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Abstract
Background/Significance of problem: Atopic Dermatitis (AD) is a common, chronic, inflammatory dermatosis and skin disease that follows a relapsing pattern and requires a dynamic stepwise approach to management. Providers feel comfortable treating chronic disease states with a guided tool or care plan in many chronic diseases. Care plans used in many chronic diseases such as asthma, diabetes, and COPD have demonstrated effectiveness in disease and healthcare provider management. There is an unmet need for a universal AD care plan for providers.
Clinical question/project purpose: A universal AD care plan was developed to improve AD disease management and patient outcomes. Post-implementation of providers & perceptions was assessed for how the AD universal care plan affected their ability to provide patient education.
Search of literature/best evidence:
Review of literature includes: CINAHL, ProQuest Health, PubMed, Fusion, and UpToDate databases from 2008-2018.Search terms included: Atopic Dermatitis, Eczema, care plans, care plan use in chronic disease.
Clinical appraisal of literature/best evidence: Analysis of the evidence supported the need for AD education, which then supported the need for a universal AD care plan for providers. Integration into practice: "Your Eczema Care Plan" was used by thirty-five healthcare providers to improve patient outcomes in a similar manner as other evidence-based care plans.Evaluation of evidenced-based practice: Post-implementation of providers & perceptions were evaluated on how the AD care plan tool affected their ability to provide patient education. Results suggest patient education, disease management, and QOL are all improved when utilizing "Your Eczema Action Plan."
J Drugs Dermatol. 2020;19(10): 950-955. doi:10.36849/JDD.2020.5090.
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Affiliation(s)
- Richard W Dehn
- Richard W. Dehn is a professor in the College of Health and Human Services at Northern Arizona University's Phoenix Biomedical Campus, a professor of practice in the Department of Biomedical Informatics at the University of Arizona College of Medicine in Phoenix, and editor-in-chief of JAAPA. The author has disclosed no potential conflicts of interest, financial or otherwise
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Affiliation(s)
- Lea R Hix
- Lea R. Hix, PA-S,* is a student in Stanford University's Master of Science in Physician Assistant Studies program, Stanford, California
- Susan M. Fernandes, LPD, PA-C, is a clinical professor of pediatrics and medicine and the associate dean for PA education at the Stanford School of Medicine, Stanford, California
| | - Susan M Fernandes
- Lea R. Hix, PA-S,* is a student in Stanford University's Master of Science in Physician Assistant Studies program, Stanford, California
- Susan M. Fernandes, LPD, PA-C, is a clinical professor of pediatrics and medicine and the associate dean for PA education at the Stanford School of Medicine, Stanford, California
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Dharaniprasad G, Srikanth L, Ballweg R, Sarma P, Indra Kumar S, Samantaray A. The Journey of Physician Assistants in India: Specialty Areas to Primary Care. J Physician Assist Educ 2019; 30:184-187. [PMID: 31385907 DOI: 10.1097/jpa.0000000000000264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Goduguchintha Dharaniprasad
- Goduguchintha Dharaniprasad, PhD, PG.Dip.PA, is a physician assistant and researcher in the Department of Anesthesiology at SVIMS University in Tirupati, Andhra Pradesh, India. Lokanathan Srikanth, PhD, is a research technician in the Department of Biotechnology at SVIMS University in Tirupati, Andhra Pradesh, India. Ruth Ballweg, MPA, PA-C, is a professor emeritus and former director of the MEDEX Northwest Physician Assistant Program at the University of Washington, Seattle, Washington. PVGK Sarma, PhD, is a professor and head in the Department of Biotechnology at SVIMS University in Tirupati, Andhra Pradesh, India. Sundi Indra Kumar, PG.Dip.PA, is a physician assistant in the Department of Endocrinology at Apollo hospitals in Hyderabad, Telangana, India. Aloka Samantaray, MD, is a professor and head in the Department of Anesthesiology at SVIMS University in Tirupati, Andhra Pradesh, India
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Abstract
PURPOSE Community medicine curriculum prepares physician assistant (PA) students to provide services to vulnerable and underserved populations. This article describes a service-learning model that uses a mobile health clinic (MHC) experience as part of the community medicine rotation. It provides an overview of the clinic's operation, patient documentation and characteristics, and student learning experiences. METHODS Students collected demographic information on patients who visited the MHC during January through December 2017. The students summarized patient demographics and reflected on their experiences in a report. RESULTS Two main outcomes are discussed: characteristics of the MHC patients and student observations about their experiences. In 2017, 113 students rotated through the MHC and recorded 813 patient encounters. The largest proportions of patients reported living on the street or in a shelter (71%) and were older than 56 years (40%), males (74%), Caucasian (43%), single (65%), nonveterans (77%), and high school graduates (41%). The top 5 reasons for visits were preventive care, cognitive/functional impairment, cardiometabolic disorders, skin issues, and respiratory illness. The MHC experience and process of recording and analyzing demographic data contributed to students' data management and analytical skills. The students identified problems of recordkeeping and their implications for patient care, gained a greater understanding of medical needs and complexities of treating the homeless, and provided suggestions for improving quality and efficiency of care. CONCLUSIONS The MHC service-learning model provides diverse, meaningful experiences for students. Our findings benefit PA programs aiming to expand and strengthen their community medicine curriculum.
