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Transformation to a Patient Centred Medical Home in an Urban Aboriginal Community Controlled Health Service: A

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This study explored implementing the Patient-Centred Medical Home (PCMH) model in an urban Aboriginal Community Controlled Health Service (ACCHS). Existing practice norms facilitated PCMH adoption, while resource and role definition issues hindered it.

Keywords:
Aboriginal and Torres Strait IslanderAustraliacare teammedical homepatient careprimary healthcarequalitative research

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Area of Science:

  • Primary Health Care
  • Indigenous Health
  • Health Service Delivery

Background:

  • The Patient-Centred Medical Home (PCMH) is a team-based, patient-centred, coordinated, accessible, quality, and safety-focused care model.
  • This study investigates the implementation of an adapted PCMH model within an urban Aboriginal Community Controlled Health Service (ACCHS) in Australia.
  • Normalisation Process Theory (NPT) was utilized to understand the facilitators and barriers to PCMH implementation and the associated workload.

Purpose of the Study:

  • To examine the enablers and barriers to implementing a PCMH within an ACCHS setting.
  • To identify practical strategies for strengthening the implementation and ongoing delivery of the PCMH model.

Main Methods:

  • Semi-structured interviews were conducted with 19 health staff members at an urban ACCHS.
  • Thematic analysis was employed to analyze interview data, mapping codes against NPT constructs (Coherence, Cognitive Participation, Collective Action, Reflexive Appraisal).

Main Results:

  • Five key themes and 14 sub-themes related to NPT constructs were identified.
  • Health staff perceived the PCMH model as coherent and actively engaged in adapting roles and embedding new practices.
  • Existing clinic characteristics and practice norms aligned with the PCMH model, serving as key enablers; however, inadequate resourcing and poorly defined roles presented barriers.

Conclusions:

  • The study identified that the inherent characteristics and practice norms of Indigenous community-controlled healthcare settings are significant enablers for PCMH implementation.
  • Suboptimal resourcing and workforce development were identified as critical barriers that require resolution to enhance PCMH implementation and delivery in ACCHS settings.