Narrative-Based Primary Care: A Practical Guide

Do PCGs need information officers?

BackgroundIn this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care.MethodsMultiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers.ResultsEspecially in the last three years, many studies have been published. The majority of the studies were positive about PNs’ actual role in primary care. However, several studies dealt with competency issues, including disagreement on respective roles. Thirteen studies were perceived as high quality. Only few studies had a representative sample. PNs’ role in chronic disease management is spreading increasingly into lifestyle counselling. Although PNs have more time to provide lifestyle counselling than general practitioners (GPs), lack of time still remains a barrier. In some countries, PNs were rather ambiguous about their role, and they did not agree with GPs on this.ConclusionThe PN can play the role of case manager lifestyle counselling regarding weight management in primary care in the UK, and wherever PNs are working under supervision of a GP and a primary health care team is already developed with agreement on roles. In countries in which a primary health care team is still in development and there is no agreement on respective roles, such as the USA, it is still the question whether the PN can play the case manager role.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-014-0197-2) contains supplementary material, which is available to authorized users.

BackgroundChronic obstructive pulmonary disease (COPD) accounts for 10–12 % of primary care consultations, 7 % of hospital admissions and 35 % of chronic incapacity related to productivity. The misuse of inhalers is a significant problem in COPD because it is associated with reduced therapeutic drug effects leading to lack of control of both symptoms and disease. Despite all advice, health care professionals’ practice management of inhalation treatments is usually deficient. Interventions to improve inhaler technique by health care professionals are limited, especially among primary care professionals, who provide the most care to patients with COPD. The aim of this study is to evaluate the efficacy of an educational intervention to train general practitioners (GPs) in the right inhalation technique for the most commonly used inhalers.Methods/designWe are conducting a pragmatic cluster randomised controlled trial. The sample population is composed of 267 patients diagnosed with COPD using inhalation therapy selected from among those in 20 general practices, divided into two groups (control and intervention) by block randomisation at 8 primary care centres. The sample has two levels. The first level is patients with COPD who agree to participate in the trial and receive the educational intervention from their GPs. The second level is GPs who are primary health care professionals and receive the educational intervention. The intervention is one session of the educational intervention with a monitor given to GPs for training in the right inhalation technique. The primary outcome is correct inhalation technique in patients. Secondary outcomes are functional status (spirometry) and quality of life. The follow-up period will be 1 year. GPs will have two visits (baseline and at the 1-year follow-up visit. Patients will have four visits (at baseline and 3, 6 and 12 months). Analysis will be done on an intention-to-treat basis.DiscussionWe carried out three previous clinical trials in patients with COPD, which showed the efficacy of an educational intervention based on monitor training to improve the inhalation technique in patients. This intervention is suitable and feasible in the context of clinical practice. Now we are seeking to know if we can improve it when the monitor is the GP (the real care provider in daily practise).Trial registrationISRCTN Registry identifier ISRCTN93725230. Registered on 18 August 2014.

BackgroundIn the Netherlands, 5.6 % of acute hospital admissions are medication-related. Almost half of these admissions are potentially preventable. Reviewing medication in patients at risk in primary care might prevent these hospital admissions. At present, implementation of medication reviews in primary care is suboptimal: pharmacists lack access to patient information, pharmacists are short of clinical knowledge and skills, and working processes of pharmacists (focus on dispensing) and general practitioners (focus on clinical practice) match poorly. Integration of the pharmacist in the primary health care team might improve pharmaceutical care outcomes.The aim of this study is to evaluate the effect of integration of a non-dispensing pharmacist in general practice on the safety of pharmacotherapy in the Netherlands.MethodsThe POINT study is a non-randomised controlled intervention study with pre-post comparison in an integrated primary care setting. We compare three different models of pharmaceutical care provision in primary care: 1) a non-dispensing pharmacist as an integral member of a primary care team, 2) a pharmacist in a community pharmacy with a predefined training in performing medication reviews and 3) a pharmacist in a community pharmacy (care as usual). In all models, GPs remain accountable for individual medication prescription. In the first model, ten non-dispensing clinical pharmacists are posted in ten primary care practices (including 5 – 10 000 patients each) for a period of 15 months. These non-dispensing pharmacists perform patient consultations, including medication reviews, and share responsibility for the pharmaceutical care provided in the practice. The two other groups consist of ten primary care practices with collaborating pharmacists. The main outcome measurement is the number of medication-related hospital admissions during follow-up. Secondary outcome measurements are potential medication errors, drug burden index and costs. Parallel to this study, a qualitative study is conducted to evaluate the feasibility of introducing a NDP in general practice.DiscussionAs the POINT study is a large-scale intervention study, it should provide evidence as to whether integration of a non-dispensing clinical pharmacist in primary care will result in safer pharmacotherapy. The qualitative study also generates knowledge on the optimal implementation of this model in primary care. Results are expected in 2016.Trial registration numberNTR4389, The Netherlands National Trial Register, 07-01-2014.

