Abstract and Introduction
Abstract
Purpose: Many primary care practices are currently attempting to transform into patient-centered medical homes (PCMHs), but little is known about how patients view aspects of the PCMH or how they define patient-centeredness.
Methods: We conducted 3 focus groups with patients from urban academic internal medicine practices. We asked questions about patients' perceptions of what patient-centered care should be; care quality, teams and access; diabetes self-management; and community connections and services. We used a grounded theory approach to the analysis.
Results: The global themes that arose in our focus groups included the desire for timely, clear, and courteous communication; a practice that is structured to facilitate an ongoing relationship with a provider who knows the patient; and a relationship that allows the patient both to trust the provider's guidance and to engage more fully in his or her own care.
Conclusions: Our patients want a provider to know them personally and to take time to listen to their issues. They feel that they cannot access their providers in a timely fashion, find our automated phone systems frustrating, and want more time with their provider. Although the technological and structural implementation of the PCMH requires considerable effort and resources, we cannot neglect the relationships we have with our patients. Patients should be involved in this process of change to ensure we address their concerns and preserve the primary care relationships they value.
Introduction
The patient-centered medical home (PCMH) seeks to address some of the widely recognized shortcomings of primary care delivery by facilitating partnerships among the patient, physician, and health care team. Patient-centered care is a core principle of this model. Although specific definitions of patient-centered care have varied, they typically are based on the belief that patients and their families desire increased involvement in and enhanced access to care as well as improved communication with their provider.
Efforts to transform primary care practices into a PCMH have largely focused on funding and infrastructure, with less attention paid to the impact of these changes on patient-centered care. The Picker Institute has delineated 8 dimensions of patient-centered care, which include respect for patient values and preferences, information and education, access, continuity, physical comfort, care coordination, emotional support, and involvement of family. Although several measures of patient-centeredness exist, they lack concurrent validity, suggesting that they do not all measure the same domain of care. Studies have identified attributes of practices that correlate with patient satisfaction, such as continuity of and ease of access to care, effective communication with the provider, office efficiency, and personal manner of provider and staff; some of these overlap with patient-centered care dimensions, but this information has not been evaluated in the context of providing patient-centered care, nor has it been used to guide implementation of the PCMH. Indeed, early evaluations of the PCMH show a decline in patient satisfaction with implementation of the model. Medical home proponents increasingly recognize that patients should be more involved in this transformative process.
At the time of this study, our practices were at the beginning of the PCMH transformation. Our objective was to obtain patient input regarding their understanding of both patient-centered care and specific components of the PCMH to aid in its implementation as part of a multipractice quality improvement effort involving 3 academic ambulatory practices.