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Affiliation(s)
- Amie Duford
- Amie Duford, MPAS, PA-C, is an assistant professor in the School of Physician Assistant Studies at Touro University Nevada, Henderson, Nevada. Oksana Matvienko, PhD, is an associate professor in the School of Physician Assistant Studies at Touro University Nevada, Henderson, Nevada
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Kroth PJ, Morioka-Douglas N, Veres S, Babbott S, Poplau S, Qeadan F, Parshall C, Corrigan K, Linzer M. Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout. JAMA Netw Open 2019; 2:e199609. [PMID: 31418810 PMCID: PMC6704736 DOI: 10.1001/jamanetworkopen.2019.9609] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE Many believe a major cause of the epidemic of clinician burnout is poorly designed electronic health records (EHRs). OBJECTIVES To determine which EHR design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. DESIGN, SETTING, AND PARTICIPANTS This survey study of 282 ambulatory primary care and subspecialty clinicians from 3 institutions measured stress and burnout, opinions on EHR design and use factors, and helpful coping strategies. Linear and logistic regressions were used to estimate associations of work conditions with stress on a continuous scale and burnout as a binary outcome from an ordered categorical scale. The survey was conducted between August 2016 and July 2017, with data analyzed from January 2019 to May 2019. MAIN OUTCOMES AND MEASURES Clinician stress and burnout as measured with validated questions, the EHR design and use factors identified by clinicians as most associated with stress and burnout, and measures of clinician working conditions. RESULTS Of 640 clinicians, 282 (44.1%) responded. Of these, 241 (85.5%) were physicians, 160 (56.7%) were women, and 193 (68.4%) worked in primary care. The most prevalent concerns about EHR design and use were excessive data entry requirements (245 [86.9%]), long cut-and-pasted notes (212 [75.2%]), inaccessibility of information from multiple institutions (206 [73.1%]), notes geared toward billing (206 [73.1%]), interference with work-life balance (178 [63.1%]), and problems with posture (144 [51.1%]) and pain (134 [47.5%]) attributed to the use of EHRs. Overall, EHR design and use factors accounted for 12.5% of variance in measures of stress and 6.8% of variance in measures of burnout. Work conditions, including EHR use and design factors, accounted for 58.1% of variance in stress; key work conditions were office atmospheres (β̂ = 1.26; P < .001), control of workload (for optimal control: β̂ = -7.86; P < .001), and physical symptoms attributed to EHR use (β̂ = 1.29; P < .001). Work conditions accounted for 36.2% of variance in burnout, where challenges included chaos (adjusted odds ratio, 1.39; 95% CI, 1.10-1.75; P = .006) and physical symptoms perceived to be from EHR use (adjusted odds ratio, 2.01; 95% CI, 1.48-2.74; P < .001). Coping strategies were associated with only 2.4% of the variability in stress and 1.7% of the variability in burnout. CONCLUSIONS AND RELEVANCE Although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.
