Table 3.

Primary Care Physician Perceptions of Barriers to Patient-Centered Care

Summary points	Key quote
A. Intra- and interpersonal: knowledge, attitudes, beliefs, personality aspects or interactions between individuals impeding patient-centered care
PCPs feel some complex patients are unable or unwilling to engage in care	“If he suddenly decides to stop going to his treatments or his follow-ups with oncology, obviously it’s just going to go downhill. Depending on his mood, he may or may not want to contact us.” [PCP#15]
PCPs may be unable to offer care plans that meet the patient needs, expectations, or goals	“Our priorities might be a little different because, as with most patients, their first priority is always pain control. That’s not generally my first priority.” [PCP#12]
B. Organizational or institutional: facility or system rules, regulations, or informal structures limiting patient-centered care
Complex patient needs do not always align with available services	“That leads to the frustration he has with the types of care that we’re able to provide—he would like us to be able to have someone to come to his house, to inject all of his doses of insulin, and there’s just no service like that available.” [PCP#09]
System features can be incompatible with patient-centeredness	“We don’t see our patients very often, which I think is a big issue, because you don’t get to know them very quickly.” [PCP#23]
C. Community or Policy: social norms or relationships between individuals or groups, or policies or laws regulating health practices interfering with patient-centered care.
Policy affects meeting complex patient needs in a patient-centered manner	“We don’t take away people’s capacity for anything in [this] state—you can be demented until the very end, and you’ll still be controlling your bank account. […] So you don’t want to jump immediately and scare them away by involving too many people, like the ethics committee, and legal, and all that stuff.” [PCP#03]