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The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context

Author

Listed:
  • Shilpa Surendran

    (Health Systems and Behavioral Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, 12 Science Drive 2, Singapore 117549, Singapore)

  • Chuan De Foo

    (Health Systems and Behavioral Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, 12 Science Drive 2, Singapore 117549, Singapore)

  • Chen Hee Tam

    (Health Systems and Behavioral Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, 12 Science Drive 2, Singapore 117549, Singapore)

  • Elaine Qiao Ying Ho

    (Health Systems and Behavioral Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, 12 Science Drive 2, Singapore 117549, Singapore)

  • David Bruce Matchar

    (Health Services and Systems Research, Duke—NUS Medical School, 8 College Road, Singapore 169857, Singapore
    Department of Medicine (General Internal Medicine), Duke University School of Medicine, 400 Morris Street 3rd Floor, Durham, NC 27701, USA)

  • Josip Car

    (Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore)

  • Gerald Choon Huat Koh

    (Health Systems and Behavioral Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, 12 Science Drive 2, Singapore 117549, Singapore)

Abstract

In recent years, there is growing interest internationally to implement patient-centered medical homes (PCMHs), and Singapore is no exception. However, studies understanding the influence of contextual policy factors on the implementation of PCMHs are limited. We conducted 10 semi-structured in-depth interviews with general practitioners working in seven out of the nine PCMHs. Audio recordings were transcribed and analyzed by two study team members in NVivo 12 Software using grounded theory techniques. Power dynamics between the stakeholders and lack of shared decision-making among them in selecting the locale of the PCMH and formulating the practice fee and pharmacy structure were the key factors which negatively affected the implementation of PCMHs on a larger scale. Over time, lack of funding to hire dedicated staff to transfer patients and misalignment of various stakeholders’ interest to other right-siting programs also resulted in low number of patients with chronic conditions and revenue. Countries seeking to implement a successful PCMH may benefit from building trust and relationship between stakeholders, engaging in shared decision-making, ongoing cost-efficiency efforts, and formulating a clear delineation of responsibilities between stakeholders. For a healthcare delivery model to succeed in the primary care landscape, policies should be developed keeping mind the realities of primary care practice.

Suggested Citation

  • Shilpa Surendran & Chuan De Foo & Chen Hee Tam & Elaine Qiao Ying Ho & David Bruce Matchar & Josip Car & Gerald Choon Huat Koh, 2021. "The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context," IJERPH, MDPI, vol. 18(4), pages 1-11, February.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:4:p:1817-:d:498973
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    References listed on IDEAS

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    Cited by:

    1. Zoe Zon Be Lim & Mumtaz Mohamed Kadir & Mimaika Luluina Ginting & Hubertus Johannes Maria Vrijhoef & Joanne Yoong & Chek Hooi Wong, 2021. "Early Implementation of a Patient-Centered Medical Home in Singapore: A Qualitative Study Using Theory on Diffusion of Innovations," IJERPH, MDPI, vol. 18(21), pages 1-20, October.
    2. Shilpa Surendran & Chuan De Foo & Chen Hee Tam & Elaine Qiao Ying Ho & David Bruce Matchar & Josip Car & Gerald Choon Huat Koh, 2022. "Reply to Ngoh et al. Comment on “Surendran et al. The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context. Int. J. Environ. Res. Public Health 2021, 18 , 1817”," IJERPH, MDPI, vol. 19(8), pages 1-2, April.
    3. Sharon Ngoh & Wern Ee Tang & Edwin Chng & Phui-Nah Chong, 2022. "Comment on Surendran et al. The Missed Opportunity of Patient-Centered Medical Homes to Thrive in an Asian Context. Int. J. Environ. Res. Public Health 2021, 18 , 1817," IJERPH, MDPI, vol. 19(8), pages 1-4, April.
    4. Andrew Teik Hong Chen & Gerald Choon-Huat Koh & Ngan Phoon Fong & Jeremy Fung Yen Lim & Zoe Jane-Lara Hildon, 2023. "Evaluating the Effects of Capacity Building Initiatives and Primary Care Networks in Singapore: Outcome Harvesting of System Changes to Chronic Disease Care Delivery," IJERPH, MDPI, vol. 20(3), pages 1-20, January.
    5. Grace Sum & Silvia Yu Hui Sim & Junxing Chay & Soon Hoe Ho & Mimaika Luluina Ginting & Zoe Zon Be Lim & Joanne Yoong & Chek Hooi Wong, 2023. "An Integrated Patient-Centred Medical Home (PCMH) Care Model Reduces Prospective Healthcare Utilisation for Community-Dwelling Older Adults with Complex Needs: A Matched Observational Study in Singapo," IJERPH, MDPI, vol. 20(19), pages 1-15, September.

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