Dr. Yan Yu

The Patient’s Medical Home (PMH) concept was first introduced to me by one of my favourite professors and mentors during medical school. It was 2012, and he was giving a lecture on CaRMS preparation for family medicine residency. “This is the future of family medicine!” he enthused, holding up the College of Family Physicians of Canada (CFPC)’s 2011 release of A Vision for Canada: Family Practice – The Patient’s Medical Home. As a keen medical student, prompted by the dual aspirations of getting into residency and being part of whatever “the future” was, I checked out the release.

What I read inspired me. I had wanted to be a family physician ever since undergrad, when I realized that I liked having a broad understanding of every aspect of the biological sciences. For me, volunteering at the local hospital reinforced that we have a “sickness” care system instead of a “health” care system. I also dreamt that one day, as a physician, I might help people stay healthy and not get sick in the first place—a dream I’m sure many of us share.

Reading about the PMH was like a kid eating his first Lindor (ah, the dopamine). Finally, a well-crafted vision for the role of family medicine in promoting health! I eagerly soaked up the PHM’s core principles:

• Everyone in Canada served by a dedicated family practice
• Care focused on the needs of patients, families, and communities
• Interprofessional teams featuring family physician leadership and offering a variety of services
• Timely access to care in the community, relieving emergency room pressures
• Continuous care built on knowing patients and their life stories
• Ongoing development through measurement and quality improvement

During residency I was delighted to work in a clinic that embodied these principles. In Alberta, where I trained and now practise, Primary Care Networks have been built in alignment with the PMH vision. Here’s what these principles look like in practice for the average family physician:

• For treating patients with chronic disease: not having to worry about routine maintenance tasks, such as following up on a patient’s A1c; another member of the healthcare team can look after it for you and consult you only in exceptional circumstances. This leaves you freer cognitively to deal with more challenging situations and provide same-day access for patients who need it.
• When caring for patients with mental illness: being able to provide a low-cost, often free resource (psychologist, behavioural health consultant, etc.), sometimes even within your own clinic. After those providers see the patient (spending about 30 minutes to an hour—much more time than you could spend), they send you a concise report about what they discussed. True, having the patient confide in someone else might detract from the physician-patient relationship. But, keep in mind, these resources are there at your discretion; you can still counsel your patient yourself if you have the time to do so.
• When helping patients with polypharmacy issues: having a pharmacist integrated into your healthcare team, often on-site, to review patients’ medications with you and/or alert you to possible drug interactions and inefficiencies.
• For optimizing the social determinants of health for your patients: having social workers (sometimes on-site) to manage your patients’ welfare, housing, job situations, and more.
• For managing your forms: gloriously, at my clinic, we even had a dedicated staff member to fill out forms for you and advise you on all things forms-related.

In Alberta the monetary cost of developing Primary Care Networks was included in provincial budgets, not borne by individual clinics. Ultimately, the value to our patients (and to our own well-being as physicians) is well worth the time getting used to this new system.

But don’t take my word for it. Here are some conclusions from a 2017 meta-analysis that Toward Optimized Practice produced based on 115 studies of practice settings that align with the PMH vision:

• Fifty-one out of 61 studies demonstrated reduced hospitalizations and ER use
• Seven of eight studies demonstrated improved access to care
• Twenty-seven out of 34 studies demonstrated cost savings to the system
• Nineteen out of 24 studies demonstrated positive results in the quality of care

As a resident I seized the opportunity to join the CFPC’s PMH Steering Committee. I met physician leaders from around Canada and had a chance to learn from their experiences. I was secretly shocked and overjoyed that they’d let me into this exclusive club with idols I’d respected and admired for years! Little did I know I would be participating in family medicine’s master plan to optimize front-line healthcare for all: a re-vamp of the PMH concept. This masterpiece was released this spring as PMH 2019.

Since the CFPC’s first PMH vision was published in 2011, a lot has happened in the family medicine landscape. Some provinces are further along the PMH track than others. Technology has come a long way, especially in terms of how we use EMRs; they can assist us in PMH development now more than ever. Challenges remain, but there is now evidence from across Canada to support the adoption of best practices. Canada needed a refreshed PMH vision to take what we’ve learned from the past eight years of PMH experiences, organize it, and produce a road map for the future. This is what the CFPC has now done in PMH 2019.

I encourage you to learn about the new vision’s increased focus on interconnected care, quality improvement, and social accountability. Check out https://patientsmedicalhome.ca and consider adopting PMH principles in your practice, or working to improve your local PMH.

Dr. Yan Yu is a family physician practising in Calgary. He is the Chair of the Patient’s Medical Home Steering Committee of the College of Family Physicians of Canada.