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Affiliation(s)
| | | | | | | | - Sara Poplau
- Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | | | | | - Kathryne Corrigan
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Mark Linzer
- Minneapolis Medical Research Foundation, Minneapolis, Minnesota
- Hennepin County Medical Center, Minneapolis, Minnesota
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Dies NF, Taylor MT. Ontario physician assistants: Decision time. Can Fam Physician 2019; 65:243-245. [PMID: 30979752 PMCID: PMC6467679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Natalie F Dies
- Physician assistant in the Division of Otolaryngology Head and Neck Surgery at the University of Alberta Hospital in Edmonton.
| | - Maureen T Taylor
- Physician assistant in the Division of Infectious Diseases at Michael Garron Hospital in Toronto, Ont
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Drennan VM, Halter M, Wheeler C, Nice L, Brearley S, Ennis J, Gabe J, Gage H, Levenson R, de Lusignan S, Begg P, Parle J. What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study. BMJ Open 2019; 9:e027012. [PMID: 30700491 PMCID: PMC6359738 DOI: 10.1136/bmjopen-2018-027012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients' experience and outcomes and the organisation of services. DESIGN Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis. SETTING Six acute care hospitals in three regions of England in 2016-2017. PARTICIPANTS 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives. RESULTS A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams' workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors. CONCLUSIONS This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice.
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Affiliation(s)
- Vari M Drennan
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - Mary Halter
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - Carly Wheeler
- Centre for Health and Social Care Research, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - Laura Nice
- Institute of Clinical Sciences, University of Birmingham, London, UK
| | - Sally Brearley
- Centre for Public Engagement, Joint Faculty of Kingston University and St. George's University of London, London, UK
| | - James Ennis
- Institute of Clinical Sciences, University of Birmingham, London, UK
| | - Jonathan Gabe
- Department of Criminology and Sociology, School of Law, Royal Holloway, University of London, Egham, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | | | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Phil Begg
- Royal Orthopaedic Hospital, Birmingham, UK
| | - James Parle
- Institute of Clinical Sciences, University of Birmingham, London, UK
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Abstract
OBJECTIVE To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. DESIGN Systematic review. SETTING Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. INCLUDED ARTICLES Peer-reviewed articles of any study design, published in English, 1995-2017. INTERVENTIONS Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. OUTCOME MEASURES Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs. RESULTS 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent. CONCLUSIONS PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting. PROSPERO REGISTRATION NUMBER CRD42016032895.
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Affiliation(s)
- Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Carly Wheeler
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Ferruccio Pelone
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guildford, Surrey, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Jim Parle
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Jonathan Gabe
- Centre for Criminology and Sociology, School of Law, Royal Holloway, University of London, London, UK
| | - Laura Nice
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Vari M Drennan
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
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Meverden RA, Szostek JH, Mahapatra S, Schleck CD, Mandrekar JN, Beckman TJ, Wittich CM. Validation of a clinical rotation evaluation for physician assistant students. BMC Med Educ 2018; 18:123. [PMID: 29866089 PMCID: PMC5987424 DOI: 10.1186/s12909-018-1242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND We conducted a prospective validation study to develop a physician assistant (PA) clinical rotation evaluation (PACRE) instrument. The specific aims of this study were to 1) develop a tool to evaluate PA clinical rotations, and 2) explore associations between validated rotation evaluation scores and characteristics of the students and rotations. METHODS The PACRE was administered to rotating PA students at our institution in 2016. Factor analysis, internal consistency reliability, and associations between PACRE scores and student or rotation characteristics were determined. RESULTS Of 206 PACRE instruments sent, 124 were returned (60.2% response). Factor analysis supported a unidimensional model with a mean (SD) score of 4.31 (0.57) on a 5-point scale. Internal consistency reliability was excellent (Cronbach α=0.95). PACRE scores were associated with students' gender (P = .01) and rotation specialty (P = .006) and correlated with students' perception of being prepared (r = 0.32; P < .001) and value of the rotation (r = 0.57; P < .001). CONCLUSIONS This is the first validated instrument to evaluate PA rotation experiences. Application of the PACRE questionnaire could inform rotation directors about ways to improve clinical experiences. The findings of this study suggest that PA students must be adequately prepared to have a successful experience on their rotations. PA programs should consider offering transition courses like those offered in many medical schools to prepare their students for clinical experiences. Future research should explore whether additional rotation characteristics and educational outcomes are associated with PACRE scores.
