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Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff. | LitMetric

Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff.

Med Anthropol Q

VISN 23 Patient Aligned Care Team Demonstration Lab and, CADRE, the Center for Comprehensive Access & Delivery Research and Evaluation Department of Veterans Affairs Iowa City VA Health Care System and Tippie College of Business, University of Iowa.

Published: March 2017

AI Article Synopsis

  • The adoption of the patient-centered medical home (PCMH) model for primary care has significantly increased globally over the past ten years, with research mainly focusing on the roles of trained clinical staff.
  • This article presents an ethnographic study examining the PACT model used by the Department of Veterans Affairs, which emphasizes within-team delegation based on clinical licensure to provide effective patient-centered care.
  • The analysis highlights how this delegation can create a clinically defined culture that may contradict PCMH principles, particularly through the often overlooked emotional labor of clerks, suggesting a need for further research into the dynamics of care, stigma, and authority in the healthcare context.

Article Abstract

International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within-team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient-centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks' care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient-centered care, stigma, and clinical authority.

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Source
http://dx.doi.org/10.1111/maq.12281DOI Listing

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