings indicate that consumers may not readily embrace the HCH model. To aid consumer acceptance, the authors recommend the terminology be clarified and the concepts, financial implications and expected outcomes of the model be clearly communicated.

Optimising health care for people living with chronic kidney disease: Health-professional perspectives.

People with chronic kidney disease are often multimorbid and have complex psychosocial needs. For health professionals to deliver holistic, person-centred care to individuals and their carers living with this multifaceted disease, they are required to communicate complex information and problem solve in a multifactorial health and disease context. To explore the perspectives and experiences of tertiary care multidisciplinary team members and primary care providers of health care to people with chronic kidney disease; identify opportunities to innovate and improve the coordinated delivery of health services. The qualitative study design used purposive sampling to recruit 39 health professionals, working in the primary and tertiary sector in a regional Australian health district. Participants included general practitioners, renal and general practice nurses, dietitians, nephrologists and social workers. The data were collected through semistructured interviews and analysed using a relativist ontological position and directed content analysis approach. Analysis of interviews was undertaken by three independent researchers and key themes were derived via consensus. A common goal to deliver person-centred individualised care was evident among health care professionals. However a deficit in shared understanding of the disease within and between disciplines was identified. The complex nature of chronic kidney disease requires up-skilling of health professionals to ensure patient education is targeted to individual health contexts and motivates self-management. Improved communication and comprehension might best be achieved across disciplines with an integrated approach to delivery of primary health care to individuals living with early-stage kidney disease.

Impact of Covid-19 on Maternal Health Seeking in Ghana.

The Covid‐19 pandemic is widely speculated to have disrupted the delivery of primary health care in low‐income countries. Yet, there is little rigorous empirical research identifying this effect. This paper estimates the impact of Covid‐19 on facility and skilled delivery and utilisation of antenatal care (ANC) services by comparing these outcomes for women who were pregnant/delivered before and during the Covid‐19 period. The results show that Covid‐19 led to 23% and 25% reductions, respectively, in the likelihood of facility delivery and four or more ANC visits during pregnancy. These findings highlight the need to build more resilient health systems in low‐income settings.

Patients' and clinicians' perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe.

BackgroundThe impact of the COVID-19 pandemic on patients’ and clinicians’ perceptions of healthcare-seeking behaviour and delivery of care is unclear. The pandemic accelerated the use of remote care, and understanding its benefits and drawbacks may inform its implementation during current and future healthcare emergencies.AimTo explore patients’ and primary care professionals’ (PCPs) experiences of primary care delivery in the first wave of the pandemic.Design & settingQualitative study using semi-structured interviews in primary care in eight European countries (England, Ireland, Belgium, the Netherlands, Greece, Poland, Sweden, and Germany).MethodA total of 146 interviews were conducted with 80 PCPs and 66 patients consulting for respiratory tract infection (RTI) symptoms, in eight European countries. Data were collected between April and July 2020, and analysed using thematic analysis.ResultsIt was found that patients accepted telemedicine when PCPs spent time to understand and address their concerns, but a minority preferred in-person consultations. PCPs felt that remote consultations created emotional distance between themselves and patients, and they reported having to manage diverse COVID-19-related medical and social concerns.ConclusionRemote consultations for RTI symptoms may be acceptable long term if both groups are happy to use this format, but it is important that PCPs take time to address patients’ concerns and provide safety-netting advice.

Abstracts Presented at the 2nd Annual Advancing Healthcare Innovation Summit: Nov 11, 2022, Cincinnati, OH

Abstracts Presented at the 2nd Annual Advancing Healthcare Innovation Summit: Nov 11, 2022, Cincinnati, OH

SPARSH electronic sub-health centers (e-SHCs) - A model of nurse-run SHCs supported by general practitioners through telemedicine.