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Affiliation(s)
- Ryan A. Meverden
- Mayo Clinic Gonda Vascular Center, Mayo Clinic, Rochester, MN USA
| | - Jason H. Szostek
- Division of General Internal Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Saswati Mahapatra
- Division of General Internal Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Cathy D. Schleck
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN USA
| | | | - Thomas J. Beckman
- Division of General Internal Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
| | - Christopher M. Wittich
- Division of General Internal Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905 USA
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Lee B, D'Souza M, Singman EL, Wang J, Woreta FA, Boland MV, Srikumaran D. Integration of a Physician Assistant Into an Ophthalmology Consult Service in an Academic Setting. Am J Ophthalmol 2018; 190:125-133. [PMID: 29604282 DOI: 10.1016/j.ajo.2018.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the impact of a physician assistant (PA) in an academic ophthalmology consult service. DESIGN Evaluation research. METHODS A PA was integrated into our ophthalmology consult service to enhance resident education. First-year resident annual surgical logs before and after the introduction of the PA were reviewed. Residents were anonymously surveyed for their perceptions regarding the impact of the PA integration on their residency experience. Consult wait time was compared for residents and the PA. Internal financial metrics for the PA were reviewed for a cost scenario analysis using 2016 national salary data for PAs. RESULTS The PA made approximately 28 days per year for each first-year resident available for alternative clinical assignments, which resulted in a 75% increase in total first-year resident annual surgical volume. The majority of residents (93%) strongly agreed that having a PA improved both their ophthalmic education (by enabling them to spend time on other clinical assignments) and their service-to-education balance on the consult rotation. Adjusted median consult wait time for residents was 28 minutes longer (P < .001) than for the PA. A PA would likely need to see an average of 8-12 patients per day to be cost neutral to a consult service. CONCLUSIONS Integrating a PA into an ophthalmology consult service can optimize the resident clinical service-to-education balance, reduce consult wait time, and be financially feasible. PAs trained in ophthalmology present a unique opportunity for all institutions that require clinical ophthalmology expertise.
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Affiliation(s)
- Benjamin Lee
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mark D'Souza
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric L Singman
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jiangxia Wang
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael V Boland
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Kreeftenberg HG, Aarts JT, de Bie A, Bindels AJGH, Roos AN, van der Voort PHJ. An alternative ICU staffing model: implementation of the non-physician provider. Neth J Med 2018; 76:176-183. [PMID: 29845940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Literature in Europe regarding implementation of nurse practitioners or physician assistants in the intensive care unit (ICU) is lacking, while some available studies indicate that this concept can improve the quality of care and overcome physician shortages on ICUs. The aim of this study is to provide insight on how a Dutch ICU implemented non-physician providers (NPP), besides residents, and what this staffing model adds to the care on the ICU. METHODS This paper defines the training course and job description of NPPs on a Dutch ICU. It describes the number and quality of invasive interventions performed by NPPs, residents, and intensivists during the years 2015 and 2016. Salary scales of NPPs and residents are provided to describe potential cost-effectiveness. RESULTS The tasks of NPPs on the ICU are equal to those of the residents. Analysis of the invasive interventions performed by NPPs showed an incidence of central venous catheter insertion for NPPs of 20 per fulltime equivalent (FTE) and for residents 4.3 per FTE in one year. For arterial catheters the NPP inserted 61.7 per FTE and the residents inserted 11.8 per FTE. The complication rate of both groups was in line with recent literature. Regarding their salary: after five years in service an NPP earns more than a starting resident. CONCLUSION This is the first European study which describes the role of NPPs on the ICU and shows that practical interventions normally performed by physicians can be performed with equal safety and quality by NPPs.
