Transforming Primary Care: Scoping Review of Research and Practice

Overview

Journal J Integr Care (Brighton)

Publisher Emerald Group Publishing

Date 2018 Sep 1

PMID 30166943

Citations 16

Authors

Robin Miller

Catherine Weir

Steve Gulati

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this paper is to reflect on research evidence and practice experience of transforming primary care to a more integrated and holistic model.

Design/methodology/approach: It is based on a scoping review which has been guided by primary care stakeholders and synthesises research evidence and practice experience from ten international case studies.

Findings: Adopting an inter-professional, community-orientated and population-based primary care model requires a fundamental transformation of thinking about professional roles, relationships and responsibilities. Team-based approaches can replicate existing power dynamics unless medical clinicians are willing to embrace less authoritarian leadership styles. Engagement of patients and communities is often limited due to a lack of capacity and belief that will make an impact. Internal (relationships, cultures, experience of improvement) and external (incentives, policy intentions, community pressure) contexts can encourage or derail transformation efforts.

Practical Implications: Transformation requires a co-ordinated programme that incorporates the following elements - external facilitation of change; developing clinical and non-clinical leaders; learning through training and reflection; engaging community and professional stakeholders; transitional funding; and formative and summative evaluation.

Originality/value: This paper combines research evidence and international practice experience to guide future programmes to transform primary care.

Citing Articles

Achieving Chronic Care Equity by Leveraging the Telehealth Ecosystem (ACCTIVATE): A Multilevel Randomized Controlled Trial Protocol.

Omomukuyo A, Ramirez A, Davis A, Velasquez A, Najmabadi A, Kong M Med Res Arch. 2024; 12(11).

PMID: 39679006 PMC: 11646453. DOI: 10.18103/mra.v12i11.6087.

The Community Primary Care Champions Fellowship: a mixed methods evaluation of an interprofessional fellowship for physician assistants and physicians.

Stryker S, Hargraves D, Velasquez V, Gottschlich M, Cafferty P, Vale D BMC Med Educ. 2024; 24(1):556.

PMID: 38773571 PMC: 11110310. DOI: 10.1186/s12909-024-05559-z.

Barriers and enablers of integrated care in the UK: a rapid evidence review of review articles and grey literature 2018-2022.

Thomson L, Chatterjee H Front Public Health. 2024; 11:1286479.

PMID: 38239795 PMC: 10794528. DOI: 10.3389/fpubh.2023.1286479.

Understanding primary care transformation and implications for ageing populations and health inequalities: a systematic scoping review of new models of primary health care in OECD countries and China.

Henderson D, Donaghy E, Dozier M, Guthrie B, Huang H, Pickersgill M BMC Med. 2023; 21(1):319.

PMID: 37620865 PMC: 10463288. DOI: 10.1186/s12916-023-03033-z.

Ten years later: A portrait of the implementation of the advanced access model in Quebec.

Breton M, Gaboury I, Beaulieu C, Deville-Stoetzel N, Martin E Healthc Manage Forum. 2023; 36(5):317-321.

PMID: 37326497 PMC: 10446410. DOI: 10.1177/08404704231181676.

References

Crabtree B, Nutting P, Miller W, McDaniel R, Stange K, Jaen C . Primary care practice transformation is hard work: insights from a 15-year developmental program of research. Med Care. 2010; 49 Suppl:S28-35. PMC: 3043156. DOI: 10.1097/MLR.0b013e3181cad65c. View

Berwick D, Nolan T, Whittington J . The triple aim: care, health, and cost. Health Aff (Millwood). 2008; 27(3):759-69. DOI: 10.1377/hlthaff.27.3.759. View

Hung D, Gray C, Martinez M, Schmittdiel J, Harrison M . Acceptance of lean redesigns in primary care: A contextual analysis. Health Care Manage Rev. 2016; 42(3):203-212. DOI: 10.1097/HMR.0000000000000106. View

Best A, Greenhalgh T, Lewis S, Saul J, Carroll S, Bitz J . Large-system transformation in health care: a realist review. Milbank Q. 2012; 90(3):421-56. PMC: 3479379. DOI: 10.1111/j.1468-0009.2012.00670.x. View

