Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr San Antonio, TX 78229-3900, USA.
Ann Fam Med. 2009 Nov-Dec;7(6):504-12. doi: 10.1370/afm.1059.
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.
We 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 behavior-specific 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' workflow and job satisfaction.
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.
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.
大多数初级保健患者至少存在 1 种主要行为风险：吸烟、危险饮酒、身体活动不足或不健康饮食。我们研究了一种基于医疗助理的方案，以识别和转介有风险行为的患者接受适当干预的效果。
我们在一个基于实践的研究网络中进行了一项随机对照试验。该试验包括来自 6 个初级保健诊所的 864 名成年患者。医疗助理对患者进行了 4 种风险行为的筛查，并应用特定于行为的算法将患者与干预措施联系起来。主要结果是标准化评估中风险行为的改善。次要结果包括参与行为干预以及该方案对医疗助理工作流程和工作满意度的影响。
在平均 12 个月时，55%的参与者可获得随访数据。与常规护理相比，医疗助理转介组转介的患者比例更高（67.4%比 21.8%；P<.001），但改善行为结果的成功率并没有更高（21.7%比 16.9%；P=0.19）。定性访谈发现，个人医疗助理和组织对方案采用都有影响。
让更多的初级保健团队成员参与解决风险行为问题可以提高转介率。需要更广泛的医疗助理培训、实践文化的改变和持续的行为干预，才能改善风险行为的结果。