The primary health care services in India suffer from inconsistent availability of providers, lack of quality, poor availability of medicines and diagnostics, and a poorly functioning referral linkage. A multi-pronged approach is required to address these issues. We describe here a model of electronic sub-health centers (e-SHCs) managed by trained nurses supported by a general practitioner over telemedicine. The e-SHCs are expected to meet two objectives - 1) to create a point of comprehensive primary health care delivery at an affordable cost and 2) to create a referral support system backed by information technology and physical movement. The model is described in nine sections - service delivery framework, human resources, diagnostics, infrastructure, quality improvement, health management information system, materials management, financing, and branding. It is a video-based real-time (synchronous) health worker to the registered medical practitioner telemedicine facility. The model has been compared with five other telemedicine and five other tele-rehabilitation models. Although there are inherent challenges to operationalize this model, it also presents a unique opportunity of testing an innovative approach of providing quality primary health care at an affordable cost. The process will generate learnings for addressing the primary care health care delivery gaps in the country.

Abstract PO-021: LGBTQ cancer care: Assessing the benefits and limitations of a novel cancer care coordination tool

Abstract Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals experience health disparities at disproportionate rates which drive reduced cancer screenings and late-stage cancer diagnoses. These disparities are the result of barriers to care including a lack of LGBTQ-competent providers, lack of health insurance, unstable housing, and avoidance of care due to medical trauma and concerns about abuse and mistreatment. Community health centers are critical for providing primary care to LGBTQ+ patients with cancer. Unfortunately, once a patient is diagnosed with cancer and referred to specialty care outside the health center, primary care services are often disrupted or even discontinued as a result of gaps in communication between primary and oncological care providers. The © 4R Oncology Model (Right Information and Right Care for the Right Patient at the Right Time) is a novel, patient-centric care coordination tool developed to facilitate cancer planning and serve as a longitudinal primary care checklist for patients and their care team. Our project aims to assess the benefits and limitations of the 4R as a component of care delivered to LGBTQ cancer survivors. Methods: In collaboration with Howard Brown Health, we conducted semi-structured interviews with clinical care team members (N=10) to assess the benefits and limitations of the 4R implementation as a component of care delivered to LGBTQ cancer survivors. A Rapid analysis process, a method used when a quick analysis is required to adopt changes to ongoing processes, will be utilized. Results: Clinical care team members indicate that a lack of adequate research on solutions to the disruption of primary care services caused by cancer care for LGBTQ cancer patients is a significant barrier for this patient population. Team members agree that the 4R is a necessary intervention for addressing primary care gaps caused by inadequate care coordination. Conclusions: The 4R shows promise as a solution for initiating and sustaining more continuous communication between primary care and cancer care delivery for LGBTQ cancer survivors. Future interviews with patients, caregivers, and community organization members will further elucidate the barriers and facilitators to cancer care coordination for this population and how iterations of the 4R can improve access to care and outcomes. Citation Format: Nihmotallahi Adebayo, Will Dunne, Toni Madorsky, Sankirtana Danner, Juan Rivera, Elena Molina, Abbey Ekong, Elizabeth Adetoro, Cassandra Osei, Julia Trosman, Christine Weldon, Melissa Simon. LGBTQ cancer care: Assessing the benefits and limitations of a novel cancer care coordination tool [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-021.

