Inter-disciplinary Nature of Primary Care and the Medical Home Model: Focusing on the role of nurses

The medical home concept was introduced by the American Academy of Pediatrics in 1967 as a model of care for children with special health care needs, emphasizing comprehensive, continuous, coordinated, and family-centered care to meet their chronic health, developmental and psychosocial service needs. The medical home subsequently evolved into an integrated primary care model that recognizes the importance of family, community, and culture, with an emphasis on enhanced access to care, prevention, wellness, and patient self-management of chronic disease. It focuses on holistic care, recognizing that a multi-disciplinary team of diverse health professionals is necessary to provide comprehensive care. As the medical home model developed, it was promoted by most major medical groups including the American College of Physicians, American Academy of Family Physicians and American Medical Association. It was described in language that suggests that the model should be implemented by primarily or exclusively by physicians, e.g., advocating that each patient have “an ongoing relationship with a personal physician” and that “the personal physician” would lead inter-disciplinary health care teams. These statements are included in the Joint Principles of the Patient-Centered Medical Home, the model most often referenced in demonstration projects and certification processes. The federally funded Medicare Demonstration Project for example, allowed for additional primary care reimbursement to support chronic disease management efforts, but only for physicians as providers. In this presentation we will discuss the inter-disciplinary nature of primary care as it should be understood in the medical home model, focusing on the role of nurses.