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Affiliation(s)
- H G Kreeftenberg
- Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, the Netherlands
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Crane SC. Building on a Strong Foundation for the Future. J Physician Assist Educ 2017; 28 Suppl 1:S6. [PMID: 28961614 DOI: 10.1097/jpa.0000000000000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Stephen C Crane
- Stephen Crane, PhD, MPH, served as the executive vice president of the American Academy of Physician Assistants from 1993-2007
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Bass RK. Role of Advocacy in the Future of Physician Assistant Education. J Physician Assist Educ 2017; 28 Suppl 1:S4. [PMID: 28961612 DOI: 10.1097/jpa.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Asprey DP. 50 Years… So What and Now What? J Physician Assist Educ 2017; 28 Suppl 1:S1-S2. [PMID: 28961610 DOI: 10.1097/jpa.0000000000000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Lovink MH, Persoon A, van Vught AJAH, Schoonhoven L, Koopmans RTCM, Laurant MGH. Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: protocol for a realist evaluation case study. BMJ Open 2017; 7:e015134. [PMID: 28600370 PMCID: PMC5734255 DOI: 10.1136/bmjopen-2016-015134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/13/2017] [Accepted: 03/13/2017] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare. METHODS AND ANALYSIS This study will use a multiple-case study design that draws upon realist evaluation principles. The realist evaluation is based on four concepts for explaining and understanding interventions: context, mechanism, outcome and context-mechanism-outcome configuration. The following steps will be taken: (1) developing a theory, (2) conducting seven case studies, (3) analysing outcome patterns after each case and a cross-case analysis at the end and (4) revising the initial theory. ETHICS AND DISSEMINATION The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) (registration number 2015/1914). Before the start of the study, the Board of Directors of the nursing home organisations will be informed verbally and by letter and will also be asked for informed consent. In addition, all participants will be informed verbally and by letter and will be asked for informed consent. Findings will be disseminated by publication in a peer-reviewed journal, international and national conferences, national professional associations and policy partners in national government.
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Affiliation(s)
- Marleen Hermien Lovink
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud university Medical Center, Radboud Institute for Health Sciences, the Netherlands
| | - Anneke JAH van Vught
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Lisette Schoonhoven
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
- University of Southampton, Faculty of Health Sciences, Southampton, UK
| | - Raymond TCM Koopmans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
- Joachim & Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Miranda GH Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
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Halter M, Wheeler C, Drennan VM, de Lusignan S, Grant R, Gabe J, Gage H, Ennis J, Parle J. Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment. Clin Med (Lond) 2017; 17:126-131. [PMID: 28365621 PMCID: PMC6297628 DOI: 10.7861/clinmedicine.17-2-126] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the UK secondary care setting, the case for physician associates is based on the cover and stability they might offer to medical teams. We assessed the extent of their adoption and deployment - that is, their current usage and the factors supporting or inhibiting their inclusion in medical teams - using an electronic, self-report survey of medical directors of acute and mental health NHS trusts in England. Physician associates - employed in small numbers, in a range of specialties, in 20 of the responding trusts - were reported to have been employed to fill gaps in medical staffing and support medical specialty trainees. Inhibiting factors were commonly a shortage of physician associates to recruit and lack of authority to prescribe, as well as a lack of evidence and colleague resistance. Our data suggest there is an appetite for employment of physician associates while practical and attitudinal barriers are yet to be fully overcome.