ОЦЕНКА ПАЦИЕНТАМИ КАЧЕСТВА МЕДИЦИНСКОЙ ПОМОЩИ В МЕДИЦИНСКИХ ОРГАНИЗАЦИЯХ ПЕРВИЧНОГО ЗВЕНА ЗДРАВООХРАНЕНИЯ г. СТАВРОПОЛЯ

Significance. Improving satisfaction with primary care is among the priorities of the project "Lean polyclinic" - "Creation of the new model of medical organization providing primary care" (2017-2022) - "Development of primary health care system" (2019 - 2024). The project is about implementing principles of lean production in the healthcare system, primarily focused on patient needs and careful attitude to the time resource as the main value. According to the project passport, approved by the Government of the Russian Federation, the index of satisfaction of the population with activities of the Ministry of Health should increase from 45.7% to 70% by 2022. The purpose of the study is to assess satisfaction with primary care delivery within the framework of the "Creation of the new model of medical organization providing primary care", using a list of indicators of public satisfaction with activities of the Ministry of Health MO on a wide profile of outpatient care facilities and identify priorities for improvement of care delivery within the framework of the project. Material and Methods. Questionnaire survey of people visiting polyclinics. The number of respondents equaled to 506. The questionnaires were filled out in primary care facilities of Stavropol city, participating in the project. The respondents' answers were analyzed using the ratio between the share of those answered and the total number of the respondents calculating a weighted average satisfaction score on a five-point scale. Such approach allowed to rank attributes by their importance on each area of MO activity, to define "area" of the highest marks and "zones" of low patient satisfaction. The information-analytical system of primary analysis of risk factors - AnkProc, as well as Excel program were used for data input and processing. Conclusion. The survey participants rate the work of health care facilities participating in the pilot project rather high. 44.7% of the respondents were highly satisfied with primary care, 39.7% - mainly satisfied, which in total amounted for 84.4% of the excellent and good marks, while the share of the less satisfied and unsatisfied equaled to 7.7% and 1.4%, respectively. 6.5% of the respondents abstained from answering. The study has identified and ranked 17 parameters of work of primary care facilities, requiring correction and improvement within the framework of the project "Creation of the new model of medical organization providing primary health care" in Stavropol. Scope of application. The study results can be used by chief physicians of health care facilities, managers, executors of the project to identify mechanisms to increase public satisfaction with the most important for patients work parameters of health care facilities.

Strengthening primary health care: contributions of young professional-led communities of practice.

Health systems that have strong primary health care at their core have overall better patient outcomes. Primary health care is key to achieving Universal Health Coverage and the broader health-related Sustainable Development Goals by 2030. In 2018, at the launch of the Declaration of Astana, the World Health Organization formed the inaugural Primary Health Care Young Leaders' Network. This paper aims to demonstrate the scope for young professional-led communities of practice in fostering support systems for young leaders and strengthening the delivery of primary health care at multiple levels. A description of the Young Leaders' Network community of practice model is presented, with examples of the work the members are doing, individually and collectively, to advance the science and practice of primary health care. This initiative brought together 21 individuals from across the world, working across disciplines and within an array of socioeconomic contexts to improve primary health care in their respective countries. This youth-led community of practice is able to share knowledge, evidence and resources to inform clinical and public health activities, policy initiatives, advocacy and research to improve primary health care delivery and health outcomes for communities across the globe.

Digital health to support primary care provision during a global pandemic.

The urgency of the COVID-19 pandemic in Australia has seen the implementation of digital health technologies to support continuity of high-quality primary care provision. Digital health innovation has been used to operationalise the nation's pandemic preparedness principles by reducing risk of infection to both healthcare workers and at-risk patients, sustaining care for chronic and acute health conditions, and supporting the mental health of the population. In this perspective piece, we document the Australian Federal government's digital health response to ensure the ongoing delivery of high-quality primary care. This includes the implementation of telehealth, point-of-care testing, electronic records and e-prescriptions, national primary care data collection and analysis, and digital communication. Digital health has been a critical element of the pandemic response and paves the way for future primary care provision during disasters and emergencies. Further research is needed to capture the effectiveness, feasibility and acceptability of these innovations for both patients and primary care practitioners.

Palliative medicine Master Classes for primary care: an evaluation.

Introduction General practitioners (GP) are key in the delivery of primary palliative care in the community, so appropriate knowledge and skills are needed. Previous research has suggested there may be gaps in training opportunities. Aims To develop and evaluate a Master Class series presented by a hospice palliative care service to their local GPs and other health-care professionals. A secondary aim was to measure the lasting impacts of the educational intervention. Methods The study setting was the Canterbury region of Aotearoa New Zealand (NZ). GPs and other health-care professionals were surveyed using a research team-designed questionnaire rating self confidence in the nominated learning objectives before and after the Master Classes. The participants were also asked to self-rate the application of the knowledge to their practice 3 years after the Master Class sessions were attended. Results There were 56 sets of questionnaires completed. The participants tended to be experienced female GPs with a range of palliative care patients in their practice. There was significant improvement in most learning outcomes across the Master Classes series. The attendees reported the Master Classes were relevant and clear, with useful resources. The improvements in the learning outcomes were largely sustained over 3 years. Discussion The provision of palliative care education that aligns with clinical practice improves knowledge, skills and confidence in GPs who provide most of the end-of-life care in New Zealand.

