September 11, 2013

The Medical Home: better health for a lower cost

The Patient-Centred Medical Home (PCMH) could improve overall population health and lower the cost of healthcare. Dr Eleanor Chew, Vice President of the Royal Australian College of General Practitioners, explains the benefits of a voluntary system where one GP co-ordinates patient care.

In Australia, patients can visit any general practitioner (GP) they choose. It’s an important freedom but it can also open the door to fragmented and uncoordinated care.

“If a patient is seeing one GP close to where they work, one close to home and another for out-of-hours consultations, it’s unlikely that they’ll all have a complete medical history,” says Dr Eleanor Chew, Vice President of the Royal Australian College of General Practitioners (RACGP).  “One doctor may not know about something that would influence the diagnosis. A patient could end up having the same tests more than once. And one doctor will often have to waste time tracking down X-rays or the results of pathology tests ordered by another.”

While the RACGP is committed to retaining freedom of choice, it does support a voluntary system which puts the patient at the centre of co-ordinated, integrated, whole-person care based on an ongoing therapeutic relationship with a personal GP. “This is what we refer to as a Patient-Centred Medical Home (PCMH),” says Dr Chew.

A simple system

There’s nothing new or complicated about the concept of PCMH. In its most basic form, it’s as simple as a patient seeing one GP on a regular basis. However, there’s evidence that encouraging and formalising this relationship can improve overall population health as it lowers healthcare spending.

A number of US studies have shown a very significant reduction in avoidable hospital admissions, length of stay in hospital and use of the emergency department following the adoption of the PCMH model. And the two areas where the benefits are most apparent are those that are likely to put most pressure on Australia’s health system in the future: aged care and the management of chronic disease.

“Voluntary enrolment would involve a simple agreement between GPs and patients,” says Dr Chew. “Patients would find a GP they felt comfortable with and confirm that they’d like him or her to coordinate their care. As well as putting a value on the relationship, this process would encourage patients to think about the role a GP can play in helping them to stay well.”

In rural and remote areas, a PCMH would be supported by telehealth, which is already enabling more consistent management of chronic disease in some areas. And, with a large medical centre, the concept could be extended to refer to a general practice rather than a general practitioner although patients would still have a nominated GP within that practice.

Dr Chew herself is an example of how this can work. “I’m a part-time GP in a large practice and my patients know I’m not there all the time,” she says. “When those with a chronic disease such as diabetes come in for regular, scheduled follow-ups they don’t see anyone else. If they have a more urgent problem and do need to see another doctor within the practice, they know I’ll read about that in their notes and refer to it next time I see them, so there’s still continuity of care.”

Easy to implement

While most GPs within Australia are already operating to some extent within the PCMH model, this has yet to be formalised.  The RACGP has proposed a staged approach to implementation, starting with voluntary patient registration and the management and coordination of chronic disease.

“The college has also recommended that GPs receive a $165 per year patient rebate for each voluntary registration to cover the costs of the clinical and administrative work required for patient recall and follow-up,” says Dr Chew. “Compared with many public health initiatives, the PCMH would be easy to implement as most of the elements are already in place.”

How can PCMH benefit Australian GPs?

The PCMH model:

  • gives primary care providers a more complete view of the patient;
  • strengthens the role of general practitioners in the health system;
  • delivers better outcomes for patients by encouraging coordinated and integrated care across the continuum of the health system.

Find out more about America’s PCMH model

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