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Affiliation(s)
- Mary Halter
- Kingston University and St George's, University of London, London, UK
| | - Carly Wheeler
- Kingston University and St George's, University of London, London, UK
| | - Vari M Drennan
- Kingston University and St George's, University of London, London, UK
| | | | - Robert Grant
- Kingston University and St George's, University of London, London, UK
| | - Jonathan Gabe
- School of Law, Royal Holloway, University of London, London, UK
| | | | - James Ennis
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jim Parle
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Bonner AM. Editorial: ASET'S Open Letter to Employers. Neurodiagn J 2016; 56:59-60. [PMID: 27373052 DOI: 10.1080/21646821.2016.1169137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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21
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Selby K. [Not Available]. Rev Med Suisse 2016; 12:765. [PMID: 27263156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Moon K. Employing Advanced Practice Providers: Balancing Benefits and Potential Malpractice Risks. Mich Med 2015; 114:22-23. [PMID: 26710562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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23
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Practice of medicine. Physician assistants. S D Med 2014; 67:515. [PMID: 25571622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kartha A, Restuccia JD, Burgess JF, Benzer J, Glasgow J, Hockenberry J, Mohr DC, Kaboli PJ. Nurse practitioner and physician assistant scope of practice in 118 acute care hospitals. J Hosp Med 2014; 9:615-20. [PMID: 25224593 DOI: 10.1002/jhm.2231] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 06/03/2014] [Accepted: 06/10/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. However, little is understood about APP roles in inpatient medicine. OBJECTIVE Describe APPs role in inpatient medicine. DESIGN Observational cross-sectional cohort study. SETTING One hundred twenty-four Veterans Health Administration (VHA) hospitals. PARTICIPANTS Chiefs of medicine (COMs) and nurse managers. MEASUREMENTS Surveys included inpatient medicine scope of practice for APPs and perceived healthcare quality. We conducted bivariate unadjusted and multivariable adjusted analyses. RESULTS One hundred eighteen COMs (95.2%) and 198 nurse managers (75.0%) completed surveys. Of 118 medicine services, 56 (47.5%) employed APPs; 27 (48.2%) used NPs only, 15 (26.8%) PAs only, and 14 (25.0%) used both. Full-time equivalents for NPs was 0.5 to 7 (mean = 2.22) and PAs was 1 to 9 (mean = 2.23). Daily caseload was similar at 4 to 10 patients (mean = 6.5 patients). There were few significant differences between tasks. The presence of APPs was not associated with patient or nurse manager satisfaction. Presence of NPs was associated with greater overall inpatient and discharge coordination ratings by COMs and nurse managers, respectively; the presence of PAs was associated with lower overall inpatient coordination ratings by nurse managers. CONCLUSIONS NPs and PAs work on half of VHA inpatient medicine services with broad, yet similar, scopes of practice. There were few differences between their roles and perceptions of care. Given their very different background, regulation, and reimbursement, this has implications for inpatient medicine services that plan to hire NPs or PAs.
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Affiliation(s)
- Anand Kartha
- Center for Healthcare Organization and Implementation Research (CHOIR) at the VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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Kulkarni N, Cardin T. Hospital medicine workforce: the impact of nurse practitioner and physician assistant providers. J Hosp Med 2014; 9:678-9. [PMID: 25224751 DOI: 10.1002/jhm.2254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/17/2014] [Accepted: 08/19/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Nita Kulkarni
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Wroten D. Three new AMS programs to start the New Year. J Ark Med Soc 2014; 110:172. [PMID: 24719993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Brock D, Bolon S, Wick K, Harbert K, Jacques P, Evans T, Abdullah A, Gianola FJ. The military veteran to physician assistant pathway: building the primary care workforce. Acad Med 2013; 88:1890-1894. [PMID: 24128629 DOI: 10.1097/acm.0000000000000011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The physician assistant (PA) profession emerged to utilize the skills of returning Vietnam-era military medics and corpsmen to fortify deficits in the health care workforce. Today, the nation again faces projected health care workforce shortages and a significant armed forces drawdown. The authors describe national efforts to address both issues by facilitating veterans' entrance into civilian PA careers and leveraging their skills.More than 50,000 service personnel with military health care training were discharged between 2006 and 2010. These veterans' health care experience and maturity make them ideal candidates for civilian training as primary care providers. They trained and practiced in teams and functioned under minimal supervision to care for a broad range of patients. Military health care personnel are experienced in emergency medicine, urgent care, primary care, public health, and disaster medicine. However, the PA profession scarcely taps this valuable resource. Fewer than 4% of veterans with health care experience may ever apply for civilian PA training.The Health Resources and Services Administration (HRSA) implements two strategies to help prepare and graduate veterans from PA education programs. First, Primary Care Training and Enhancement (PCTE) grants help develop the primary care workforce. In 2012, HRSA introduced reserved review points for PCTE: Physician Assistant Training in Primary Care applicants with veteran-targeted activities, increasing their likelihood of receiving funding. Second, HRSA leads civilian and military stakeholder workgroups that are identifying recruitment and retention activities and curricula adaptations that maximize veterans' potential as PAs. Both strategies are described, and early outcomes are presented.
