Perceptions of High-Risk Patients and Their Providers on the Patient-Centered Medical Home

Abstract

To explore perceptions of high-risk patients and their practice staff on the patient-centered medical home, we conducted a multisite qualitative study with chronically ill, low-income patients and their primary care practice staff (N = 51). There were 3 key findings. Both patients and staff described a trade-off: timely care from an unfamiliar provider versus delayed access to their personal physician. Staff were enthusiastic about enhancing access through strategies such as online communication, yet high-risk patients viewed these as access barriers. Practices lacked capacity to manage high-risk patients and therefore frequently referred them to the emergency room.

Inappropriate ED visits: patient responsibility or an attribution bias?

“…This lopsided revenue has incentivised healthcare systems to funnel patients into hospitals instead of preventing illness in community or practice-based settings. Primary care practices and community-based services such as home care have fewer resources to manage the growing complexity of ageing, chronically ill and comorbid populations 8. High-quality primary care is even more elusive for patients with socioeconomic risk 9.…”

“…However, with some exceptions, the expanded time availabilities have not been matched by expanded clinical infrastructure (ie, on-site laboratory testing and imaging). So, patients often sense that even when they get timely appointments, practices are ill equipped to help them 8. Ultimately, efforts to grow the clinical capacity of practices may have constraints.…”

Moving Toward Implementation of Person‐Centered Care for Older Adults in Community‐Based Medical and Social Service Settings: “You Only Get Things Done When Working in Concert with Clients”

“…Although several important efforts have been made to capture the patient Perspective in outpatient person‐centered primary care, the organizational and provider perspective is needed to better understand the feasibility, challenges, and effect of providing PCC in community‐based healthcare and social services settings. This pertinent information can also inform development of a single, agreed‐on definition of PCC for older adults with chronic illness and functional limitations.…”

Exploring the Patient and Staff Experience With the Process of Primary Care

“…9 Patient experience surveys, however, have been used primarily with Medicare and privately insured populations, leaving the voices of patients in the lowest socioeconomic status underrepresented. 10 Qualitative studies suggest that vulnerable patients place a high value on access to care, care coordination, and continuity, 11,12 but may perceive primary care to be less accessible and of lower technical quality than hospital care. 6 Patient experience is rarely compared with clinician experience, despite the fact that job satisfaction of both primary care clinicians and support staff has been correlated with patient satisfaction.…”