Health services across the developed world are evolving rapidly, and over the coming years some of the most wide-ranging changes are expected to occur in primary care. Primary care includes...

To address the prevalence of chronic diseases in Newfoundland and Labrador, the province has committed to primary health care reform, including implementing interdisciplinary primary care (PC) teams. To inform discussions regarding integrating nurse practitioners (NPs), registered nurses (RNs), and licensed practical nurses (LPNs) into these teams, better understanding of their roles in PC is needed. A scoping review was conducted to examine and synthesize existing evidence related to nursing roles and resources in PC settings across Atlantic Canada (Newfoundland and Labrador, New Brunswick, Nova Scotia, Prince Edward Island), and associated contributions to patient care. Joanna Briggs Institute scoping review methodology was used. The Nursing Role Effectiveness Model guided the review. Twenty articles met inclusion criteria. Roles of RNs and NPs in PC included chronic disease management, education, and health promotion. No literature focused on LPNs. Interdisciplinary collaboration was evident across studies. However, nurses’ functions within teams were limited by institutional constraints and other providers. PC settings with nurses had positive clinical outcomes, improved access to services, and high patient satisfaction. The prevalence of nursing in PC throughout Atlantic Canada and how nurses’ roles are enacted is unclear. There is opportunity for future inquiry into specific attributes of nursing and PC teams that result in positive patient and system outcomes.

To assess the value of Smiles for Life: A National Oral Health Curriculum (SFL) in influencing oral health practices of primary care professionals (PCPs).The National Maternal and Child Oral Health Resource Center’s Partnership for Integrating Oral Health Care into Primary Care (PIOHCPC) project is working with five project teams in Georgia, Illinois, Maryland, Michigan, and Rhode Island that are integrating interprofessional oral health core clinical competencies into primary care practice. The competencies were developed to facilitate change in the clinical practice of PCPs working with vulnerable or underserved populations that lack or have limited access to oral health care.An initial PIOHCPC project requirement was for PCPs (physicians, nurse practitioners, nurse midwives, nurses) to complete at least two SFL courses based on their project population of focus (eg, pregnant women, children, adolescents). The curriculum consists of the following courses: Course 1: Relationship of Oral and Systemic Health; Course 2: Child Oral Health; Course 3: Adult Oral Health; Course 4: Acute Dental Problems; Course 5: Oral Health for Women: Pregnancy and Across the Lifespan; Course 6: Caries Risk Assessment, Fluoride Varnish, and Counseling; Course 7: The Oral Exam; and Course 8: Geriatric Oral Health. Three months after completion of the SFL courses, a 10‐question feedback form was sent to PCPs.PCPs working in primary care settings (community health centers, local health department, medical center women’s health clinic) serving pregnant women, children, and adolescents who completed at least two SFL courses as part of the PIOHCPC project.Thirteen PCPs (three physicians, three nurse practitioners, three nurse midwives, four nurses) completed the feedback form. One hundred percent of respondents strongly agreed/agreed that SFL courses (1) reinforced the importance of oral health to a patient’s overall health and well‐being, (2) increased their awareness of and familiarity with oral health issues in their patients, and (3) increased their confidence in integrating oral health care into primary care. Seventy‐seven percent of respondents strongly agreed/agreed that SFL courses helped reduce barriers to incorporating oral health care into primary care. Sixty‐two percent of respondents strongly agreed/agreed that integrating oral health care into primary care improved their patients’ oral health outcomes. The majority (ranging from 85 to 100 percent) of PCPs strongly agreed/agreed that SFL courses helped them integrate the interprofessional oral health core clinical competencies into primary care.Three months after completing SFL courses, PCPs indicated that the curriculum had a positive influence on oral health practices in the primary care setting. These findings are consistent with a 2017 study that examined SFL influence on clinical practice and found that the curriculum positively influenced oral health practices in the primary care setting. Additional feedback could be gathered 1 year post‐training to assess retention of PCPs’ practices related to integrating oral health care into primary care.Oral health training is essential for enhancing PCPs’ knowledge and practices related to integrating oral health care into primary care. To respond to the need to integrate oral health care into primary care, SFL should be considered as a training for PCPs.Health Resources and Services Administration.

