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Role expansion on interprofessional primary care teams: Barriers of role self-efficacy among clinical associates.
Healthc (Amst). 2016 Dec; 4(4):321-326.H

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

IMPLICATIONS

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.

Authors+Show Affiliations

Center for Innovation to Implementation, VA Palo Alto Healthcare System, United States. Electronic address: karleen.giannitrapani@va.gov.Ceders-Sinai Medical Center, United States.Center for the Study of Healthcare Innovation, Implementation and Policy, VA, United States; Greater Los Angeles Healthcare System, University of California Los Angeles, United States.University of California Berkeley, United States.Center for the Study of Healthcare Innovation, Implementation and Policy, VA, United States; Greater Los Angeles Healthcare System, United States.Center for the Study of Healthcare Innovation, Implementation and Policy, VA, United States; Greater Los Angeles Healthcare System, University of California Los Angeles, United States.Center for the Study of Healthcare Innovation, Implementation and Policy, VA, United States; Greater Los Angeles Healthcare System, University of California Los Angeles, United States.Center for the Study of Healthcare Innovation, Implementation and Policy, VA, United States; Greater Los Angeles Healthcare System, University of California Los Angeles, Rand Corporation, United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28007226

Citation

Giannitrapani, Karleen F., et al. "Role Expansion On Interprofessional Primary Care Teams: Barriers of Role Self-efficacy Among Clinical Associates." Healthcare (Amsterdam, Netherlands), vol. 4, no. 4, 2016, pp. 321-326.
Giannitrapani KF, Soban L, Hamilton AB, et al. Role expansion on interprofessional primary care teams: Barriers of role self-efficacy among clinical associates. Healthc (Amst). 2016;4(4):321-326.
Giannitrapani, K. F., Soban, L., Hamilton, A. B., Rodriguez, H., Huynh, A., Stockdale, S., Yano, E. M., & Rubenstein, L. V. (2016). Role expansion on interprofessional primary care teams: Barriers of role self-efficacy among clinical associates. Healthcare (Amsterdam, Netherlands), 4(4), 321-326. https://doi.org/10.1016/j.hjdsi.2016.03.004
Giannitrapani KF, et al. Role Expansion On Interprofessional Primary Care Teams: Barriers of Role Self-efficacy Among Clinical Associates. Healthc (Amst). 2016;4(4):321-326. PubMed PMID: 28007226.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role expansion on interprofessional primary care teams: Barriers of role self-efficacy among clinical associates. AU - Giannitrapani,Karleen F, AU - Soban,Lynn, AU - Hamilton,Alison B, AU - Rodriguez,Hector, AU - Huynh,Alexis, AU - Stockdale,Susan, AU - Yano,Elizabeth M, AU - Rubenstein,Lisa V, Y1 - 2016/05/27/ PY - 2015/08/15/received PY - 2016/03/03/revised PY - 2016/03/07/accepted PY - 2016/12/24/entrez PY - 2016/12/23/pubmed PY - 2017/9/26/medline KW - Interprofessional teams KW - Patient-centered medical home KW - Qualitative research KW - Veterans SP - 321 EP - 326 JF - Healthcare (Amsterdam, Netherlands) JO - Healthc (Amst) VL - 4 IS - 4 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. IMPLICATIONS: 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. SN - 2213-0772 UR - https://www.unboundmedicine.com/medline/citation/28007226/Role_expansion_on_interprofessional_primary_care_teams:_Barriers_of_role_self_efficacy_among_clinical_associates_ DB - PRIME DP - Unbound Medicine ER -