Primary Care Practice Development: A Relationship-Centered Approach

Currently, the College of Family Physicians of Canada (CFPC) is preparing a position paper on the patient-centred primary care medical home; a follow-up on our medical home discussion paper released in 2009.

The Annals of Family Medicine's supplement on the National Demonstration Project (NDP) on the patient-centred medical home (PCMH) is a welcome contribution to the body of international literature the CFPC has been examining as we further develop a model appropriate for the Canadian health care system.

We read with particular interest "Primary Care Practice Development: A Relationship Centered Approach" (Miller et al) as the concept of patient or relationship-centredness is at the core of our medical home vision. Quoting Canadian family physician and father of family medicine, Dr. Ian McWhinney (1989), our medical home model is based on "enter[ing] the patient's world, to see the illness through the patient's eyes…"

In addition to being patient-centred, our vision of the medical home sees the family physician as the foundation. In the Miller et al paper, we appreciated the mention of boundary-setting to help clarify the direction of the medical home. Casalino (2010) offers a comprehensive examination of how a family physician's time could be better used in the context of new models of primary care practice and quite rightly notes that quality is not only measured during patient visits but also between visits. These ideas are well worth including in our concept of the medical home.

Finally, some provinces in Canada have embarked on medical home pilot projects. According to Glazier and Redelmeier (2010), from 2002 to 2010, about 75% of Ontarians and 10,000 primary care physicians joined medical home models with "patient rostering, after-hours coverage, incentives for preventive health care, and payments for chronic disease management" (p. 2186). Unfortunately, evaluation of these models has not only started too late, we may not be privy to results since evaluations are to be made public if "terms and conditions which the Minister, in his sole direction, considered appropriate" (Glazier and Redelmeier, 2010, p. 2187).

We are pleased that the NDP has provided us with such a tremendous amount of evidence based on evaluation. Our hope is that medical homes across Canada will do the same.

References:

Casalino, L.P. (2010). A Martian's prescription for primary care: Overhaul the physician's workday. Health Affairs, 29(5), 785-790.

Glazier, R.H., & Redelmeier, D.A. (2010). Building the patient-centered medical home in Ontario. JAMA, 303(21), 2186-2187.

McWhinney, I. (1989). The need for a transformed clinical method. In M. Stewart & D. Roter (Eds), Communicating with medical patients. London: Sage.

Competing interests:   None declared