Will physician associates be replacing doctors?

BackgroundThe physician assistant (PA) and the nurse practitioner (NP) were introduced into The Netherlands in 2001 and 1997 respectively. By the second decade, national policies had accelerated the acceptance and development of these professions. Since 2015, the PA and NP have full practice authority as independent health professionals. The aim of this research was to gain a better understanding of the tasks and responsibilities that are being shifted from Medical Doctors (MD) to PAs and NPs in hospitals. More specifically in what context and visibility are these tasks undertaken by hospital-based PAs and NPs in patient care. This will enable them to communicate their worth to the hospital management.Study designA descriptive, non-experimental research method design was used to collect and analyze both quantitative and qualitative data about the type of tasks performed by a PA or NP. Fifteen medical departments across four hospitals participated.MethodsThe patient scheduling system and hospital information system were probed to identify and characterize a wide variety of clinical tasks. The array of tasks was further verified by 108 interviews. All tasks were divided into direct and indirect patient care. Once the tasks were cataloged, then MDs and hospital managers graded the PA- or NP-performed tasks and assessed their contributions to the hospital management system.FindingsIn total, 2883 tasks were assessed. Overall, PAs and NPs performed a wide variety of clinical and administrative tasks, which differed across hospitals and medical specialties. Data from interviews and the hospital management systems revealed that over a third of the tasks were not properly registered or attributed to the PA or NP. After correction, it was found that the NP and PA spent more than two thirds of their working time on direct patient care.ConclusionsNPs and PAs performed a wide variety of clinical tasks, and the consistency of these tasks differed per medical specialty. Despite the fact that a large part of the tasks was not visible due to incorrect administration, the interviews with MDs and managers revealed that the use of an NP or PA was considered to have an added value at the quality of care as well to the production for hospital-based medical care in The Netherlands.

Medical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. In this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n = 179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. We distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P = 0.000), while MDs spend more time on scientific research (P = 0.030). Across different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care.

When the office is swamped on Monday mornings and pediatricians get behind, Chris Barry, PA-C, M.M.Sc., keeps appointments moving by serving as a floater. “Parents don’t like to wait, especially when they have a sick child,” said Barry, a physician assistant (PA) at a practice in Raleigh, N.C

BackgroundMedical care for admitted patients in hospitals is increasingly reallocated to physician assistants (PAs). There is limited evidence about the consequences for the quality and safety of care. This study aimed to determine the effects of substitution of inpatient care from medical doctors (MDs) to PAs on patients’ length of stay (LOS), quality and safety of care, and patient experiences with the provided care.MethodsIn a multicenter matched-controlled study, the traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which besides MDs also PAs are employed (PA/MD model). Thirty-four wards were recruited across the Netherlands. Patients were followed from admission till one month after discharge. Primary outcome measure was patients’ LOS. Secondary outcomes concerned eleven indicators for quality and safety of inpatient care and patients’ experiences with the provided care.ResultsData on 2,307 patients from 34 hospital wards was available. The involvement of PAs was not significantly associated with LOS (β 1.20, 95%CI 0.99–1.40, p = .062). None of the indicators for quality and safety of care were different between study arms. However, the involvement of PAs was associated with better experiences of patients (β 0.49, 95% CI 0.22–0.76, p = .001).ConclusionsThis study did not find differences regarding LOS and quality of care between wards on which PAs, in collaboration with MDs, provided medical care for the admitted patients, and wards on which only MDs provided medical care. Employing PAs seems to be safe and seems to lead to better patient experiences.Trial registrationClinicalTrials.gov Identifier: NCT01835444

To determine the role played by physician assistants (PAs) in Mohs surgery, researchers surveyed 576 surgeons who were members of the American College of Mohs Surgery. Results from the mail-in survey revealed that 43 of 143 of respondents (30%) used PAs and typically employed one PA. The number of tumors …

