General Practice Academic Unit, School of Medicine, University of Wollongong, Wollongong, Australia.
The Royal Australian College of General Practitioners, East Melbourne, Australia.
BMC Fam Pract. 2021 Jun 21;22(1):120. doi: 10.1186/s12875-021-01485-x.
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 (PHN).
Qualitative and quantitative data were collected over a twelve month period, including semi-structured 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 (24 pre and 25 post) 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.
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.
Our study examined the experiences of implementing PCMH initiatives in an 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.
随着澳大利亚人口老龄化和慢性病负担的增加，以患者为中心的医疗之家 (PCMH) 护理模式已被确定为改善初级保健和改善医疗保健结果的潜在选择。除北美以外，PCMH 模式的采用情况描述得并不多。我们研究了澳大利亚 7 家普通实践中实施与 PCMH 价值观和目标一致的项目的经验，这些项目得到了当地初级保健网络 (PHN) 的支持。
在为期 12 个月的时间里，收集了定性和定量数据，包括半结构化访谈、参与观察和实践数据，以详细检查研究主题；在 7 家普通实践中实施 PCMH 项目。我们对普通医生、诊所经理、诊所护士和 PHN 工作人员进行了 49 次访谈（24 次在实施前，25 次在实施后）。使用逻辑模型的领域进行框架分析，以综合和分析数据。
实施成功、可持续变革的促进因素包括：实践的能力和意愿来进行变革；整个实践参与具有向 PCMH 变革的共同愿景；有参与的领导；培训和支持；以及提供基于团队、数据驱动的护理所需的结构和流程。实施的障碍包括变革疲劳、持续参与领导的挑战和实施 PCMH 变革的时间不足。
我们的研究检查了在澳大利亚普通实践环境中实施 PCMH 计划的经验，描述了 PCMH 变革的促进因素和障碍。我们的研究结果为澳大利亚的 PHN 和实践以及有兴趣开展类似质量改进项目的国际普通实践提供了指导。
