Patient engagement and barriers to health care in the patient-centered medical home

Background: In the United States, there has been a call to transform the model by which primary medical care is provided. The current approach is unsustainable: it is too unreliable, too expensive and health care providers are becoming burned out. Specifically, there is a call for a “transition in medicine from a reactive, acutely focused system of sick care to a proactive, life-focused system of health care.” (Hesse et al., 2012) Given this need, programs have been developed to transition current general and family medicine practices to the Patient Centered Medical Home (PCMH) model. Methods: The goal of the current study was to develop and implement a patient survey that: 1. Identifies the services that patients utilize or are interested in utilizing in the developing PCMH setting; and 2. Aids practices in identifying pitfalls in their transformations PCMHs. The instrument was developed using the literature, reviewed with practice teams, and pilot tested with patients. During a one week period medical students administered the survey in waiting rooms and made phone calls to patients on high risk registries. Results: A total of 266 patients completed the survey in four clinical sites, including one rural health center, a community health center, and two hospital-run health centers. Respondents generally had long relationships with the practices and 69% had a chronic health condition. The largest barrier to health care use was transportation (29%); a quarter of patients also reported issues with understanding or reading medical terms. While a large majority (81%) reported wanting to learn more to manage their health, only 55% felt their own efforts played the most important role. The majority (83%) reported that it would be useful or very useful to talk with other patients with the same health conditions, but older patients and those with poorer health status reported less willingness to attend a group visit. Just over half (58.5%) reported they had a ‘health care team', although 97% said that having a team would improve their health. Nevertheless, most patients reported only interacting with the primary care provider and not other potential health care team members such as nurses, case managers, or behavioral health specialists. Conclusions: The findings suggest that practices transforming to PMCH models need to improve communication with patients about the team approach to health care, and the role of care management and group visits to better manage chronic conditions.