Simulation is a vehicle to develop Interprofessional (IP) Education Collaboration. In a situation where hands-on simulation is not possible, especially with online and distance programs, learning may happen through observation, active participation in debriefing, and self-reflection. With the need to develop IP activities for the Laboratory Sciences distance track, an IP simulation was designed to immerse students in IP Education concepts by providing counseling regarding syphilis test results to a pregnant patient. Pre-readings were provided and IP student teams were assigned. Teams prepared before experiencing a standardized participant encounter. Following the encounter, teams participated in debriefing where they reflected on the team performance. Students completed pre- and post-activity evaluations of self-assessments of the learner9s perceptions of IPE and the simulation, using a Likert scale. Students from pharmacy, genetic counseling, medical laboratory sciences, cytotechnology, physician assistant, and public health participated. Results from both face-to-face and online evaluations were compared. There was statistical significance between the pre- and post- assessment scores in simulation experiences (p

Routine daily laboratory testing among clinically stable patients is wasteful and diminishes healthcare value. Although advanced practice providers

s, including 145 duplicates removed. Full texts of the remaining 110 articles were obtained. A further 70 articles were excluded as they did not meet the criteria pertaining to NP prescribing practices in the specific countries reviewed. Non-English and systematic reviews and other integrative review papers were also not selected, leaving 40 articles selected for the review (Figure 1). Surveys or questionnaires were the most commonly used method (n=20), followed by focus groups/interviews/expert panel review (n=10), retrospective designs (n=5), audits (n=4), and one randomized control trial (n=1). USA Nurse prescribing has been in place in the USA since the 1960s, with the purpose of reducing the workload of physicians and addressing the needs of patients in remote areas. Nurse and midwife prescribing has evolved in the USA out of the establishment of the advanced practice roles such as NP, physician assistants (PAs), and nurse–midwife. NPs were granted prescriptive privileges in 1969, when initially legislation was introduced to allow NPs to prescribe medications under the rules and regulations of the regulatory Boards of Medicine and Nursing and was limited to a dependant/ collaborative arrangement. By 2005, 13 states and the District of Columbia authorized NPs to independently prescribe, including controlled drugs. This involved state-mandated requirements for collaborative practice arrangements, between the NP and medical practitioner. There are now 21 states in America deemed to have full practice authority. This authority includes prescriptive authority without mandated collaborative arrangements. To obtain licensure in the USA as an NP, candidates must hold a master’s degree, a post-master’s certificate, or a doctoral degree in nursing from an accredited program. There is a move toward a full requirement for a doctorate as the entry level qualification. Generally, NPs are licensed by the Board of Nursing for the state in which they will practice; laws differ depending on the state. Depending on each state’s regulations, licenses must be periodically renewed, with some states requiring continuing education in order to renew licenses. Although NPs have had prescriptive authority for some time, surprisingly, there is limited research published regarding patient outcomes of NP prescribing practice in the USA. Hooker and Cipher studied the prescriptive practices of NPs, PAs, and medical practitioners by analyzing data from The National Ambulatory Medical Care Survey and found that NPs wrote significantly more prescriptions in rural areas when compared to PAs and medical practitioners. It was proposed that this may relate to more primary care NPs being located in nonmetropolitan areas compared to the number of physicians in these areas. There is no significant difference found in antibiotic prescribing by NPs compared to medical practitioners in a retrospective study of data from the National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey between 1997 and 2001, which investigated NPs (n=506) and medical practitioners (n=13,692) prescribing for upper respiratory infections. It appears that in the elderly, the most commonly prescribed drugs by NPs in the USA include antihypertensive drugs, analgesics, cardiovascular drugs, and diabetic medications. In the 2004 AANP National Nurse Practitioner Sample Survey, a survey of 16,543 NPs identified that the most commonly prescribed medications were nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics followed by antihypertensive medications, diabetic medications, contraceptives, and bronchodilators. This study reported that NPs routinely prescribe in all 50 states and in the District of Columbia, as well as in all practice settings, regardless of specialty. The types of medications prescribed in the USA support the notion that NPs employ pharmacotherapy in the management of acute and complex chronic conditions as well as health maintenance and diseases prevention. Studies that compared NP’s prescribing practices with other clinicians demonstrated the principal finding that there is no difference between NP and medical practitioners prescribing practices. Europe In mainland European countries, some nurses have prescriptive authority, although this varies among specific European countries. Sweden has had prescriptive authority for nurses since 1994, whereas the Netherlands and Spain have explored legislative and procedural amendments to allow prescriptive authority. The Finnish Government has also proposed that nurses working in national public health centers are given a limited right to prescribe medication to patients in their care. Nurse prescriptive authority was primarily implemented in Europe for similar reasons to the USA to improve the patient’s access to medicines, in particular for those in remote areas to both supplement the shortage of physicians and reduce the work load of medical practitioners. In many European countries, NPs have been practicing in the health care system for years, although the level of education can vary between countries and even within the states

