A systematic review of the challenges to implementation of the patient‐centred medical home: lessons for Australia

Abstract

Objective: To review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms.Study design: Systematic review of peer-reviewed literature.Data sources: PubMed and Embase databases were searched in December 2012 for studies published in English between January 2007 and December 2012.Study selection: Studies of any type were included if they defi ned PCMH using the Patient-Centered Primary Care Collaborative Joint Principles, and reported data on challenges and barriers to implementation and adoption of the PCMH model. Data extraction:One researcher with content knowledge in the area abstracted data relating to the review objective and study design from eligible articles. A second researcher reviewed the abstracted data alongside the original article to check for accuracy and completeness.Data synthesis: Thematic synthesis was used to in three stages: free line-by-line coding of data; organisation of "free codes" into related areas to construct "descriptive" themes and develop "analytical" themes. The main barriers identifi ed related to: challenges with the transformation process; diffi culties associated with change management; challenges in implementing and using an electronic health record that administers principles of PCMH; challenges with funding and appropriate payment models; insuffi cient resources and infrastructure within practices; and inadequate measures of performance.Conclusion: This systematic review documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable evidence for Australian clinicians, policymakers, and organisations approaching adoption of PCMH elements within reform initiatives in this country.A systematic review of the challenges to implementation of the patient-centred medical home: lessons for AustraliaOnline fi rst 21/07/14 A ustralia's fi rst National Primary Health Care Strategy 1 and resulting National Primary Health Care Strategic Framework 2 initiated growing interest and development in our primary care sector, particularly general practice. Clinicians, governments and organisations are now actively searching for new approaches, models of care and business levers to support the primary care quality, effi ciency and access gains sought. In December 2012, then Minister for Health Tanya Plibersek announced a focus on the patient-centred medical home (PCMH) as a model of interest. 3 The Royal Australian College of General Practitioners (RACGP) has also been a consistent champion of the model, urging adoption of its elements as part of current reforms and calling for the federal government to fund and implement key elements in its 2013-14 Budget submission. 4 The PCMH concept of care was introduced by the American Academy of Pediatrics in 1967, and was adopted in 2002 by the family medicine specialty. Four major primary care physician associations in the United ...

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