Skip Navigation LinksHome > October/December 2013 - Volume 38 - Issue 4 > Care guides: An examination of occupational conflict and rol...
Health Care Management Review:
doi: 10.1097/HMR.0b013e31825f3df9
Features

Care guides: An examination of occupational conflict and role relationships in primary care

Wholey, Douglas R.; White, Katie M.; Adair, Richard; Christianson, Jon B.; Lee, Suhna; Elumba, Deborah

Collapse Box

Abstract

Background:

Improving the efficiency and effectiveness of primary care treatment of patients with chronic illness is an important goal in reforming the U.S. health care system. Reducing occupational conflicts and creating interdependent primary care teams is crucial for the effective functioning of new models being developed to reorganize chronic care. Occupational conflict, role interdependence, and resistance to change in a proof-of-concept pilot test of one such model that uses a new kind of employee in the primary care office, a “care guide,” were analyzed. Care guides are lay individuals who help chronic disease patients and their providers achieve standard health goals.

Purpose:

The aim of this study was to examine the development of occupational boundaries, interdependence of care guides and primary care team members, and acceptance by clinic employees of this new kind of health worker.

Methodology/Approach:

A mixed methods, pilot study was conducted using qualitative analysis; clinic, provider, and patient surveys; administrative data; and multivariate analysis. Qualitative analysis examined the emergence of the care guide role. Administrative data and surveys were used to examine patterns of interdependence between care guides, physicians, team members, and clinic staff; obtain physician evaluations of the care guide role; and evaluate the effect of care guides on patient perceptions of care coordination and follow-up.

Findings:

Evaluation of implementation of the care guide model showed that (a) the care guide scope of practice was clearly defined; (b) interdependent relationships between care guides and providers were formed; (c) relational triads consisting of patient, care guide, and physician were created; (d) patients and providers were supported in managing chronic disease; and (e) resistance to this model among traditional employees was minimized.

Practice Implications:

The feasibility of implementing a new care model for chronic disease management in the primary care setting, identifying factors associated with a positive organizational experience, was shown in this study.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Login

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.