Abstract:
Background: Patient experience of care has increasingly become a focus for policy and decision makers internationally. This shift to the prioritisation of patients across the system has had a large influence at the primary care level. In addition, primary practice is facing numerous challenges and pressures from a combination of an increasing and ageing population, with more people living with one or more long term conditions. Challenges are also present in the ageing and shortage of the primary care workforce. In New Zealand, the response to these challenges has involved the introduction of the Healthcare Home model of primary practice. Northland District Health Board and the two Northland Primary Health Organisations have introduced the Neighourhood Healthcare Homes pilot in six primary practices across the region. Aims: This research sought to understand the experiences of patients accessing primary care in a practice that has transitioned to a Neighbourhood Healthcare Home practice in Northland, New Zealand. It aims to explore the relationships, experiences and contact patients have with their practice, and what impact the Healthcare Home may have on these. Methods: The qualitative methods employed by this research fit within the realist paradigm. Realist evaluation speaks of testing theories and hypotheses about programmes in the health and social sectors. The realist evaluation methodology informed this research process to understand what parts of the Healthcare Home model are working, and for whom. Patients at two Healthcare Home practices in Northland were invited to participate in this research. Twelve interviews were conducted across the two practices. A semi-structured interview schedule was used to guide data collection. Data was analysed using thematic analysis. Findings: Three key themes were identified from the interviews: patient knowledge and awareness of the model, patient relationships with their primary care practitioners and the use of communication technologies in primary care. The findings of this research suggest that patients were not often aware of changes that were going on in their practice, yet this did not directly impact on their reported experience of care. Patients valued their relationships with their primary care practitioners more than any gains in efficiency the Healthcare Home may offer through attending consults with other health professionals. There also remains many contextual barriers to patient adoption of communication technologies in primary care such as patient portals, including lack of access to the technology itself, such as computers and the internet, and the change in culture and behavior required to make use of it. Conclusion: Features of the Healthcare Home that are designed to reorganise systems in primary care and respond to the challenges in the sector have varying effects on patients' experiences of care. It is clear that the inclusion of the patient voice in the implementation process and evaluation of new initiatives and programmes is critical to ensuring these initiatives are not only carrying out their function but are responsive to patient needs.