СОСТОЯНИЕ И ТЕНДЕНЦИИ ЗАБОЛЕВАЕМОСТИ БОЛЕЗНЯМИ МОЧЕПОЛОВОЙ СИСТЕМЫ ВЗРОСЛОГО НАСЕЛЕНИЯ АРХАНГЕЛЬСКОЙ ОБЛАСТИ В 2010-2019 ГГ

Significance. A significant level of prevalence of diseases of the genitourinary system and a high level of incidence in working-age population are one of the leading factors determining high socio-economic significance of this pathology. However, analytical data on incidence of uronephrological disorders in population of the Russian northern regions are scarce. Purpose. To analyze incidence of diseases of the genitourinary system in adult population of the Arkhangelsk region in 2010-2019 in comparison with the Russian Federation (RF) and the Northwestern Federal District. Material and Methods. The level of prevalence and incidence of diseases of the genitourinary system in adult population of the Arkhangelsk region, Northwestern Federal District and the Russian Federation in 2010-2019 were analyzed on the basis of official statistics. Results. The study has identified increase in the prevalence of diseases of the genitourinary system in adult population of the Arkhangelsk region across almost all nosologies (except for glomerular and tubulointerstitial kidney diseases). At the same time, the incidence decreased (except for male infertility). The study shows that the average values ​​of prevalence and incidence across almost all categories of uronephrological disorders in the region are lower than in the country as a whole. The average total prevalence in the Northwestern Federal District is higher compared to the one in the Arkhangelsk region, while the incidence rates across most of the analyzed nosologies are comparable. Conclusion. Dynamics in incidence of the diseases of the genitourinary system demonstrates deterioration of their detection, defects in organization of primary and urological-neurological care delivery in the region. Changes in prevalence, especially against the background of the decreased incidence, suggests a significant "accumulation" of this pathology against the background of the demographic aging of the population.

Early Response of Primary Care Practices to COVID-19 Pandemic.

Introduction:The emergence of the COVID-19 pandemic and subsequent public health mitigation strategies resulted in rapid and significant changes to delivery of primary care. The field of primary care faced an unprecedented dual challenge of providing routine care to patients while ensuring patient and staff safety and managing patients with a highly transmissible disease. This study describes how a diverse group of primary care practices addressed these challenges at the start of the COVID-19 pandemic, in Spring 2020.Methods:A cross-sectional electronic survey of representatives from primary care practices in the WWAMI region Practice and Research Network (WPRN). Survey topics included clinical workforce, operations, and use of telemedicine in the first 3 months of the COVID-19 pandemic.Results:To safely manage patients with COVID-19 symptoms all clinics modified operations; 81.3% diverted patients with respiratory symptoms to a telemedicine evaluation, 68.8% diverted these patients to be seen in-person at another location, and 75% made in-clinic changes to maintain safety. The set of operational changes employed by clinics was diverse. To continue to provide routine patient care, all clinics employed telemedicine. Over 80% of clinics had never used telemedicine prior to March 2020.Conclusions:A diverse group of primary care clinics all rapidly implemented a variety of operational adaptations to address patient needs and maintain patient and staff safety at the onset of the COVID- 19 pandemic. Telemedicine, together with other measures, provided critical pathways for maintaining delivery of care.

'We are largely left out': workplace and psychosocial experiences of Australian general practitioners during the initial months of the COVID-19 pandemic.

The COVID-19 pandemic continues to exert a significant toll on the Australian primary healthcare system. Although wellbeing challenges faced by hospital-based healthcare workers are widely discussed, less is known about the experiences of general practitioners (GPs) during the initial phases of the pandemic. This paper reports qualitative survey data from Australian GPs, examining their workplace and psychosocial experiences during the initial months of the pandemic. An Australia-wide, cross-sectional, online survey of frontline healthcare workers was conducted in 2020. A qualitative approach using content analysis was utilised to examine responses to four free-text questions from GPs. A total of 299 GPs provided 888 free-text responses. The findings reveal that general practice was overlooked and undervalued within the pandemic response, resulting in negative impacts on GP wellbeing. Four themes were identified: (1) marginalisation of GPs; (2) uncertainty, undersupported and undervalued in the workplace; (3) isolation and disrupted personal lives; and (4) strategies to support GPs during times of crises. Key concerns included poor access to personal protective equipment, occupational burnout and poor wellbeing, insufficient workplace support, and conflicting or confusing medical guidelines. Primary healthcare constitutes an essential pillar of the Australian healthcare system. This study presents the many factors that impacted on GP wellbeing during the COVID-19 pandemic. Enabling GP voices to be heard and including GPs in decision-making in preparation for future crises will enhance the delivery of primary care, reducing the burden on hospital services, and help sustain a safe and effective health workforce long term.