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

Home visit is a modality of health care that is expanding in Brazil and in the world. Public and private services have invested in the implementation of this type of assistance. It happens due to its potential to transform the model of care, highlighting the work quality of the primary health care teams. To analyze house call rates in primary care in the Brazilian public healthcare system according to professional categories and health macro-regions in the state of Minas Gerais, southeast region of Brazil. An ecological study that used as the information source the production data from the Primary Care Information System (2010 to 2015). House call rates (per 3000 inhabitants) by primary care professionals constituted the response variable. The independent variables were professional categories and the 13 health macro-regions of the state. The data were analyzed using the Mann-Whitney test. A total of 26,932,463 house calls were performed in the period, but the number of visits in 2015 was significantly lower compared to 2010. Significantly higher house call rates were found for some professional categories (mid-level professionals and nurses) and significant differences were found among the macro-regions (P < 0.05). The profile of house calls by primary care professionals revealed the constant presence of this care modality, but the distribution of these visits is uneven among the different professional categories and macro-regions of the state.

When I was young, I wanted to become a physician because I was interested in human beings and curious to know more about the biology and psychology of these creatures. If you are interested in people, there is no better job than that of a GP. Many young medical students share my enthusiasm for their career, yet few of them would like to specialize in general practice. As a teacher of medical students, I have noticed that during the first years of study general practice seems to be a possible choice for them, yet the longer the studies continue, the more a good many of them prefer a career in a narrower, hospital-based specialty. A recent article in this journal surveyed fifth-year medical students’ opinions on general practice [1]. While students respected GPs’ versatile and challenging work, they were concerned that the work was too hasty and pressing. The majority of the students (82%) considered that the most important aim of the GP's work is to identify serious diseases in order to refer patients for specialized care, which means that they overlooked the GP's important role in public health, i.e. the aim of better health for all people. Another concern among medical students was that GPs have to deal too much with non-medical problems. Bureaucratic duties such as sickness certification take up a large part of a GP's day, and GPs often consider these tasks problematic [2]. We need a continuous discussion about which jobs GPs should and should not do. As generalists, we are needed for many different tasks; however, not all of them are considered efficient use of the GP's time nor do they contribute to achieving the main aims of the GP's work. In Helsinki, the general practice training has been updated to help young doctors cope with the current challenges of primary care. General practice courses now get more positive feedback than before, and the number of young doctors wanting to specialize in general practice has increased. Nevertheless, young doctors who choose a career in primary care still face several barriers. The shortage of primary care physicians seems to continue, and young doctors often tend to leave after their mandatory period in general practice. In Finland, a primary care reform has been planned for several years, and one initiative was launched in 2012. However, it is based on municipalities as organizers of primary health care, and the initiative is strongly linked to a parallel reform of the number of municipalities. Few believe that this reform is going to solve the problems of primary care in Finland. GPs play a decreasing role in the leadership of primary care. High demands and limited resources challenge their role as primary care leaders, a similar situation to what was lately described in rural primary care in Norway [3]. Recently, three enthusiastic young physicians described their vision of future primary care in an editorial in the New England Journal of Medicine [4]. They emphasized multi-professional teams, quality-improvement cycles, patient groups, and the use of new technologies in communication with patients. Some of these ideas, such as teamwork and focus on quality, seem familiar in Scandinavia. Many countries, including the United States, Norway, and Finland, are simultaneously carrying out primary health care reforms. Despite the challenges, the many good practices and innovations in primary health care in Scandinavia are important models for the current reforms. Times are interesting for the transforming of primary care systems. The number of young physicians who choose a career in primary care serves as a good measure for the success of transformation. A journal like this plays an important part in letting us read and write about the importance of primary care and the successful innovations that are made in the few well-functioning systems. All this knowledge is useful for the GPs who are taking the lead in re-imaging the future of primary care.

