Foundational Knowledge and Basic Science

The role of an MA is primarily to work alongside a provider in an outpatient or ambulatory health care setting, such as a medical office.The MA can be cross-trained to perform both administrative and clinical duties. Administrative duties include greeting patients, scheduling, handling In addition, the MA is often responsible for obtaining medical histories from patients, providing patient education, performing laboratory tests, and preparing and administering immunizations. An MA achieves credentialing by passing a national certification exam.

Allied Health Professionals

Medical laboratory technicians perform diagnostic testing on blood, bodily fluids, and other specimens under the supervision of a medical technologist.

Medical receptionists check patients in and out, answer phones, schedule appointments, and perform other administrative tasks.

Occupational therapists assist patients who have conditions that disable them developmentally, emotionally, mentally, or physically.

Pharmacy technicians may perform routine medication dispensing functions that do not require the expertise or judgment of a licensed pharmacist. Pharmacy technicians must work under the direct supervision of a pharmacist.

Physical therapists assist patients in improving mobility, strength, and range of motion.

Radiology technicians use various imaging equipment to assist the provider in diagnosing and treating certain diseases.

TYPES OF HEALTH CARE ORGANIZATIONS AND DELIVERY MODELS

Inpatient and Outpatient

Inpatient care occurs while the patient is admitted to a hospital or facility. Ambulatory care refers to any care received in an outpatient facility. This includes many types of care settings.

Primary Care Clinics

Primary care clinics are outpatient care settings where patients are seen for routine type visits,

minor acute needs. Primary care will be discussed in more detail later in the chapter.

Specialty Care Clinics

Specialty care clinics are outpatient facilities where patients who have complex or severe diseases and conditions are seen for routine visits by doctors who specialize in a specific disease or condition.

Home Health

Home health refers to specific types of care provided to those who cannot leave their home easily.

Physical, occupational, and speech therapy are common types of home care. Skilled nursing is also common in the home health setting. It must be prescribed and overseen by a provider, typically a primary care provider (PCP). Home health is not used on an ongoing basis for a patient but is ordered for a set period based on an acute event, usually hospitalization. Home health orders include goals for the patient, such as managing their medications and ambulating safely. The service is complete when the goals are reached. Medical assistants working for the ordering provider are often responsible for submitting the order for home health, coordinating to ensure the patient is enrolled and scheduled, and assisting with the administrative aspects of the orders.

Mobile Health Units

Mobile health units bring health care to the communities that most need it and may otherwise lack access to the services provided. Teams working in a mobile health unit are equipped with means of transportation that allow for the setup and use of specialized medical equipment. There are mobile health units in the U.S. While this concept has been in use for services such as mobile stroke units, mobile urgent cares, and mobile mammogram buses, the COVID-19 pandemic brought this type of care to much of the country in the form of mobile testing and vaccination options.

Hospice

Hospice care is end-of-life care focused on comfort rather than curative efforts. Patients can qualify for hospice care if they have a terminal illness at the end stage. It can be delivered as outpatient or inpatient care. Typically, a patient will begin hospice outpatient but can transition to inpatient care as they need a higher level of care near the end of life.

TELEHEALTH AND VIRTUAL VISITS

Telehealth is health care delivered virtually, most commonly via video call. The increase in telehealth expanded to eliminate patients from coming in contact with communicable diseases, provide convenience, and allow patients in rural areas to obtain specialty care where it may not have been offered before. Telehealth can be an excellent option for patients and providers to review many aspects of care, but it does come with limitations. Medical assistants may have multiple responsibilities when it comes to virtual visits. Scheduling virtual visits may require more time because the MA must gather or confirm the patient's email address, ensure the link has been sent, and review instructions. Some offices offer patients a test visit in which an administrator or MA will log into the link to ensure the patient can access it when it is time for their appointment. Medical assistants may also participate in the actual visit, just as they would with a standard office visit. This can include gathering a history, verifying medication and pharmacy information, setting an agenda, and following up with the patient on the next steps, such as referral or diagnostic testing coordination.

