A medical-assistant based approach to identify four major risk behaviors and arrange referrals was much more effective than usual care at linking patients with interventions, but did not lead to greater success in changing the behaviors.
Most primary care patients have at least one major behavioral risk—smoking, risky drinking, low physical activity or unhealthy diet. Primary care is well positioned to address these behaviors, but physicians’ workload hinders effective management. Recent proposals to transform primary care highlight the importance of redefining practice roles to optimize teamwork and appropriate application of skills.
This study, a randomized control trial in a practice-based research network including 864 patients from six primary care practices, examines the effectiveness of using medical assistants (MAs) to identify and refer patients with risk behaviors to appropriate interventions. Outcomes measured were improved risk behaviors, participation in referrals, and MA workflow and job satisfaction.
- Patients screened by medical assistants for smoking, physical inactivity or unhealthy diet were much more likely to attend a referral.
- More patients in the MA referral group (67.4%) attended at least one risk behavior intervention versus 21.8 percent of the usual care group.
- MAs reported that pressure to keep the patient flow moving was a barrier to arranging referrals.
This study was limited by the potential for recruitment and reporting bias, and by the loss of 45 percent of the sample to follow-up. More extensive MA training and sustained behavioral interventions will be necessary to improve risk behavior and outcomes.