Daniel Skinner1, Berkeley Franz, Jenna Howard, Kelly Kelleher, Benjamin F Crabtree. 1. assistant professor of health policy, Heritage College of Osteopathic Medicine, Ohio University, Dublin, Ohio assistant professor of community-based health, Heritage College of Osteopathic Medicine, Athens, Ohio research associate II, Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey director, Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio professor, Department of Family Medicine and Community Health, Robert Wood Johnson Medical School.
Abstract
EXECUTIVE SUMMARY: The purpose of this study is to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. Data were obtained from the 2015 Working Conference for PCMH (Patient-Centered Medical Home) Innovation funded by the Agency for Healthcare Research and Quality. The conference convened representatives from 10 innovative primary care practices and content experts to discuss experiences with integrating care for two nontraditional populations: patients with substance abuse issues and cancer survivors. Transcripts of the conference, one-on-one interviews, and written summaries of practice innovations were coded in NVivo (QSR International) and analyzed by means of an immersion/crystallization approach to identifying thematic patterns. Our study findings suggest that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust. Though support is increasing for primary care expansion and care integration, policy change may precede the identity transformations necessary for medical practitioners to embrace new primary care-centered models. For this reason, it is important that the formation and entrenchment of professional identities be critically considered as part of future efforts to transform primary care practice.
EXECUTIVE SUMMARY: The purpose of this study is to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. Data were obtained from the 2015 Working Conference for PCMH (Patient-Centered Medical Home) Innovation funded by the Agency for Healthcare Research and Quality. The conference convened representatives from 10 innovative primary care practices and content experts to discuss experiences with integrating care for two nontraditional populations: patients with substance abuse issues and cancer survivors. Transcripts of the conference, one-on-one interviews, and written summaries of practice innovations were coded in NVivo (QSR International) and analyzed by means of an immersion/crystallization approach to identifying thematic patterns. Our study findings suggest that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust. Though support is increasing for primary care expansion and care integration, policy change may precede the identity transformations necessary for medical practitioners to embrace new primary care-centered models. For this reason, it is important that the formation and entrenchment of professional identities be critically considered as part of future efforts to transform primary care practice.
Authors: Madeleine Love; Marc Debay; Anne Charity Hudley; Todd Sorsby; Linda Lucero; Stuart Miller; Sagus Sampath; Arya Amini; Dan Raz; Jae Kim; Ranjan Pathak; Yi-Jen Chen; Andreas Kaiser; Kurt Melstrom; Marwan Fakih; Virginia Sun Journal: J Prim Care Community Health Date: 2022 Jan-Dec