• Paul Sawchuk, Amanda Condon, and Tara Stewart.
• Family physician with a comprehensive family practice in Victoria, BC. paul.sawchuk@islandhealth.ca.
• Can Fam Physician. 2022 Nov 1; 68 (11): 829835829-835.

Problem AddressedWhile the home-based primary care model offers potential patient and system-level benefits, implementation of interprofessional home-based primary care teams has not been widespread. When caring for homebound patients, family physicians are often not included as regular contributors or participants in the team that coordinates and plans much of the care for these patients.Objective Of ProgramTo describe a selection of home-based primary care practices and to identify barriers to and facilitators of the creation and sustainability of these models within the publicly funded health care system.Program DescriptionFive existing home-based primary care practices were examined: 1 each in Victoria and Vancouver in BC; 1 in Winnipeg, Man; and 2 in Toronto, Ont. The research team conducted semistructured team interviews, interviews with the physician leads, and informal observation of elements of team-based care planning at these 5 sites. From these sources, descriptions of each practice were developed in terms of practice history, context, and initiating factors; practice goals and performance management; and practice design elements, including target population, referral sources, and team composition. A qualitative thematic content analysis was used to extract and distil implementation barriers and facilitators across the 5 practices. Members of each practice team validated the interpretation of thematic information. Substantial heterogeneity was found in the composition of the interprofessional teams. The overarching initiating factor for the home-based component of all practices could be described as identifying and addressing unmet community need. Physician leadership, creative funding models, team camaraderie, and community partnerships were the main facilitators. Limited health system support, geography, and lack of existing models of care were the main barriers.ConclusionSubstantial barriers to wider implementation of home-based primary care practices persist. Examination of existing practices identifies the importance of physician leadership and commitment to meeting community need.Copyright © 2022 the College of Family Physicians of Canada.

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