• Claire E Kendall, Esther S Shoemaker, Janessa E Porter, Lisa M Boucher, Lois Crowe, Ron Rosenes, Christine Bibeau, Philip Lundrigan, Marissa L Becker, Shabnam Asghari, Sean B Rourke, and Clare Liddy.
• From the CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada (CEK, ESS, JEP, LMB, LC, RR, CB, PL, CL); Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (CEK, ESS, CL); School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (CEK, LMB); Department of Family and Community Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada (CEK, ESS); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (CEK); Departments of Medicine, Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (MLB); Department of Family Medicine, Centre for Rural Health Studies, Memorial University of Newfoundland, St. John's, Newfoundland, Canada (SA); Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada (SBR); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada (SBR). ckendall@uottawa.ca.
• J Am Board Fam Med. 2019 Mar 1; 32 (2): 158-167.

PurposeFor people living with HIV (PLWH) using continuous antiretroviral therapy, HIV is now a complex chronic condition often managed in primary care settings. The patient-centered medical home (PCMH) is a model to deliver comprehensive, coordinated, and integrated primary care that promotes collaboration between primary and specialist care and allied services. The study assessed how both Canadian primary and specialist HIV care settings align with the PCMH.MethodsMixed-methods surveys and interviews with providers in Canadian HIV care settings.ResultsTwenty-two settings completed the survey, 12 of which participated in follow-up interviews. Settings had a mean PCMH score of 8.06/12 (SD = 1.53), indicating the basic elements of each PCMH domain have been implemented. We found no significant differences between HIV primary care and specialist care settings. Continuous team-based healing relationships had the highest score (mean = 9.2; SD = 2.15), and quality improvement strategy had the lowest score (mean = 7.19; SD = 2.26). The themes that arose from the interviews were 1) endorsement of the domains of the PCMH by all settings, 2) organizational structures of settings located in hospitals facilitating the implementation of the PCMH through existing technology, patient advisory boards, and accessible services, and 3) dissonance between complex care needs and existing organizational structures in some settings, including limited clinic hours, lack of electronic medical records, and limited mental health services.ConclusionsHIV care in Canada is reasonably well aligned with the PCMH, irrespective of structure of settings. We propose the need for improvements in the use of electronic medical records, quality improvement strategies, and integration of mental health services to achieve better care delivery and health outcomes among PLWH in Canada.© Copyright 2019 by the American Board of Family Medicine.

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