Background: Countries experiencing the dual problem of an aging population and a decline in numbers of GPs have delegated roles to other health providers, including health assistants (HAs) and medical scribes. HAs are trained in administrative and clinical assisting roles, whilst scribes document clinical consultations, in real-time, into the health record. The existing health emergency required rapid deployment and training of staff from a variety of medical and nonmedical roles to become HA-scribes. In a GP-led COVID-19 respiratory clinic HAs directly assisted GPs with patient management and scribes operated remotely via video-call (tele-scribes). An evaluation of acceptability and safety of a Melbourne respiratory clinic explored HA-scribe perceptions about their role and risks around infection control, and assessed the quality of scribe records.
Method: Mixed methods included six semi-structured interviews with HA-scribes and a retrospective, blinded review of 200 respiratory clinic encounters, remotely recorded by 22 scribes. Two GP-researchers used a modified version of a validated tool, QNote, scoring seven elements of the encounter as fully/ partially acceptable or unacceptable, missing or not-applicable.
Results: Thematic analysis of interview transcripts indicated HA-scribes were motivated by a desire to serve the community during the pandemic. They felt confident with levels of personal protective equipment and satisfied with job-variety, but had to be highly flexible in their role. Mental health stressors associated with COVID19 work were largely mitigated through training, practice policies and procedures. Clinical record review showed more than 90 percent of encounters were deemed acceptable.
Discussion: HA-scribes upheld quality and safety of procedures in the respiratory clinic. Quality of GP records could be measured using the QNote tool.
Implications for practice: HAs-scribes could be employed in routine general practice. Future research could explore professional boundaries, training and competence, cost-effectiveness and patient and GP acceptance of the HA-scribe role.