1.7 Telehealth Appropriate

• Follow-up on medication adjustments

• Chronic condition review and discussion

• Patient education

• Evaluation of minor or common rashes and skin concerns

• Follow-up on new medical equipment, such as a CPAP machine

• Discussion of lab results

1.8 In-Person Evaluation Needed

• Diagnostic testing, such as imaging or lab work

• New pain symptoms

• Physical examination

1.13 Medication Classifications: Indications and Examples

Schedule I includes substances with a high potential for abuse and currently no approved medical use in the U.S. They are illegal, and providers may not prescribe them. These include heroin, mescaline, and lysergic acid diethylamide (LSD). Schedule I still includes cannabis (marijuana) even though it is legal for medical use with a prescription in many states. States can add substances to a schedule as a matter of state law, even if not included in federal scheduling. In the case of marijuana, the federal government does not federally prosecute those who use cannabis in states that allow it.

Schedule II includes substances that have a high potential for abuse, are considered dangerous, and can lead to psychological and physical dependence. Unlike schedule I drugs, schedule II drugs are approved for medical use. Schedule II drugs include morphine, methadone, oxycodone, hydromorphone, hydrocodone, fentanyl, and amphetamine. Schedule II prescriptions must be signed by hand, except as rules allow regarding distribution of electronic or printed prescriptions. Prescribers may electronically transmit prescriptions directly to the pharmacy in states where the prescription meets the requirement of state and federal regulations. Schedule II substances must be stored in a safe or steel cabinet of substantial construction. If the safe or cabinet is less than 750 pounds, it must be mounted or secured to something of substantial construction. The device should have an inner and outer door with locks for each door requiring different keys.

Schedule III includes substances with moderate to low potential for physical and psychological dependence. These include ketamine, anabolic steroids, acetaminophen with codeine, and buprenorphine.

Schedule IVincludes substances that have a low potential for abuse and dependence. These include tramadol and benzodiazepines including diazepam, alprazolam, chlordiazepoxide, and clonazepam.

Schedule V includes substances that contain limited quantities of some narcotics, usually for antidiarrheal, antitussive, and analgesic purposes. These include diphenoxylate with atropine, guaifenesin with codeine, and pregabalin.

Schedule III, IV, and V controlled substances may not be filled or refilled more than 6 months after the date on which the prescription was issued and may not be refilled more than five times in 6 months.

For a current alphabetical list of all controlled substances and their CSA schedule number, go to the resources section of the Office of Diversion Control website.

1.22 Nonparenteral Routes

1.24 Common Parenteral Routes for Medications-Injectable

1.26 Common Parenteral Routes— Noninjectable

Right Technique

Medical assistants must know and understand the correct techniques for administering medications.

For example:

• When administering an intramuscular injection, the correct angle of insertion of the needle is
  90 degrees.

• The correct angle of insertion of an intradermal injection is 10 to 15 degrees.

• The correct angle for subcutaneous injections is 45 degrees.

Right Documentation

Always document administering medication after the patient receives it, not before. If the MA does not administer a medication as prescribed, the documentation must include this and why the patient did not receive it. Proper documentation includes date, time, quantity, medication, strength, method and location of administration, lot number, manufacturer, expiration date, and patient outcome, including any reaction or adverse effects a patient may have had to the medication, noting that the patient tolerated it well.

1.34 Common Vitamins and Supplements: Intended Benefits and Safety Considerations

1.34 Common Vitamins and Supplements: Intended Benefits and

Safety Considerations (continued)

EATING DISORDERS

Medical assistants are likely to encounter patients who have eating disorders, which are food patterns that can impair health and well being. The most common are anorexia nervosa, bulimia nervosa and binge-eating disorder.

ANOREXIA

Anorexia nervosa affects people of all ages, genders, and races. Characteristically, patients are high achievers no colt severe control over their ending and race, ten, therests a family history o

major life changes, and high stress levels.

najor life cha alcohol use disorder. Some patients havanterns, often, there id trauma, depression,

Warning signs and symptoms of anorexia nervosa include the following.

• Self-starvation

• Perfectionism

• Extreme sensitivity to criticism

• Excessive fear of weight gain

• Weight loss of at least 15%

• Amenorrhea (no menstrual periods)

• Denial of feelings of hunger

• Excessive exercising

• Ritualistic eating behavior

• Extreme control of behavior

• Unrealistic image of the self as obese

Medical assistants who observe or suspect any of these manifestations should alert the provider immediately, as this disorder can be life-threatening. Treatment involves hospitalization with parenteral nutrition or nasogastric feedings, plus psychotherapy. Educating the patient and family about nutrition is also essential.