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Affiliation(s)
- Douglas Brock
- Dr. Brock is associate professor, University of Washington Department of Family Medicine and MEDEX Northwest, Seattle, Washington. Dr. Bolon is chief, Primary Care Medical Education Branch, Division of Medicine and Dentistry, Bureau of Health Professions, Department of Health Resources and Services Administration, U.S. Department of Health and Human Services, Washington, DC. Dr. Wick is assistant professor, University of Washington Department of Family Medicine and MEDEX Northwest, Seattle, Washington. Dr. Harbert is dean and program director, South College School of Physician Assistant Studies, Knoxville, Tennessee. Dr. Jacques is associate professor, Division of Physician Assistant Studies, Medical University of South Carolina, Charleston, South Carolina. Dr. Evans is associate professor, University of Washington Department of Internal Medicine and MEDEX Northwest, Seattle, Washington. Ms. Abdullah is director of government relations, Physician Assistant Education Association, Alexandria, Virginia. Mr. Gianola is lecturer, University of Washington Department of Family Medicine and MEDEX Northwest, Seattle, Washington
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Abstract
For over four decades, physician assistants (PAs) have demonstrated that they are effective partners in a changing health care environment, readily adaptable to the needs of an evolving delivery system. With increased expectations of physician shortages, especially in primary care, PAs will be called on to fill provider gaps and new roles in interprofessional team-based delivery systems. There are over 90,000 certified PAs in the workforce and 173 accredited programs yielding an estimated 6,545 graduates annually, with an estimated 65 new programs seeking provisional accreditation by the end of 2016. New data on the PA pipeline and practice provide key information about the potential of this workforce; however, the overall impact of the PA pipeline on projected shortages remains unclear. Barriers exist to optimal deployment, including faculty shortages, scope-of-practice regulations, and a lack of clinical placement sites.This article brings together data from the Physician Assistant Education Association and the National Commission on Certification of Physician Assistants and its supporting organization, the nccPA Health Foundation. Primary sources include PA candidates, educational programs, students, and certified PAs. Collectively, these data provide a comprehensive picture of PAs' contributions to the health care workforce. Armed with pipeline and graduate practice data, policy makers and workforce planners will be equipped to design new models of practice that maximize the potential contributions of this growing PA workforce on health care teams.
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Affiliation(s)
- Anita Duhl Glicken
- Ms. Glicken is president/CEO, nccPA Health Foundation, Johns Creek, Georgia, and associate dean and professor emerita, University of Colorado School of Medicine, Denver, Colorado. Mr. Miller is senior director of education policy and strategy, Physician Assistant Education Association, Alexandria, Virginia, and distinguished professor, Division of Physician Assistant Studies, Shenandoah University, Winchester, Virginia
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Evans KA. For a true team approach, get interprofessional. Adv NPs PAs 2013; 4:10. [PMID: 24279064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Hills L. Overcoming the ten most common barriers to effective team communication. J Med Pract Manage 2013; 29:99-103. [PMID: 24228371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Communication is at the heart of medical practice management. Yet there are many barriers to effective communication that can interfere with the smooth running of the practice. This article describes the 10 most common barriers to effective medical practice team communication and offers six steps the practice manager can take to break them down. This article also suggests that the practice develop a team communication strategy. It suggests 10 communication principles readers can share directly with their teams and describes three hallmarks of effective team communication. Finally, this article provides a list of 25 practical questions practice managers can use to improve their team's communication.
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Affiliation(s)
- Laura Hills
- Blue Pencil Institute, 10618 Regent Park Court, Fairfax, VA 22030, USA.
