Journal of General Practice

Linking Primary Care to the Community: A Study of Pediatric Practices in Florida

Abstract

Caprice Knapp, Vanessa Madden, Ivana Sehovic, Danie Fernandez-Baca, Jacqueline Baron-Lee, Ruth S. Gubernick, Cristina Pelaez, and Gwendolyn Quinn

Abstract Background and Objectives: Linking primary care practices to community entities is critical for providing comprehensive and continuous care. The patient centered medical home (PCMH) should facilitate linkages to the community. Our study aims to understand what challenges pediatric primary care practices in Florida face in developing these linkages. Methods: Interviews were conducted with three-person core project teams working in 20 pediatric practices across Florida. All practices are participating in a longitudinal, PCMH demonstration project. Results: At baseline, most practices reported positive connections with specialists, but about half reported insurance as the main barrier. Practices reported both negative and positive aspects of their connection to hospitals and emergency rooms. While some practices saw the emergency room as source of referral back to their practice, others felt that hospitals or emergency rooms did not communicate well or collaborate in patient care. Most practices felt that current communication with traditional and special schools was insufficient (paperwork-based) and infrequent (as-needed basis), and that a more formal and proactive system was needed. While most practices were able to provide numerous examples of their involvement in the community, their responses indicated a lack of organization or planning for future events. The majority of practices found it easier to describe one-time, past events rather than provide a list of current or recurring projects. Conclusions: Integration on all levels is fundamental to the PCMH. Our study demonstrates that PCMH facilitators and accreditation agencies must take into account the varying barriers and infrastructures present in a practice’s community when providing effective strategies for coordinated care.