The Patient Centered Medical Home and Psychosocial Issues

The passage of federal health care reform in 2010 has made this issue even more controversial in the United States. Health care spending currently represents approximately 18% of the U.S. gross domestic product (GDP) and is projected to surpass 20% within a decade (Sisko et al., 2009). Concern about uninsured and underinsured persons remains, although new legislation to mandate insurance overage is scheduled to take effect in 2014.

Numerous perspectives exist on how the health care system needs to change, but a consensus is emerging that focuses on the importance of primary care and on managing chronic disease in the context of a high-quality physician-patient relationship (Bein, 2009). This consensus reflects the accumulating evidence that higher-quality health care at lower cost is achieved when primary care is emphasized (Starfield et al., 2005).

The concept of the patient-centered medical home (PCMH) embodies this emerging emphasis. As discussed in Chapter 2, the numerous components of a PCMH (or "health home") include the use of an electronic health record, better access and scheduling processes, use of evidence-based medicine, more point-of-care services (e.g., multidisciplinary teams, group visits), and an ongoing emphasis on quality improvement. Some argue that incremental change in this regard is insufficient, and that transformation of practices is necessary (Nutting et al., 2009). Such transformation would include a broad, population-based approach to preventive services and chronic care, beyond a "single patient at a time" approach. However, services are individualized to each patient based on the patient's goals and unique needs, which includes attention to the psychosocial factors that affect chronic disease prevention and management.

These trends represent an opportunity for family medicine to take a leadership role in health care reform, with an emphasis on psychosocial aspects. The PCMH philosophy is consistent with family medicine's long-standing emphasis on whole-person care in the context of a high-quality physician-patient relationship. Ideally, the family physician in a health home setting will address the psychosocial needs of patients in collaboration with ancillary providers, as needed.

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