In North Carolina, ∼5% or 57 000 children enrolled in Medicaid have complex medical conditions and account for >50% of the Medicaid dollars spent each year on the medical care of children. In 2012, Community Care of North Carolina (CCNC) received a Center for Medicare and Medicaid Innovations grant to establish the North Carolina Child Health Accountable Care Collaborative (CHACC) to address the health care needs of these children. Care coordination is an integral part of health reform activities, including many Medicare programs. CHACC appears to use a unique approach of targeting higher-cost pediatric Medicaid patients and placing specialty care managers in tertiary children's services.1,2 CCNC serves North Carolina Medicaid beneficiaries through a statewide, community-based public–private partnership, providing care through medical homes using population management approaches to improve care and contain costs.3 CHACC encourages medical and other health professionals to improve quality and cost-effectiveness of care for children on Medicaid with complex medical conditions. A primary goal of CHACC is to ensure that every child with a complex illness has a medical home in the community where he or she lives and receives coordinated primary and subspecialty care to reduce care fragmentation and cost. One target is reduction of unnecessary emergency department visits and hospitalizations. Although hospital revenues will be affected, hospitals will be better positioned to compete in the value-based care environment.4 CHACC patients are all North Carolina Medicaid beneficiaries enrolled in CCNC for care, allowing seamless identification and clinical information exchange by CHACC staff who are CCNC employees.Historically, CCNC has focused on primary care; however, CHACC bridges subspecialty and hospital-based care at 13 North Carolina hospitals with tertiary children's services with embedded care coordinators. The care coordinators are nurses or social workers with pediatric clinical experience. Their activities include completion of a comprehensive assessment of patient and family needs, care plan development, referrals to community services, patient and caretaker education, and collaboration with providers and caregivers to facilitate transitions in care. They provide a "warm handoff" to the community-based CCNC care coordinators in primary care practices and serve as dedicated links between the subspecialist team and primary care professionals. Care plans for these children are posted on a secure CCNC web-based provider portal, giving primary care professionals a centralized site to review and download care plans and to communicate with the community-based and tertiary care coordinators and subspecialists. The care plans have been well received by the community-based physicians caring for these children, reducing the communication burden of caretakers as intermediaries. A family satisfaction survey is being used to gain insight into caretaker perspectives. As one of the participating pediatric surgeons said, "This [CHACC program] is what I have been waiting for. With the care plan, I had everything I needed to care for the child in front of me. It is better than our brand new EHR!"Identifying the target population for CHACC enrollment is a continuing challenge. Nationally accepted tools for predictive models to identify children with complex medical conditions whose care may be "impactable" (quality improvement and cost reduction) have not been developed. To address this gap, North Carolina Medicaid claim data were used to help identify patient populations who may benefit from the program. In parallel, claim data for CHACC-enrolled children are being collected to determine impact on Medicaid costs, initially comparing CHACC patients with historical groups of similar patients. Advanced analytics are being developed to create predictive models to identify "impactable" patients early in their course, providing the opportunity for care managers to improve quality of care, comanagement, and cost reduction. To date, >1500 patients have been enrolled in CHACC in the first 6 months of the program. Collaborative learning is a key part of CHACC. At the 5 academic centers, work is under way to develop approaches for transitioning care to medical homes in the community using comanagement partnerships with subspecialists. For example, in a 29-county area of eastern North Carolina, the Department of Pediatrics at East Carolina University established the Center for Children with Complex