Team-based care: an expanded medical assistant role - enhanced rooming and visit assistance.

Primary care practices face significant challenges as they pursue the Quadruple Aim. Redistributing care across the interprofessional primary care team by expanding the role of the medical assistant (MA) is a potential strategy to address these challenges. Two sequential, linked processes to expand the role of the MA, called Enhanced Rooming and Visit Assistance, were implemented in four family medicine residency clinics in Minnesota. In Enhanced Rooming, MAs addressed preventive services, obtained a preliminary visit agenda, and completed a warm hand-off to the provider. In Visit Assistance, MAs stayed in the room the entire visit to assist with the visit workflow. Enhanced Rooming and Visit Assistance processes were successfully implemented and sustained for over one year. MAs and providers were satisfied with both processes, and patients accepted the expanded MA roles. Mammogram ordering rates increased from 10% to 25% (p < 0.0001). After Visit Summary (AVS) print rates increased by 12% (p < 0.0001). Visit Turn-Around-Time (TAT) decreased 3.1 minutes per visit (p = 0.0001). Expanding the MA role in a primary care interprofessional team is feasible and a potentially useful tool to address the Quadruple Aim.

Team-based approach to improving medication reconciliation rates in family medicine residency clinics.

OBJECTIVE: The objective of this quality improvement project was to design and implement a systematic team-based care approach to medication reconciliation, with a goal of physician-documented medication reconciliation at 70% of all patient office visits. SETTING: Ambulatory clinics located in urban, underserved communities in Minneapolis and St. Paul, MN. PRACTICE DESCRIPTION: Four family medicine residency clinics, with pharmacists integrated at each site. All clinics use the Epic electronic medical record (Epic Systems Corporation). PRACTICE INNOVATION: A team-based care approach to medication reconciliation was designed and implemented involving medical assistants (MAs), physicians, and pharmacists. The MAs did an initial review with patients, the physicians addressed discrepancies, and difficult situations were escalated to the pharmacist for a detailed assessment. EVALUATION: The percentage of visits with physician-documented medication reconciliation was measured preintervention and then for 18 months postintervention in 6-month intervals involving more than 118,000 patient visits. Satisfaction surveys of team members were done pre- and postintervention. RESULTS: The percentage of visits with physician-documented medication reconciliation improved significantly from 6.5% preintervention to 58.7% (P < 0.001) postintervention, and was sustained and further improved to 70.3% (P < 0.001) 1 year later. The team members had a statistically significant improvement in their ability to articulate the medication reconciliation process. Satisfaction improved significantly for physicians, but MAs did not experience a statistically significant change. CONCLUSION: A team-based care approach to medication reconciliation was successfully implemented and sustained at 4 family medicine clinics. There was significant improvement in physician-documented medication reconciliation. Future studies need to address whether this process improves medication-list discrepancies, completeness, and accuracy.

Emergency contraceptive pills: dispensing practices, knowledge and attitudes of South Dakota pharmacists.

CONTEXT: Despite a decision by the Food and Drug Administration to deny over-the-counter status to emergency contraceptive pills, pharmacists play a crucial role in a woman's access to this medication, especially in areas with large rural populations. Pharmacists' knowledge about and attitudes toward emergency contraceptive pills may affect whether pharmacies carry the medication and whether individual pharmacists dispense it. METHODS: In October 2003, all registered pharmacists living and working in South Dakota were mailed a survey to assess their dispensing practices for, knowledge about, and attitudes toward emergency contraceptive pills. Data for 501 respondents were analyzed through chi-square testing and multivariate logistic regression. RESULTS: Fifty-four percent of respondents worked in pharmacies that carried emergency contraceptive pills. Of these, 67% had dispensed the medication in 2003, and 24% were not comfortable providing customer counseling about the method. Thirty-seven percent of all pharmacists did not understand its mechanism of action; 43% and 21%, respectively, incorrectly answered questions about the medication's link to birth defects and health risks. Only 5% correctly answered all three questions. Eighty-four percent of surveyed pharmacists believed that the medication should not be made available over the counter. Multivariate analysis showed that knowledge of emergency contraception and support for over-the-counter status were relatively low among pharmacists working in small communities. CONCLUSIONS: The education of pharmacists about emergency contraceptive pills must be strengthened to ensure that women receive accurate medical information and access to all contraceptive services.