An Examination of Trends in Patient-Centered Care, Specific to the Treatment of Substance Misuse and Mental Health Conditions, Using Data From a Family Medicine Residency Program

Student Researcher:
Emily Chapman

Supervisors / Principle Investigators:
Dr. Deena Hamza
Dr. Shelley Ross

MD Class of 2021


Background: Patient-centered care (PCC) is essential for delivery of appropriate and effective healthcare. Although PCC is taught comprehensively, the Patient Centered Medical Home (PCMH) model has focused on “in house” management of 5 chronic diseases: asthma, diabetes, heart disease, and cancer. Evidence suggests barriers to providing PCC when treating substance misuse and/or mental illness. As such, a comparison of evidence of PCC with patients by residents in 2010 (introduction of PCMH) and in 2018 (8 years after introduction of PCMH) was undertaken.

Study Design: Secondary data analysis. Setting: Canadian family medicine residency program. Data source: Archived de-identified resident low-stakes assessments (FieldNotes). Main outcomes: Comments reflecting patient-centered care on FieldNotes. Numbers of FieldNotes by Picker’s Eight Principles of Patient-Centered Care. Analyses: Contemporary and summative content analysis.

Results: A statistically significant increase in training was observed for: incorporating patient context (p = 0.004); coordination of clinical care (p<0.001); informing and educating patients (p = 0.02); and documented continuity through follow-up (p<0.001). Changes in providing physical comfort, emotional comfort, and including family/friends in the decision-making process were not statistically significant.

Conclusions: Results indicate a statistically significant increase in training provided to family medicine residents in the provision of patient-centered care specific to individuals seeking treatment for substance misuse and/or mental illness. These results support the inclusion of substance misuse and mental illness as an additional and distinct pillar in the PCMH model of chronic disease management with “in-house” continuity of care.