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The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context
In recent years, there is growing interest internationally to implement patient-centered medical homes (PCMHs), and Singapore is no exception. However, studies understanding the influence of contextual policy factors on the implementation of PCMHs are limited. We conducted 10 semi-structured in-dept...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917999/ https://www.ncbi.nlm.nih.gov/pubmed/33668610 http://dx.doi.org/10.3390/ijerph18041817 |
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author | Surendran, Shilpa Foo, Chuan De Tam, Chen Hee Ho, Elaine Qiao Ying Matchar, David Bruce Car, Josip Koh, Gerald Choon Huat |
author_facet | Surendran, Shilpa Foo, Chuan De Tam, Chen Hee Ho, Elaine Qiao Ying Matchar, David Bruce Car, Josip Koh, Gerald Choon Huat |
author_sort | Surendran, Shilpa |
collection | PubMed |
description | In recent years, there is growing interest internationally to implement patient-centered medical homes (PCMHs), and Singapore is no exception. However, studies understanding the influence of contextual policy factors on the implementation of PCMHs are limited. We conducted 10 semi-structured in-depth interviews with general practitioners working in seven out of the nine PCMHs. Audio recordings were transcribed and analyzed by two study team members in NVivo 12 Software using grounded theory techniques. Power dynamics between the stakeholders and lack of shared decision-making among them in selecting the locale of the PCMH and formulating the practice fee and pharmacy structure were the key factors which negatively affected the implementation of PCMHs on a larger scale. Over time, lack of funding to hire dedicated staff to transfer patients and misalignment of various stakeholders’ interest to other right-siting programs also resulted in low number of patients with chronic conditions and revenue. Countries seeking to implement a successful PCMH may benefit from building trust and relationship between stakeholders, engaging in shared decision-making, ongoing cost-efficiency efforts, and formulating a clear delineation of responsibilities between stakeholders. For a healthcare delivery model to succeed in the primary care landscape, policies should be developed keeping mind the realities of primary care practice. |
format | Online Article Text |
id | pubmed-7917999 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-79179992021-03-02 The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context Surendran, Shilpa Foo, Chuan De Tam, Chen Hee Ho, Elaine Qiao Ying Matchar, David Bruce Car, Josip Koh, Gerald Choon Huat Int J Environ Res Public Health Article In recent years, there is growing interest internationally to implement patient-centered medical homes (PCMHs), and Singapore is no exception. However, studies understanding the influence of contextual policy factors on the implementation of PCMHs are limited. We conducted 10 semi-structured in-depth interviews with general practitioners working in seven out of the nine PCMHs. Audio recordings were transcribed and analyzed by two study team members in NVivo 12 Software using grounded theory techniques. Power dynamics between the stakeholders and lack of shared decision-making among them in selecting the locale of the PCMH and formulating the practice fee and pharmacy structure were the key factors which negatively affected the implementation of PCMHs on a larger scale. Over time, lack of funding to hire dedicated staff to transfer patients and misalignment of various stakeholders’ interest to other right-siting programs also resulted in low number of patients with chronic conditions and revenue. Countries seeking to implement a successful PCMH may benefit from building trust and relationship between stakeholders, engaging in shared decision-making, ongoing cost-efficiency efforts, and formulating a clear delineation of responsibilities between stakeholders. For a healthcare delivery model to succeed in the primary care landscape, policies should be developed keeping mind the realities of primary care practice. MDPI 2021-02-13 2021-02 /pmc/articles/PMC7917999/ /pubmed/33668610 http://dx.doi.org/10.3390/ijerph18041817 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Surendran, Shilpa Foo, Chuan De Tam, Chen Hee Ho, Elaine Qiao Ying Matchar, David Bruce Car, Josip Koh, Gerald Choon Huat The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context |
title | The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context |
title_full | The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context |
title_fullStr | The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context |
title_full_unstemmed | The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context |
title_short | The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context |
title_sort | missed opportunity of patient-centered medical homes to thrive in an asian context |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917999/ https://www.ncbi.nlm.nih.gov/pubmed/33668610 http://dx.doi.org/10.3390/ijerph18041817 |
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