Arar N, Noel P, Leykum L, Zeber J, Romero R, Parchman M . Implementing quality improvement in small, autonomous primary care practices: implications for the patient-centred medical home. Qual Prim Care. 2011; 19(5):289-300. PMC: 3313551. View

Irwin R, Stokes T, Marshall T . Practice-level quality improvement interventions in primary care: a review of systematic reviews. Prim Health Care Res Dev. 2015; 16(6):556-77. DOI: 10.1017/S1463423615000274. View

Gottlieb K . The Nuka System of Care: improving health through ownership and relationships. Int J Circumpolar Health. 2013; 72. PMC: 3752290. DOI: 10.3402/ijch.v72i0.21118. View

Hilts L, Howard M, Price D, Risdon C, Agarwal G, Childs A . Helping primary care teams emerge through a quality improvement program. Fam Pract. 2012; 30(2):204-11. DOI: 10.1093/fampra/cms056. View

Fontaine P, Whitebird R, Solberg L, Tillema J, Smithson A, Crabtree B . Minnesota's Early Experience with Medical Home Implementation: Viewpoints from the Front Lines. J Gen Intern Med. 2014; 30(7):899-906. PMC: 4471008. DOI: 10.1007/s11606-014-3136-y. View

10.

Schluter P, Hamilton G, Deely J, Ardagh M . Impact of integrated health system changes, accelerated due to an earthquake, on emergency department attendances and acute admissions: a Bayesian change-point analysis. BMJ Open. 2016; 6(5):e010709. PMC: 4874100. DOI: 10.1136/bmjopen-2015-010709. View

11.

Miller-Day M, Applequist J, Zabokrtsky K, Dalton A, Kellom K, Gabbay R . A tale of four practices. J Health Organ Manag. 2017; 31(6):630-646. DOI: 10.1108/JHOM-01-2017-0015. View

12.

Anderson S, Allen P, Peckham S, Goodwin N . Asking the right questions: scoping studies in the commissioning of research on the organisation and delivery of health services. Health Res Policy Syst. 2008; 6:7. PMC: 2500008. DOI: 10.1186/1478-4505-6-7. View

13.

Goldberg D . Primary care in the United States: practice-based innovations and factors that influence adoption. J Health Organ Manag. 2012; 26(1):81-97. DOI: 10.1108/14777261211211106. View

14.

Jackson C, Donald M, Russell A, McIntyre H . Establishing a new model of integrated primary and secondary care based around general practice: a case study of lessons learned and challenges. Aust Health Rev. 2017; 42(3):299-302. DOI: 10.1071/AH16147. View

15.

Nutting P, Miller W, Crabtree B, Jaen C, Stewart E, Stange K . Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home. Ann Fam Med. 2009; 7(3):254-60. PMC: 2682981. DOI: 10.1370/afm.1002. View

16.

Russell G, Miller W, Gunn J, Levesque J, Harris M, Hogg W . Contextual levers for team-based primary care: lessons from reform interventions in five jurisdictions in three countries. Fam Pract. 2017; 35(3):276-284. PMC: 5965082. DOI: 10.1093/fampra/cmx095. View

17.

Hudson Scholle S, Asche S, Morton S, Solberg L, Tirodkar M, Jaen C . Support and strategies for change among small patient-centered medical home practices. Ann Fam Med. 2013; 11 Suppl 1:S6-13. PMC: 3707241. DOI: 10.1370/afm.1487. View

18.

Donahue K, Halladay J, Wise A, Reiter K, Lee S, Ward K . Facilitators of transforming primary care: a look under the hood at practice leadership. Ann Fam Med. 2013; 11 Suppl 1:S27-33. PMC: 3707244. DOI: 10.1370/afm.1492. View

19.

McNellis R, Genevro J, Meyers D . Lessons learned from the study of primary care transformation. Ann Fam Med. 2013; 11 Suppl 1:S1-5. PMC: 3707240. DOI: 10.1370/afm.1548. View

20.

Homer C, Baron R . How to scale up primary care transformation: what we know and what we need to know?. J Gen Intern Med. 2010; 25(6):625-9. PMC: 2869426. DOI: 10.1007/s11606-010-1260-x. View