ПОСТКОВИДНЫЙ СИНДРОМ: ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ И МЕДИЦИНСКАЯ АКТИВНОСТЬ ПАЦИЕНТОВ, ПЕРЕНЕСШИХ COVID-19

The COVID-19 pandemic has introduced massive and drastic changes into healthcare. A significant part of the population has suffered a new coronavirus infection of varying severity and they need attention and follow-up at the outpatient level. Assessment and monitoring over functional status of the COVID-19 survivors is one of the important objectives of organizing medical rehabilitation in primary health and developing preventive measures. The purpose of the study is to analyze changes in functional status and assess rehabilitation potential of the COVID-19 survivors. Material and methods used include questionnaire survey, analytical and statistical analysis. Results. Based on the questionnaire, assessment of functional status of the COVID-19 survivors was carried out using a special scale, presence and degree of functional limitations were determined. According to the survey, 65.5% of the COVID-19 survivors did not feel any limitations in everyday life. Minor functional limitations were reported by 26.5% of the respondents, while an equal number of the respondents, 4% each, noted mild and moderate limitations of body functions. The COVID-19 survivors indicated the following symptoms: easy fatiguability - 33.3%, fatigue - 26%, shortness of breath on exertion (unusual) - 15%, “smell disorder” - 13%, and headache and joint pain - 12.4%; however, 36.7% of the respondents did not report any symptoms. After the disease, 50.8% of the respondents returned to their usual state, while 35% of the respondents chose the answer “rather yes than no”. 14.2% did not return to their usual state, choosing the answer “rather not” (8.5%) and “no” (5.7%). Rehabilitation measures in the first three months after the disease were carried out by 49.2% of the respondents (327 patients). Conclusion. Functional status of the COVID-19 survivors is largely determined by the initial state of somatic health, peculiar features of the biological and psychophysiological characteristics of a person, and a complex of external factors that allow the person to realize potential abilities to compensate for the existing functional limitations. Compliance with rehabilitation measures requires active participation of medical specialists in terms of quality control and correctness of their implementation. The data obtained can be used to organize primary care delivery both at the stage of rehabilitation and development of rehabilitation programs, as well as for the purpose of timely prevention of post-COVID conditions.

Transforming Primary Care in New York Through Patient-Centered Medical Homes: Findings From Qualitative Research.

Background:The patient-centered medical home (PCMH) model, an important component of healthcare transformation in the United States, is an approach to primary care delivery with the goal of improving population health and the patient care experience while reducing costs. PCMH research most often focuses on system level indicators including healthcare use and cost; descriptions of patient and provider experience with PCMH are relatively sparse and commonly limited in scope. This study, part of a mixed-methods evaluation of a multi-year New York State initiative to refine and expand the PCMH model, describes patient and provider experience with New York State PCMH and its key components.Methods:The qualitative component of the evaluation included focus groups with patients of PCMH practices in 5 New York State counties (n = 9 groups and 67 participants) and interviews with providers and practice administrators at New York State PCMH practices (n = 9 interviews with 10 participants). Through these focus groups and interviews, we elicited first-person descriptions of experiences with, as well as perspectives on, key components of the New York State PCMH model, including accessibility, expanded use of electronic health records, integration of behavioral health care, and care coordination.Results:There was evident progress and some satisfaction with the PCMH model, particularly regarding integrated behavioral health and, to some extent, expanded use of electronic health records. There was less evident progress with respect to improved access and reasonable wait times, which caused patients to continue to use urgent care or the emergency department as substitutes for primary care.Conclusions:It is critical to understand the strengths and limitations of the PCMH model, so as to continue to improve upon and promote it. Strengths of the model were evident to participants in this study; however, challenges were also described. It is important to note that these challenges are difficult to separate from wider healthcare system issues, including inadequate incentives for value-based care, and carry implications for PCMH and other models of healthcare delivery.