Introduction Store-and-forward (SAF) teledermatology involves non-dermatologists sending clinical images to dermatologists. This improves patient care while reducing unwarranted face-to-face (FTF) specialist office visits. Comparisons between dermatologist diagnostic concordance with referring provider, treatment change recommendations, and FTF referrals have yet to be compared by type of provider and practice setting. Methods This retrospective chart review examined SAF teledermatology eConsults from four practice settings: Doctor of Medicine (MD)/Doctor of Osteopathic Medicine (DO) office visits, MD/DO walk-in clinics, nurse practitioner (NP)/physician assistant (PA) office visits and NP/PA walk-in clinics. The most recent 100 MD/DO office- and 100 NP/PA walk-in-referred patient charts were reviewed. There were only 71 NP/PA office and 47 MD/DO walk-in eConsults to review. Results Teledermatologists agreed with referring provider diagnoses 50% of the time for MD/DO office visits, 29.8% for MD/DO walk-in clinics, 33.8% for NP/PA office visits and 34% for NP/PA walk-in clinics. Diagnostic concordance was significantly higher for eConsults from MD/DO office visits than MD/DO walk-in clinics (p = 0.021), NP/PA office visits (p = 0.035) or NP/PA walk-in clinics (p = 0.022). There were significantly more treatment changes recommended after walk-in eConsults than office visits (67 versus 44%, p < 0.0001). FTF visits were recommended more after office visits than walk-in clinics (46 versus 27%, p = 0.001). Overall, 21% (68/318) of patients ultimately attended FTF appointments. Discussion SAF teledermatology improves diagnosis, reducing barriers to specialty care. Overall, potential FTF visit reduction was 79%. Expanding eConsult programmes, particularly in walk-in settings, and for use by NP/PAs or early career internists, may render dermatological care more expeditiously and avoid unnecessary FTF visits.

Purpose: The purpose of this study was to compare the cost of physical therapist (PT) management of patients with musculoskeletal (MSK) disorders to management by traditional primary care managers (PCMs); medical doctors (MDs), doctors of osteopathic medicine (DOs), advanced registered nurse practitioners (ARNPs), and physician assistants (PAs). Methods: This is a retrospective study of electronic medical records using an exploratory, non-experimental, cross-sectional, and quantitative design method. The records of patients with MSK disorders were assessed at an Air Force military medical clinic for 18 months from January 2016 through June 2017. Results: PT management of MSK patients resulted in a significantly lower rate of imaging studies, NSAIDS, and cost of care when compared to MDs, DOs, PAs, or ARNPs. Patients with MSK disorders managed by PTs had no significant difference in return-to-work rate when compared to MDs, DOs, PAs, or ARNPs. Conclusions:The military model of physical therapy direct access care has been shown to be cost effective when compared to care provided by traditional primary care managers.

Objective: The aim of this research was to study the prescribing trends of antibiotics for adherence to the guidelines issued by the American Academy of Paediatrics by utilizing the National Ambulatory Medical Survey (NAMCS) 2016 database. Methods: This was a retrospective, secondary database analysis research exploring the antibiotic prescribing patterns for Urinary Tract Infections (UTI) in infants and children aged 2 to 24 months for the year of 2016 using National Ambulatory Medical Care Survey data. This database was based on a sample of visits to non-federally employed office-based physicians who are engaged in direct patient care and community health centers. Patient sex, race, as well as the source of payment, and the provider type were among the demographic variables studied for adherence to the guidelines. Results: The total number of ambulatory care visits was 316. Of those, 144 (45.6%) patient were prescribed inappropriate antibiotics. Nurse practitioners and physician assistants (48), general/family practitioners (31) and internists (28) were responsible for the majority of inappropriate prescriptions. African American patients (79) received inappropriate prescriptions in most of the cases. Conclusion: Antibiotic resistance is a public health problem of increasing magnitude, and finding effective solutions to address this problem is critical. Antibiotic resistance is also an economic burden on healthcare. Adherence to guidelines minimizes antibiotic resistance and promotes patients and public health.

