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

Abstract

Background: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes.Methods: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory.Results: MA roles and responsibilities changed from a mostly reactive role, completing tasks dependent on physician orders during the patient visit and facilitating patient flow through the office, to a more proactive one, conducting previsit planning, engaging in the overall care for patients, and assisting with population management. MAs differed in their attitudes about increased responsibilities, with some welcoming the opportunity to take on expanded roles, others resenting their increased responsibilities, and some expressing insufficient understanding regarding why new tasks and procedures were being implemented.

Real-Life Observational Studies Provide Actionable Data for Family Medicine

“…Ferrante et al 10 note that medical assistant roles move from relatively passive to more active in Patient-Centered Medical Homes. There are multiple barriers to this shift, and multiple personal responses to the new roles by both clinicians and medical assistants.…”

Determining the effect of an educational intervention on medical support personnel's knowledge to administer a standardized developmental screening tool.

“…Despite their lack of formal training, medical support personnel are being tasked with responsibilities such as: tracking lab reports (Naughton, Adelman, Bricker, Miller-Day, & Gabbay, 2013); administering vaccines (Ladden et al, 2013); serving as health coaches to improve lifestyle behaviors (Djuric et al, 2017); clinical scribing (Bodenheimer et al, 2014); and screening patients for risky behaviors (smoking, drinking, low physical activity, and unhealthy diet) (Ferrer, Mody-Bailey, Jaen, Gott, & Araujo, 2009). Outcomes in studies that have focused on or included the role expansion of medical support personnel have varied, and there is currently a limited understanding as to why there was success in some studies and not in others (Ferrante et al, 2018). Having a clearer understanding of how to best equip medical support personnel for their changing roles in healthcare is critical to patient care outcomes, and can provide insights into an understudied area of the transformation that is occurring in primary care practice (Bodenheimer et al, 2014;Ferrante et al, 2018).…”

“…Outcomes in studies that have focused on or included the role expansion of medical support personnel have varied, and there is currently a limited understanding as to why there was success in some studies and not in others (Ferrante et al, 2018). Having a clearer understanding of how to best equip medical support personnel for their changing roles in healthcare is critical to patient care outcomes, and can provide insights into an understudied area of the transformation that is occurring in primary care practice (Bodenheimer et al, 2014;Ferrante et al, 2018).…”

“…into an understudied area of the transformation that is occurring in primary care practice (Bodenheimer et al, 2014;Ferrante et al, 2018).…”

“…Specifically, primary care physicians report a lack of selfperceived competency, a desire for education, and a need for improved, specific training in developmental screening (Golnik, Ireland, & Borowsky, 2009). Facilitators to implementation have also been identified and evaluated; most notably is the expanding roles of medical support personnel (Baker et al, 2010;Bernier, Strobel, & Lucas, 2018;Bodenheimer et al, 2014;Ferrante et al, 2018). The duration of formal training for medical support personnel, typically at a community college or a commercial training program, varies from three months to two years, with little standardization of curricula, and few programs exist nationally that address the skills needed for expanded roles (Bodenheimer et al, 2014).…”