Abstract
Background: The Patient Medical Home (PMH) model, also called the ‘medical home’ or ‘health home,’ has been globally recognized for strengthening interprofessional primary health care (PHC) delivery. This model provides integrated, team-based, and patient-centred care tailored to the community’s needs and preferences, thereby enhancing the patient experience and improving the quality of care. In Alberta, Canada, the Indigenous Primary Health Care and Policy Research (IPHCPR) Network convened experts to explore ways to adapt the PMH model to better serve Indigenous patients, ensuring culturally relevant and effective PHC delivery.
Approach: This research is built on a transdisciplinary research paradigm characterized by a collaborative approach to co-design and implementation. Addressing the conference theme of “Collaborative Approaches to Integrated Care,” PHC experts, Indigenous-focused clinician physicians, and Indigenous Knowledge Holders were engaged in the critical and reflexive exploration of the mainstream PMH Model implemented in Alberta’s Primary Care Networks. Idea generation techniques, including small group discussions, communicating and reflecting on ideas, and brainstorming future directions, were applied for an in-depth exploration of the PMH model. In small groups, participants explored three questions: (1) What resonates with you in the PMH model? (2) What features or components of the model are critical to exploring or advocating for Indigenous PHC delivery? (3) What are some concerns about the model? Following small group and roundtable discussions, participants learned from an adapted evidence-based Indigenous PMH model in Queensland, Australia.
Results: Four themes emerged regarding key features of the PMH model that are critical to implement for Indigenous PHC delivery: (1) Relational continuity; (2) Incorporation of localized Indigenous perspectives and ways of knowing; (3) Being adaptable and flexible to fit the local context and meet the needs of the communities it serves; and (4) Exploring workforce and leadership characteristics required to guide the development, implementation, and daily functioning of an Indigenous PMH. Concerns about the PHM model include its focus on individual rather than community health, its need for more attention to upstream health determinants, and possible conflicts with Indigenous worldviews during implementation. These findings align with several pillars of integrated care: population health needs and local context, people as partners in health and care, and workforce capacity and capability.
Implications: The expert gathering is an initial step toward adapting the PMH model for Indigenous PHC delivery in Alberta, Canada, which is Indigenous-led and co-designed, grounded in community needs, priorities, and Indigenous knowledge to foster relational integrated care. This work aligns with the province’s Modernizing Alberta’s Primary Health Care System reform strategy, which presents a window of opportunity to share our findings with decision-makers. A recent report published by the Indigenous Advisory Panel provided 22 recommendations to strengthen Indigenous PHC in the province, with the top priority being to connect Indigenous peoples to a culturally safe medical home2. We will apply lessons from collaboration with experts to develop design features and implementation aspects for an Indigenous PMH Model in Alberta.