Medical assistants (MAs) are a flexible and low-cost resource for primary care practices and their roles are swiftly transforming. We surveyed MAs and family physicians in primary care practices in North Carolina to assess concordance in their perspectives about MA roles, training, and confidence in performing activities related to visit planning; direct patient care; documentation; patient education, coaching or counseling; quality improvement; population health and communication. For most activities, we did not find evidence of role confusion between MAs and physicians, physician resistance to delegate tasks to properly trained MAs, or MA reluctance to pursue training to take on new roles. Three areas emerged where the gap between the potential and actual implementation of MA role transformation could be narrowed—population health and panel management; patient education, coaching, and counseling; and scribing. Closing these gaps will become increasingly important as our health care system moves toward value-based models of care.
Background and Objectives: At a time when the US health care system needs greater access to comprehensive, on-demand primary care, the University of North Carolina Family Medicine Center found itself struggling to meet patient demands within the confines of an outdated facility. Clinic leadership sought to redesign the physical space to expand capacity, integrate other members of the care team, support extended hours of operation, and improve patient experience. Methods: Clinic leadership employed experienced lean coaches to train our entire department in lean methodology, to implement a comprehensive approach to redesigning our workflows, and to use those perfected workflows to redesign and renovate our new clinical workspace. Results: Upon completion of the renovation and redesign, the clinic experienced significant growth in patient volumes (24%) and unprecedented improvement in patient satisfaction (89th to 92nd percentile). Conclusions: Lean methodology proved to be an effective strategy for analyzing our current workflows and use of physical space. Moreover, lean strategies proved vital for redesigning and renovating our clinic.
The training family medicine residents receive will have a lasting impact on how they deliver care in the future. Evidence demonstrates an imprinting effect based on the training environment itself. Thus, residency training represents a critical time for establishing clinical experiences that embody core primary care principles and ensure excellent care delivery. This paper focuses on the clinical experience in the family medicine practice setting. We have used Starfield’s four C’s of primary care and added two more: cost and community, as the tools to achieve the triple aim. In reviewing the current state of residency programs across the country, we noted that there was a lack of measurement on how programs were performing when it came to the six C’s. We will briefly describe some recent innovative collaboratives among residencies. Next, we examine the six C’s of primary care in context of current care. These six C’s inform our recommendations for residency training standards to create the family physicians of the future. The overarching theme of these recommendations is the need to measure and report on what we want to ultimately improve.
Purpose: Patients who use tobacco often are not provided evidence-based interventions because of barriers such as lack of time or expertise. Using a chronic disease model, we sought to improve delivery of care with an innovative decision support tool and a tobacco use registry.Methods: We designed and implemented a decision support tool in an academic family medicine clinic. To assess barriers, we measured duration of visit and provider confidence (scale of 0 -10) in prescribing cessation medications before and after the introduction of the tool. We examined fidelity through daily counts of returned forms.Results: No significant differences in mean office visit cycle times occurred for tobacco users (64.7 vs 63.1 minutes; P ؍ .90) or between tobacco users and nontobacco users (63.1 vs 62.5 minutes; P ؍ 1.00) before or after implementation of the decision support tool. Mean provider confidence in prescribing cessation medications increased significantly for nicotine inhalers (4.8 vs 6.4; P ؍ .01), nicotine nasal spray (3.9 vs 5.5; P ؍ .03) and combination nicotine replacement therapy (5.5 vs 6.2; P ؍ .05). Two years after implementation, 88% of forms were filled out and returned daily, and >2200 tobacco users have been entered into the registry.
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