Center for Innovation to Implementation, VA Palo Alto Healthcare System, United States.
Ceders-Sinai Medical Center, United States.
Healthc (Amst). 2016 Dec;4(4):321-326. doi: 10.1016/j.hjdsi.2016.03.004. Epub 2016 May 27.
Interprofessional team-based models of primary care that expand the role of clinical associates (CAs) are increasingly adopted in primary care practices. In this study we query team members of a newly implemented patient centered medical home (PCMH) to identify facilitators and barriers of occupational role self-efficacy, a belief of possessing the capacity to execute their new team based role effectively.
79 key informants, members of primary care teams at six Veterans Health Administration (VA) clinics, were interviewed to assess their experiences with implementing expanded roles for CAs. All sites had implemented Patient Aligned Care Teams, the VA's version of PCMH.
Three themes that produced the self-efficacy necessary for successful role expansion of CAs were identified: (1) role training (2) time and resources for roles and (3) cross-disciplinary role agreement. Sub-themes emerged around role challenges. Training sub themes included incomplete or limited training, inconsistencies in trainings within a site, and not receiving training with team members. Insufficient resources sub-themes included limited time for expanded tasks, inadequate space, low staffing, and poor task mix. Cross-disciplinary agreement failed to occur specifically when there was insufficient coordination between medicine and nursing leadership about staff roles, poor primary care provider (PCPs) knowledge of the boundaries of staff roles, and lack of synchronicity between staff roles and what PCPs would like staff roles to include.
These identified themes have implications for healthcare professionals working in interprofessional teams in a variety of settings and indicate the need for interdisciplinary leadership based solutions.
Clarifying the factors that impact self-efficacy for the role expansion of PACT staff can inform strategies for role transformation for enhanced primary care delivery.
越来越多的初级保健以专业团队为基础的模式扩大了临床助理员（CA）的作用。在这项研究中，我们向新实施的以患者为中心的医疗之家（PCMH）的团队成员询问，以确定职业角色自我效能的促进因素和障碍，这是一种相信自己有能力有效地执行新的团队角色的信念。
对 6 家退伍军人事务部（VA）诊所的初级保健团队的 79 名主要信息提供者进行了访谈，以评估他们在实施 CA 扩大职责方面的经验。所有的站点都实施了患者一致护理团队，这是 VA 版的 PCMH。
确定了三个主题，这些主题产生了 CA 成功扩展角色所需的自我效能：（1）角色培训；（2）角色的时间和资源；（3）跨学科角色协议。次要主题出现在角色挑战周围。培训子主题包括培训不完整或有限、站点内培训不一致以及没有与团队成员一起接受培训。资源不足的子主题包括扩大任务的时间有限、空间不足、人员配备不足以及任务组合不佳。当医学和护理领导层之间对员工角色的协调不足、初级保健提供者（PCP）对员工角色边界的知识不足以及员工角色与 PCP 希望员工角色包括的内容之间缺乏同步性时，跨学科协议未能达成。
这些确定的主题对在各种环境中从事跨专业团队工作的医疗保健专业人员具有影响，并表明需要基于跨学科领导的解决方案。
明确影响 PACT 员工角色扩展自我效能的因素，可以为增强初级保健服务提供的角色转换策略提供信息。
