title: Who is responsible for what tasks within primary care: Perceived task allocation among primary care providers and interdisciplinary team members.
abstract: BACKGROUND
  Unclear roles in interdisciplinary primary care teams can impede optimal team-based care. We assessed perceived task allocation among primary care providers (PCPs) and staff during implementation of a new patient-centered care model in Veterans Affairs (VA) primary care practices.
  
  
  METHODS
  We performed a cross-sectional survey of PCPs and primary care staff (registered nurses (RNs), licensed practical/vocational nurses (LPNs), and medical assistants/clerks (MAs)) in 23 primary care practices within one VA region. We asked subjects whether PCPs performed each of 14 common primary care tasks alone, or relied upon staff for help. Tasks included gathering preventive service history, disease screening, evaluating patients and making treatment decisions, intervening on lifestyle factors, educating patients about self-care activities and medications, refilling prescriptions, receiving and resolving patient messages, completing forms, tracking diagnostic data, referral tracking, and arranging home health care. We then performed multivariable regression to determine predictors of perceived PCP reliance on staff for each task.
  
  
  RESULTS
  162 PCPs and 257 staff members responded, a 60% response rate. For 12/14 tasks, fewer than 50% of PCPs reported relying on staff for help. For all 14 tasks, over 85% of RNs reported they were relied upon. For 12/14 tasks, over 50% of LPNs reported they were relied on, while for 5/14 tasks a majority of MAs reported being relied upon. Nurse practitioners and physician assistants (NP/PAs) reported relying on staff less than physicians.
  
  
  CONCLUSIONS
  Early in the implementation of a team-based primary care model, most PCPs perceived they were solely responsible for most clinical tasks. RNs, and LPNs felt they were relied upon for most of the same tasks, while medical assistants/clerks reported being relied on for fewer tasks. Better understanding of optimal inter-professional team task allocation in primary care is needed.
authors.affiliation: Section of General Internal Medicine, Veterans Affairs (VA) Portland Health Care System, Portland, OR, United States; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States; Division of General Internal Medicine and Geriatrics, Oregon Health and Sciences University, Portland, OR, United States. Electronic address: samuel.edwards@va.gov.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Edwards
authors.affiliation: RAND Corporation, Santa Monica, CA, United States; Center for the Study of Healthcare Implementation, Innovation and Policy, VA Greater Los Angeles, Los Angeles, CA, United States; Department of Health Policy & Management, University of California Los Angeles (UCLA) School of Public Health, Los Angeles, CA, United States; Department of Medicine, UCLA School of Medicine, Los Angeles, CA, United States.
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.affiliation: RAND Corporation, Santa Monica, CA, United States; Center for the Study of Healthcare Implementation, Innovation and Policy, VA Greater Los Angeles, Los Angeles, CA, United States.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Meredith
authors.affiliation: RAND Corporation, Santa Monica, CA, United States.
authors.forename: Nicole
authors.initials: N
authors.lastname: Schmidt Hackbarth
authors.affiliation: Center for the Study of Healthcare Implementation, Innovation and Policy, VA Greater Los Angeles, Los Angeles, CA, United States.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Stockdale
authors.affiliation: Center for the Study of Healthcare Implementation, Innovation and Policy, VA Greater Los Angeles, Los Angeles, CA, United States; Department of Medicine, UCLA School of Medicine, Los Angeles, CA, United States.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Cordasco
authors.affiliation: Center for the Study of Healthcare Implementation, Innovation and Policy, VA Greater Los Angeles, Los Angeles, CA, United States.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Lanto
authors.affiliation: VA Loma Linda Healthcare System, Loma Linda, CA, United States.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Roos
authors.affiliation: Center for the Study of Healthcare Implementation, Innovation and Policy, VA Greater Los Angeles, Los Angeles, CA, United States; Department of Health Policy & Management, University of California Los Angeles (UCLA) School of Public Health, Los Angeles, CA, United States.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D006801:Humans; D010348:Patient Care Team; D018802:Patient-Centered Care; D010823:Physician Assistants; D058007:Physicians, Primary Care; D011320:Primary Health Care; D012648:Self Care; D014481:United States
keywords: Allied health personnel; Health care teams; Health manpower; Patient-centered medical home; Primary care