Implementation of a patient centred medical home (PCMH) initiative in general practices in New South Wales, Australia
With an ageing population and an increase in chronic disease burden in Australia, Patient Centred Medical Home (PCMH) models of care have been identified as potential options for primary care reform and improving health care outcomes. Adoption of PCMH models are not well described outside of North America. We examined the experiences of seven general practices in an Australian setting that implemented projects aligned with PCMH values and goals supported by their local Primary Health Network
... N). Method Qualitative and quantitative data were collected over a twelve month period, including semistructured interviews, participant observation, and practice data to present a detailed examination of a subject of study; the implementation of PCMH projects in seven general practices. We conducted 49 interviews with general practitioners, practice managers, practice nurses and PHN staff. Framework analysis deploying the domains of a logic model was used to synthesis and analyse the data. Findings Facilitators in implementing successful, sustainable change included the capacity and willingness of practices to undertake change; whole of practice engagement with a shared vision towards PCMH change; engaged leadership; training and support; and structures and processes required to provide team-based, data driven care. Barriers to implementation included change fatigue, challenges of continued engaged leadership and insufficient time to implement PCMH change. Conclusion Our study examined the experiences of implementing PCMH initiatives in Australian general practice setting, describing facilitators and barriers to PCMH change. Our findings provide guidance for PHNs and practices within Australia, as well as general practice settings internationally, that are interested in undertaking similar quality improvement projects. illness is well recognised (1-3) . This is reflected in general practice in the caseloads of practitioners where currently over 40% of all consultations address chronic illness (4, 5). There is a pressing need therefore for high-performing primary care that focuses on preventive health and the management of chronic disease (6). Understandably, there is significant health policy interest in structural reform to enable the health system to best meet the needs of an ageing population and increasing prevalence of chronic disease (7). Expanding the medical workforce and enhancing the roles of nursing staff and other health care professionals in a patient centred, team-based care environment are some elements of practice reorganisation that have been recommended to help meet these needs in an Australian setting (8, 9) . Patient-Centred Medical Home (PCMH) models of care have been active and evolving in the United States for over a decade (10). The PCMH concept is based on restructuring patient care; enhancing patient experience of care, improving efficiency and use of information technology, thereby improving health outcomes and ultimately, reducing emergency room visits, hospital admissions and overall health care costs (11-13). The PCMH model has been described more recently, in relation to ten "building blocks" that characterise high-performing primary care, with foundational elements of engaged leadership, data-driven improvement, empanelment (linking patients to a care team), and team-based care (14) . PCMH models are also aligned to the Quadruple Aim (15); enhancing patient and provider experience, improving the health of the population and reducing health related costs.