Role of Pharmacists in the Medical Home

David W. Bates

Disclosures

Am J Health Syst Pharm. 2009;66(12):1116-1118. 

In This Article

Introduction

Introduction

The concept of the "medical home" was developed over 40 years ago and came from the field of pediatrics as a way to address the needs of children with special health care needs.[1] More broadly, the reasoning was that all patients should have a home where they can receive much of their care and through which their care can be coordinated; this includes but goes beyond having a primary care provider. The medical home is not a physical structure but a fundamental rethinking of the way care should be delivered. The medical home concept has been embraced by a variety of fields, including family medicine and general internal medicine.[2,3] The features of a medical home include (1) integrated and comprehensive physician-led team care, (2) clinical information systems to support this care, including decision support and registry functions, (3) ready access to care when the patient needs it, (4) routine patient feedback to physicians, (5) patient engagement in care and decision-making, (6) patient-centered care with an emphasis on dignity and respect, and (7) publicly available information on quality and efficiency.[4]

The impetus for changing the structure of medical care was in large part due to the rising costs of care in the United States. Health care in the United States is the world's most expensive, yet the outcomes we achieve are some of the worst among developed countries.[5] Although there are many reasons for these results, the lack of emphasis on primary care in the United States relative to other nations is likely a major contributor to poor health outcomes.[6] This lack of emphasis on primary care has been fostered by a fee-for-service reimbursement system, another major contributor to high health care costs and poor health outcomes.

The United States currently faces a crisis in primary care.[7] There is a greater need for providers than in the past, yet few medical students are pursuing a career in primary care. One likely reason for this is that primary care providers need to work unusually hard and are poorly reimbursed.

All of these factors have led to the renaissance of the medical home. The medical home has the potential to improve the quality and safety of the health care system while reducing health care costs, a combination that has been difficult to achieve. Multiple pilot studies of the effect of the medical home on health care are being conducted in the United States. The medical home represents one of the most exciting changes in health care today.

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