RT Journal Article
SR Electronic
T1 Canadian HIV Care Settings as Patient-Centered Medical Homes (PCMHs)
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 158
OP 167
DO 10.3122/jabfm.2019.02.180231
VO 32
IS 2
A1 Claire E. Kendall
A1 Esther S. Shoemaker
A1 Janessa E. Porter
A1 Lisa M. Boucher
A1 Lois Crowe
A1 Ron Rosenes
A1 Christine Bibeau
A1 Philip Lundrigan
A1 Marissa L. Becker
A1 Shabnam Asghari
A1 Sean B. Rourke
A1 Clare Liddy
YR 2019
UL http://www.jabfm.org/content/32/2/158.abstract
AB Purpose: For people living with HIV (PLWH) using continuous antiretroviral therapy, HIV is now a complex chronic condition often managed in primary care settings. The patient-centered medical home (PCMH) is a model to deliver comprehensive, coordinated, and integrated primary care that promotes collaboration between primary and specialist care and allied services. The study assessed how both Canadian primary and specialist HIV care settings align with the PCMH.Methods: Mixed-methods surveys and interviews with providers in Canadian HIV care settings.Results: Twenty-two settings completed the survey, 12 of which participated in follow-up interviews. Settings had a mean PCMH score of 8.06/12 (SD = 1.53), indicating the basic elements of each PCMH domain have been implemented. We found no significant differences between HIV primary care and specialist care settings. Continuous team-based healing relationships had the highest score (mean = 9.2; SD = 2.15), and quality improvement strategy had the lowest score (mean = 7.19; SD = 2.26). The themes that arose from the interviews were 1) endorsement of the domains of the PCMH by all settings, 2) organizational structures of settings located in hospitals facilitating the implementation of the PCMH through existing technology, patient advisory boards, and accessible services, and 3) dissonance between complex care needs and existing organizational structures in some settings, including limited clinic hours, lack of electronic medical records, and limited mental health services.Conclusions: HIV care in Canada is reasonably well aligned with the PCMH, irrespective of structure of settings. We propose the need for improvements in the use of electronic medical records, quality improvement strategies, and integration of mental health services to achieve better care delivery and health outcomes among PLWH in Canada.