and Chronic Conditions (C5) in 2008. From 2008 to 2010, C5 enrolled 234 children with complex conditions (eg, tracheostomies, gastrostomy tubes, ventilators, feeding pumps, cerebral palsy, intellectual disabilities, complex genetic syndromes) and began coordinating inpatient and outpatient care of these children. CHACC is aiding C5 with additional care managers and new communication links with primary care physicians. So far, C5 staff have documented a 20% reduction in average inpatient length of stay for ventilator-dependent patients, a 36% reduction in readmissions during the first month after discharge, a 26% reduction in readmissions during the first year after initial discharge, a 55% reduction in overall rehospitalizations, and an 11% reduction in emergency department visits. The calculated savings total for 2008 to 2010 is >$6 million.5 To continue this program, care coordination is necessary to support these children in the community. Also, residents, primary care physicians, and parents need more education about the patient's care.To address issues of access to subspecialists across North Carolina, CHACC is developing concise guidelines to aid primary care providers in the care of children with common pediatric conditions often referred prematurely or unnecessarily to pediatric subspecialists. CHACC guidelines are developed in joint day-long work groups of pediatric subspecialists from North Carolina academic medical centers and community primary care physicians. The work group reviews evidence-based data, published guidelines, and, where conclusive data are not available, consensus of subspecialists and primary care physicians on guideline content. A subgroup writes a draft guideline, sharing it for review with subspecialists and generalists across the state. The final guideline is published on the CCNC Web site (https://www.communitycarenc.org/emerging-initiatives/child-health-accountable-care-collaborative/chacc-gi/). Guidelines include consensus recommendations for appropriate primary care clinical evaluation, including laboratory, imaging, management guidance, "red flag" guidelines for immediate referral, and patient and family educational material. Final guidelines include endorsement from the subspecialty groups at all 5 North Carolina academic medical centers. The CHACC steering committee works with the North Carolina chapter of the American Academy of Pediatrics and the CCNC networks across the state to educate primary care health professionals about the guidelines and to encourage their use. Guidelines for constipation, gastroesophageal reflux, and chronic abdominal pain are available, and a guideline for headaches is in draft review.Informal feedback from primary care providers describes the guidelines as easy to download in a busy primary care practice and useful for patient care and family education. It is expected that this tool will aid in convincing families and patients to continue care in the primary care setting unless patients manifest "red flag" symptoms or meet referral guidelines. More formal evaluation of the impact of these guidelines on subspecialty access is under way.CHACC appears to create a unique, care management–based, statewide engagement of pediatric subspecialists and general pediatricians and primary care providers for developing comanagement protocols for children with complex conditions and promoting coordinated, efficient, high-quality, and cost-effective care. As medical providers in North Carolina engage in payment reform transition, including risk-based contracting, CHACC provides a platform to evaluate high-cost medical care for children. We anticipate that the cost savings from CHACC will be useful in justifying continuation of the program after completion of the grant-funded work and will be a stepping stone to value-based care for children in North Carolina Medicaid and adults with high-cost chronic illness moving between levels of care.Our work leads us to call for more development of tools for predictive analysis and risk adjustment for medically complex children, and we are pleased to see others working in this area.6 More work is needed in subspecialty referral management using tools such as the CHACC guidelines. We believe the medically complex child and the structure of the health care delivery system for these children reinforces the old saying, "Children are not just little adults."7Elizabeth Cuervo Tilson, MD, carried out the initial review of the manuscript and provided revisions to the original document.

