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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...

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Autores principales: Surendran, Shilpa, Foo, Chuan De, Tam, Chen Hee, Ho, Elaine Qiao Ying, Matchar, David Bruce, Car, Josip, Koh, Gerald Choon Huat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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