Patient Centred Medical Home (PCMH) transitions in western Sydney, Australia: a qualitative study

Abstract

Background Patient Centred Medical Homes (PCMHs), increasingly evidenced to provide high quality primary care, are new to Australia. To learn how this promising new healthcare model works in an Australian setting we explored experiences of healthcare providers in outer urban Sydney, where a number of practices are transitioning from traditional Australian general practice models to incorporate elements of PCMH approaches. Methods We collected qualitative data from semi-structured interviews with healthcare providers working in a range of transitioning practices and thematically analysed the data. We interviewed 35 participants including general practitioners, practice managers and practice nurses from 25 purposively sampled general practices in western Sydney, Australia, seeking maximal variation in practice size, patient demographics and type of engagement in practice transformation. Results Interviewees described PCMH transformation highlighting the importance of whole of practice engagement with a shared vision; key strategies for transformation to PCMH models of care including leadership, training and supportive information technology; structures and processes required to provide team-based, data-driven care; and constraints such as lack of space and the current Australian fee-for-service general practice funding model. They also reported their perceptions of early outcomes of the PCMH model of care, describing enhanced patient and staff satisfaction and also noting fewer hospital admissions, as likely to reduce costs of care. Conclusions Our study exploring the experience of early adopters of PCMH models of care in Australia, informs the international movement towards PCMH models of care. Our findings provide guidance for practices considering similar transitions and describe the challenges of such transitions within a fee-for-service payment system.

The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context

“…On the other hand, in Australia, misalignment of funding with PCMH goals discourages GP practices from transforming to PCMH [17]. In simple words, no matter how attractive PCMH might appear as a model of care, GP practices will not transform to it if they must sacrifice their livelihood [16,17]. However, according to our study findings, some FMC GPs felt that funding possibly weakened GPs intrinsic motivation to make FMC's operation more efficient.…”

“…Only a handful of studies have explored the broader contextual policy factors affecting PCMHs' implementation [12][13][14][15][16][17]. For example, studies [12,[14][15][16][17] reported misalignment of practice payment models with PCMH strategies and lack of funding as factors impeding practices to transform to PCMHs. Additionally, studies [16,17] identified workforce policy issues and the need for developing shared vision as factors hindering and facilitating PCMH transformation, respectively.…”

“…For example, studies [12,[14][15][16][17] reported misalignment of practice payment models with PCMH strategies and lack of funding as factors impeding practices to transform to PCMHs. Additionally, studies [16,17] identified workforce policy issues and the need for developing shared vision as factors hindering and facilitating PCMH transformation, respectively. To add to this limited evidence base, this study's objective is to identify the contextual healthcare policy factors that influence the implementation of FMCs on a larger scale in Singapore.…”

“…Secondly, internationally, countries are moving towards implementing PCMH or PCMH-like initiatives to strengthen their primary care. Therefore, demonstrating the intricacies of implementing a PCMH in different environments will be beneficial for those working on such models of healthcare delivery in other countries [17].…”

“…Funding was provided to FMCs to shield GPs from any financial catastrophe during the partnership years and provide an avenue for GPs who have either sold their practice to continue general practice or those without tangible assets to pursue general practice. On the other hand, in Australia, misalignment of funding with PCMH goals discourages GP practices from transforming to PCMH [17]. In simple words, no matter how attractive PCMH might appear as a model of care, GP practices will not transform to it if they must sacrifice their livelihood [16,17].…”