Understanding the experiences of health professionals in primary care with the Child Health Booklet in child health care. A qualitative study with a phenomenological approach, in which participated nurses and doctors from six teams of the Family Health Strategy (FHS) in Belo Horizonte, MG. In total, were carried out 12 non-directive interviews, using two guiding questions. A comprehensive analysis of the speeches enabled the construction of three categories that signal the experiences of the professionals with the booklet. The experiments revealed difficulties arising from the limitations of knowledge about the instrument; incomplete filling out of the booklet by many professionals that care for children; the daily confrontations of the process and the organization of work teams; disinterest of families with the instrument. The research points possible and necessary ways to improve the use of booklets as an instrument of full child health surveillance.

BackgroundThe coronavirus pandemic has exerted significant impacts on primary care, causing rapid digital transformation, exacerbating social isolation, and disrupting medical student and General Practice [GP] trainee education. Here we report on a medical student telephone initiative set-up by a final year GP trainee (the equivalent of a family medicine resident), which aimed to support patients at high risk and vulnerable to the Coronavirus Disease of 2019 [Covid-19]. In addition, it was hoped the project would mitigate a digital divide, enable proactive anticipatory planning, and provide an active learning environment to compensate for the pandemic’s impact on medical education.MethodsThirty-three medical students conducted daily telephone conversations with high risk and vulnerable patients as specified by the initial NHSE published lists. They confirmed public health messages, offered details for voluntary support groups, established need for medication delivery, explored levels of digital connectivity, and prompted discussions around end-of-life choices. Students had access to online reflective resources and daily remote debriefing sessions with the GP trainee.A convergent mixed-methods evaluation was subsequently undertaken, using quantitative process and descriptive data and individual qualitative interviews were conducted according to a maximal variation sampling strategy with students, General Practitioners [GPs], and the GP trainee. Inductive thematic analysis was then applied with cross-validation, respondent validation, and rich evidential illustration aiding integrity.ResultsNinety-seven ‘high risk’ and 781 ‘vulnerable’ calls were made. Individuals were generally aware of public heath information, but some struggled to interpret and apply it within their own lives. Therefore respondents felt students provided additional practical and psychological benefits, particularly with regard to strengthening the links with the community voluntary groups. The project was widely liked by students who reported high levels of skill development and widened awareness, particularly valuing the active learning environment and reflective feedback sessions.ConclusionThis study demonstrates utilization of medical students as wider assets within the primary health care team, with an initiative that enables support for vulnerable patients whilst promoting active medical education. Ongoing integration of students within ‘normal’ primary health care roles, such as chronic disease or mental health reviews, could provide similar opportunities for supported active and reflective learning.

Plain English summaryMaking primary care clinics more patient-centered is key to improving patients’ experience of care. If patients themselves were engaged in helping define priorities and suggesting quality improvements in the clinic, care would respond better to their needs. However, patient engagement is a new phenomenon, particularly in community based primary care clinics. How to engage patients in quality improvement in these clinics, or what effect this might have, is not well known. The involvement of patients needs to be adapted to the way these clinics function. The aim of this study is to create and evaluate a new model of patient engagement for quality improvement in community based primary care clinics. Patients, primary care professionals and researchers will create advisory councils in two primary care clinics in Quebec City (Canada). In each clinic, the advisory council will include 12 patients or caregivers registered at the clinic, a clinician and a clinic manager. The advisory council will meet every 6 weeks for a total of six meetings. Two patient-experts will facilitate meetings. During meetings, members of the council will list their needs in order of importance. Then they will suggest improvements in line with these needs. We will study if our advisory council model is well adapted to community based primary care settings and meets participants’ expectations. At the end of the study we will be able to offer guidance about engaging patients with health professionals in quality improvement in primary care clinics.BackgroundInvolvement of end-users, including patients, managers and clinicians, in identifying quality improvement and research priorities might improve the relevance of projects and increase their impact. Few patient engagement initiatives have taken place in community based primary care practices (CBPCPs) and best practices for engaging patients in such settings are not well defined. The aim of this pilot study is to develop and assess the feasibility of a new collaborative model of advisory council involving clinicians, managers, patients and caregivers in CBPCP to strengthen their capacity to conduct quality improvement and patient-oriented research projects.MethodsWe will conduct a participatory action research project in two non-academic CBPCPs in Quebec City (Canada). In each CBPCP, the advisory council will include 12 patients or caregivers, a clinician and a clinic manager. Patients or their caregivers will be identified by clinicians and contacted by patient-experts. They will be eligible if they are registered at the practice, motivated, and available to attend meetings. The council will meet every 6 weeks for a total of six meetings. Two patient-experts will guide council members to identify quality improvement priorities and patient-oriented research questions based on their experience in the clinic. They will then be supported to plan actions to target these priorities. Analysis of meetings will be based on feasibility criteria, notes by non-participant observers in log books, audio-recording of the meetings and questionnaires to evaluate council members’ perceptions and the likelihood they would engage in such councils.DiscussionThe results of this study will be a model of patient engagement and a discussion of factors to improve the model to fit the needs of primary care patients and professionals. This will lay the foundation for a sustainable structure for long-term patient engagement and contribute to the development of a patient-centered and quality-improvement culture in CBPCPs.