BackgroundWearable devices can be used for continuous patient monitoring in the general ward, increasing patient safety. Little is known about the experiences and expectations of patients and health care professionals regarding continuous monitoring with these devices.ObjectiveThis study aimed to identify positive and negative effects as well as barriers and facilitators for the use of two wearable devices: ViSi Mobile (VM) and HealthPatch (HP).MethodsIn this randomized controlled trial, 90 patients admitted to the internal medicine and surgical wards of a university hospital in the Netherlands were randomly assigned to continuous vital sign monitoring using VM or HP and a control group. Users’ experiences and expectations were addressed using semistructured interviews. Nurses, physician assistants, and medical doctors were also interviewed. Interviews were analyzed using thematic content analysis. Psychological distress was assessed using the State Trait Anxiety Inventory and the Pain Catastrophizing Scale. The System Usability Scale was used to assess the usability of both devices.ResultsA total of 60 patients, 20 nurses, 3 physician assistants, and 6 medical doctors were interviewed. We identified 47 positive and 30 negative effects and 19 facilitators and 36 barriers for the use of VM and HP. Frequently mentioned topics included earlier identification of clinical deterioration, increased feelings of safety, and VM lines and electrodes. No differences related to psychological distress and usability were found between randomization groups or devices.ConclusionsBoth devices were well received by most patients and health care professionals, and the majority of them encouraged the idea of monitoring vital signs continuously in the general ward. This comprehensive overview of barriers and facilitators of using wireless devices may serve as a guide for future researchers, developers, and health care institutions that consider implementing continuous monitoring in the ward.Trial RegistrationClinicaltrials.gov NCT02933307; http://clinicaltrials.gov/ct2/show/NCT02933307.

Significant medical workforce shortages, particularly in rural and remote locations, have prompted a range of responses in Australia at both state and Commonwealth levels. One such response was a pilot project to test the suitability of the Physician Assistant (PA) role in the Australian context. Five US-trained and accredited PAs were employed by Queensland Health and deployed in urban, rural and remote settings across Queensland. A concurrent mixed-method evaluation was conducted by Urbis, an independent research firm. The evaluation found that the PAs provided quality, safe clinical care under the supervision of local medical officers. The majority of nurses and doctors who worked with the PAs believed that the PAs made a positive contribution to the health care team by increasing capacity to meet patient needs; reducing on-call requirements for doctors; liaising with other clinical team members; streamlining procedures for efficient patient throughput; and providing continuity during periods of doctor changeover. The Pilot demonstrated that a delegated PA role can provide safe, quality health care by augmenting an established healthcare team. The PA role has the potential to benefit the community by increasing the capacity of the health care system, and to improve recruitment and retention by providing an additional professional pathway. The small size of the Pilot limits the ability to generalise regarding the future efficacy of the PA role in Australia. Further research is required to test training and deployment of PAs in a wider range of Australian clinical settings, including general practice and rural health clinics.

Objective To compare and analyze the clinical skill score of 20 866 candidates from 9 provinces (autonomous regions and municipalities) in 2016 China pilot medical licensing examination for rural assistant general physicians, learn from the analysis and further improve the examination. Methods Passing rate, rate of correct answer and mean score are applied in comparison and analysis. Results Passing rate is related to gender, nationality, district, education and career background. Routine physical examinations and operations are best observed, while basic knowledge needs to be improved. Conclusions The result of examination data analysis verifies the scientificity and rationality of the examination design, and lays the foundation for the formal implementation of the examination. It also provides a reference for the decision-making department to further strengthen the construction of primary medical and health teams. Key words: Rural assistant general physicians; Clinical skill test; Score analysis

Predictors of Likelihood and Intensity of Past-Year Mental Health Service Use in an Active Canadian Military Sample