Mapping policies, regulations, and practice supports for medical office assistants in primary care: a scoping review

Abstract Importance Medical Office Assistants (MOAs) are non-clinicians who carry out critical tasks in primary care settings. Despite their central roles as the first point of contact for patients or at the front desk, there are no reviews of policies, supports or interventions that could help support MOAs within complex primary care clinics. Objective We systematically scoped the literature to identify interventions, regulations, policies, practice supports, or resources targeting MOAs in primary care. Evidence review Searches were conducted in Pubmed, EMBASE, Web of Science, and grey literature sources (Google, Google Scholar, and Duckduckgo), for items set in high-income countries and reported in English or French, from January 2000 to December 2024. We additionally searched for references for all articles through Scopus. Articles, reports, papers, or other online materials or articles were included if they reported anything about supporting MOAs in primary care clinics. Data analysis involved descriptive numerical summaries and content analysis. Findings Sixty articles were included, covering team building or reconfiguration of the team (18/60; 30%), education/counselling/health coaching (15/60; 25%), navigator or care management of patients (10/60; 17%), training or credentials for MOAs (8/60; 13%), screening activities (6/60; 10%), and advanced rooming (3/60; 5%). Articles were primarily set in the United States (47/60; 78%). Workforce well-being was the most common positive outcome (26/60; 43%). Equity outcomes were rarely reported (5/60; 8%). Commonly identified barriers to implementing interventions included time and resource constraints, staffing challenges, inadequate training, and lack of provider buy-in. Involving MOAs in planning, offering role flexibility, and fostering leadership support were important for success. Furthermore, strong leadership, collaborative relationships, and fair compensation were key components of an environment conducive to change. Conclusion and relevance This review reveals gaps in supporting MOAs as members of the primary care team. Most of the literature focuses on clinic-level changes, with limited evidence on MOA training and/or career growth. Given their strong impact on primary care access and experience for patients, more focus on MOAs in health system reform is warranted.