Delivering PACT-principled care: are specialty care patients being left behind?
BACKGROUND
With the reorganization of primary care into Patient Aligned Care Teams (PACT) teams, the Veteran Affairs Health System (VA) aims to ensure all patients receive care based on patient-centered medical home (PCMH) principles. However, some patients receive the preponderance of care from specialty rather than primary care clinics because of the special nature of their clinical conditions. We examined seven VA (HIV) clinics as a model to test the extent to which such patients receive PCMH-principled care.


OBJECTIVE
To examine the extent to which HIV specialty care in VA conforms to PCMH principles.


METHODS
Qualitative study.


METHODS
Forty-one HIV providers from seven HIV clinics and 20 patients from four of these clinics.


METHODS
We conducted semi-structured interviews with HIV clinic providers and patients about care practices and adherence to PCMH principles. Using an iterative approach, data was analyzed using both a content analysis and an a priori, PCMH-principled coding strategy.


RESULTS
Patients with HIV receive varying levels of PCMH-principled care across a range of VA HIV clinic structures. The more PCMH-principled HIV clinics largely functioned as PCMHs; patients received integrated, coordinated, comprehensive primary care within a dedicated HIV clinic. In contrast, some clinics were unable to meet the criteria of being a patient's medical home, and instead functioned primarily as a place to receive HIV-related services with limited care coordination. Patients from the less PCMH-principled clinics reported less satisfaction with their care.


CONCLUSIONS
Even in a large, integrated healthcare system, there is wide variation in patients' receipt of PCMH-principled care in specialty care settings. In order to meet the goal of having all patients receiving PCMH-principled care, there needs to be careful consideration of where primary and specialty care services are delivered and coordinated. The best mechanisms for ensuring that patients with complex medical conditions receive PCMH-principled care may need to be tailored to different specialty care contexts.
Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA, gemmae.fix@va.gov.
Gemmae M
GM
Fix
Steven M
SM
Asch
Hemen N
HN
Saifu
Michael D
MD
Fletcher
Allen L
AL
Gifford
Barbara G
BG
Bokhour
D015331:Cohort Studies; D003695:Delivery of Health Care / Q000379:methods / Q000639:trends*; D006801:Humans; D008511:Medicine / Q000379:methods / Q000639:trends*; D010348:Patient Care Team / Q000639:trends*; D018802:Patient-Centered Care / Q000379:methods / Q000639:trends*; D011320:Primary Health Care / Q000379:methods / Q000639:trends*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000639:trends*