A Medical Assistant-Based Program to Promote Healthy Behaviors in Primary Care

Abstract

PURPOSE Most primary care patients have at least 1 major behavioral risk: smoking, risky drinking, low physical activity, or unhealthy diet. We studied the effectiveness of a medical assistant-based program to identify and refer patients with risk behaviors to appropriate interventions. METHODSWe undertook a randomized control trial in a practice-based research network. The trial included 864 adult patients from 6 primary care practices. Medical assistants screened patients for 4 risk behaviors and applied behaviorspecifi c algorithms to link patients with interventions. Primary outcomes were improved risk behaviors on standardized assessments. Secondary outcomes included participation in a behavioral intervention and the program's effect on the medical assistants' workfl ow and job satisfaction.RESULTS Follow-up data were available for 55% of participants at a mean of 12 months. The medical assistant referral arm referred a greater proportion of patients than did usual care (67.4 vs 21.8%; P <.001) but did not achieve a higher success rate for improved behavioral outcomes (21.7 vs 16.9%; P = 0.19). Qualitative interviews found both individual medical assistant and organizational effects on program adoption.CONCLUSION Engaging more primary care team members to address risk behaviors improved referral rates. More extensive medical assistant training, changes in practice culture, and sustained behavioral interventions will be necessary to improve risk behavior outcomes. INTRODUCTIONS moking, risky drinking, physical inactivity, and unhealthy diet are pervasive challenges to health across the world. 1,2 With its high population contact rate, 3,4 primary care is well-positioned to address unhealthy behaviors, but its historical development as a physician-centered acute care delivery system has hampered its ability to manage the large burden of unhealthy behaviors and the chronic diseases that follow. 5 Most practices confront behavioral risks with a very limited response set-physician assessment and management-creating a bottleneck limited by the fl ow of physician workload. 6,7 Better outcomes call for a model of primary care that manages population risk at the necessary scale. 8 Such management requires engaging other members of the primary care team and forging linkages with community resources that can amplify the practice's impact. 9 A framework for managing behavioral risks in primary care emerges from the concept of multiscale complexity. 10 Organizations that address complicated problems must perform an array of tasks that vary in complexity and scale. Complexity measures the degree to which tasks require independent judgment and customization to produce a good outcome. Scale quantifi es the number of tasks to be performed. An important principle in optimizing effi ciency, therefore, is to correctly design a system that can respond to its environment with both low-variety and low-complexity tasks delivered on a 505 PRO GR A M TO PRO M OT E HE A LT HY BEHAV IOR Slarge scale, and high-variety and hig...

Improving Multiple Health Risk Behaviors in Primary Care: Lessons from the Prescription for Health COmmon Measures, Better Outcomes (COMBO) Study

“…21,29 Other Prescription for Health investigators noted that implementation of interventions were uneven and difficult in some networks. 30,31 Although the ability to implement an intervention is important to consider when evaluating the utility of an intervention in practices, it was not possible in this study to assess how implementation variance affected the outcomes or how to interpret positive findings.…”

“…Several networks have reported results based on their own analyses of their network's data. 30,34,35 Because our analysis used different statistical methods and different outcome variable definitions, findings of specific health behavior outcomes may be different.…”

Barriers and Facilitators to Expanding Roles of Medical Assistants in Patient-Centered Medical Homes (PCMHs)

“…iors 2 , track lab reports 3 , identify preventive and chronic care gaps [3][4][5] , outreach to patients for cancer screenings 6 , call patients after emergency department visits or hospitalizations 3 , reconcile medications 7 , scribe clinical encounters in electronic medical records 1 , offer HIV screenings 8 , and administer vaccinations per protocol. 5 They also serve as health coaches to improve lifestyle behaviors 9 , chronic disease care processes 3,10 -18 , and medication adherence.…”

“…5 They also serve as health coaches to improve lifestyle behaviors 9 , chronic disease care processes 3,10 -18 , and medication adherence. 19 These innovative MA roles have been reported across diverse settings, including private practices 2,3,5,20 , community health centers 5,10,13,15,16,19 , academic primary-care practices 8,9,12,14 , rural practices 17 , and large health care systems. 4,5,7 Outcomes in studies that have focused on or included MA role expansion or innovation have varied.…”

Electronic Health Record Impact on Work Burden in Small, Unaffiliated, Community-Based Primary Care Practices

“…[40][41][42][43][44][45][46][47] There is increasing recognition that a team-care approach is needed in primary care, as the physician-centric model is proving to be insufficient to manage the large burden of chronic illnesses and increasing preventive care recommendations. [48][49][50] The limits of the physician-centric model of care may become even more apparent after small practices adopt an EHR system. Evidence from our two exemplary practices (P5 and P6) suggests that thoughtful implementation and workflow redesign can circumvent the problem of overburdening clinicians, while optimizing use of EHR as a tool to enable population-based care.…”