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A patient medical home (PMH) is a family practice that operates at an ideal level to provide longitudinal patient care.

It is the foundation of care delivery in an integrated system of primary and community care and primary care networks (PCNs) in local communities.

A PMH has 12 attributes that define how a practice can support patients, including through team-based care.

As an ideal family practice, a PMH enables family doctors to:

  • Use accurate patient data to increase proactive, preventative care.
  • Get support for patients from health care teams located in the practice or in the community, and from networks of colleagues. Everyone can work to their strengths, and support and rely on each other to ensure patients get the best care.
  • Participate in primary care networks (PCNs) to access a broader system of services and supports in the community.

Within a PMH, physicians (or sometimes nurse practitioners) as the most responsible care provider play a central role in leading and coordinating patient care.

Other primary care clinics, such as a community health centre or health authority-run clinic can also function as a PMH.

For patients

Through a PMH, patients have greater access to continuous, comprehensive, and coordinated primary care.

For doctors

Within a PMH, GPs can:

  • Increase their ability to provide optimal care for patients, and conveniently access a full range of supports and services for patients.
  • Spend more time on difficult diagnoses and strengthening patient relationships.
  • Reduce the burden of caring for patients alone, which can help to prevent burnout.
  • Increase the efficiency of the practice and streamline processes to maximize time, resources and capacity.

Get involved

The GPSC is supporting family doctors to move toward the PMH model of care in four key areas of work:

  • Panel management
    Use patient data to inform and plan proactive care.
  • Team-based care
    Access other health care providers to support quality patient care.
  • Physician networks
    Get support from colleagues to provide continuous, comprehensive patient care.
  • Primary care networks
    Participate in a supportive network of local primary care services to increase comprehensive care.

International model, adapted for BC

The PMH model is being implemented and tested around the world, which has given BC a chance to learn from what others have done.

The 12 attributes of a patient medical home in BC are based on the College of Family Physicians of Canada’s framework and pillars.

The GPSC has adapted the PMH model to recognize strong partnerships and networks that have been established through the divisions of family practice, health authorities and community partners. The provincial model also takes into account the collaborative partnership between the Government of BC and Doctors of BC, represented by the GPSC, that is unique to BC.

Proven model of care

There’s strong evidence that a system based on robust primary care is better for the patients, better for the physicians and other providers, and saves the system money.

Read more:

Supports

  • $8.5M PMH funding to local divisions over three years
  • Practice Characteristics Matrix
    A guide that illustrates the continuum of the 12 attributes. 
    Downloadable PDF | Printable large poster
  • PMH Assessment
    An e-survey that highlights practice strengths and suggests opportunities for improvements, in relation to the 12 attributes.
  • Patient Experience Tool
    An e-questionnaire that collects patients' perspectives on their visits to a GP's practice.

Resources