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Paton A, Stein DE, D'Agostino R, Pastores SM, Halpern NA. Critical care medicine advanced practice provider model at a comprehensive cancer center: successes and challenges. Am J Crit Care 2013; 22:439-43. [PMID: 23996424 DOI: 10.4037/ajcc2013821] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Alichia Paton
- Department of Nursing, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Abstract
This policy statement reviews important trends and other factors that affect the pediatrician workforce and the provision of pediatric health care, including changes in the pediatric patient population, pediatrician workforce, and nature of pediatric practice. The effect of these changes on pediatricians and the demand for pediatric care are discussed. The American Academy of Pediatrics (AAP) concludes that there is currently a shortage of pediatric medical subspecialists in many fields, as well as a shortage of pediatric surgical specialists. In addition, the AAP believes that the current distribution of primary care pediatricians is inadequate to meet the needs of children living in rural and other underserved areas, and more primary care pediatricians will be needed in the future because of the increasing number of children who have significant chronic health problems, changes in physician work hours, and implementation of current health reform efforts that seek to improve access to comprehensive patient- and family-centered care for all children in a medical home. The AAP is committed to being an active participant in physician workforce policy development with both professional organizations and governmental bodies to ensure a pediatric perspective on health care workforce issues. The overall purpose of this statement is to summarize policy recommendations and serve as a resource for the AAP and other stakeholders as they address pediatrician workforce issues that ultimately influence the quality of pediatric health care provided to children in the United States.
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Newitt VN. Blazing a trail in convenient care. Adv NPs PAs 2013; 4:20. [PMID: 23923220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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34
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Kiefer B. [What is the revolt of assistants-is it a sign?]. Rev Med Suisse 2013; 9:1288. [PMID: 23821851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Shock LP. Are you an advocate for your profession? Adv NPs PAs 2013; 4:15. [PMID: 23795410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Lisa P Shock
- Cornerstone Internal Medicine at Westchester in High Point, N.C., USA
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36
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Moog G. [Competence of medical assistance professions - The bng-concept for advance]. Z Gastroenterol 2013; 51:514-515. [PMID: 23828961 DOI: 10.1055/s-0032-1319529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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37
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Shock LP. Care coordination and care team redesign. Adv NPs PAs 2013; 4:13. [PMID: 23599989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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38
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Naughton D, Adelman AM, Bricker P, Miller-Day M, Gabbay R. Envisioning new roles for medical assistants: strategies from patient-centered medical homes. Fam Pract Manag 2013; 20:7-12. [PMID: 23547608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Dana Naughton
- Pennsylvania State University in University Park, PA, USA
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Stempniak M. Closing the primary care gap. Hosp Health Netw 2013; 87:45-1. [PMID: 23617120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Millions of new patients soon will flood health care systems, exacerbating a nationwide shortage of primary care physicians. This gatefold explores how nurse practitioners and physician assistants can help to fill the void.
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40
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Kalininskaya AA, Mescheryakov DG, Ildarov RB. [The standard of position of physician-stomatologist-therapeutist in the conditions of working together with assistant-stomatological]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2013:33-38. [PMID: 23672069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The article presents scope of work, algorithms of labor operations, standardization of work of stomatologist-therapeutist in the conditions of working together with assistant-stomatological in four hands. The calculations are given concerning the standard numbers of positions of stomatologist in new conditions of work.
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Abstract
Advanced practice professionals (APP), primarily nurse practitioners and physician assistants, are increasingly being integrated into oncology practices. The reasons are numerous, and models of care options are numerous as well. Models of care have developed without much forethought and are often the result of the relative interests of the physician, the APP, and the mutual "comfort" of practice style. The increasing complexity of oncology care, the pressures of the health care crisis and health care reform mean that it is necessary that we examine models of collaborative care in terms of both quality of care and productivity.
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Dahring R. Predictions and resolutions for 2013. Adv NPs PAs 2013; 4:7. [PMID: 23487884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Cawley JF. Primary care and population health. Adv NPs PAs 2012; 3:16. [PMID: 22856111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- James F Cawley
- Department of Prevention and Community Health, School of Public Health and Health Services, George Washington University, Washington, USA
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Regulatory authorities try to reach agreement. Nurs N Z 2012; 18:7. [PMID: 22919963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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[The functioning of feldsher-midwife stations]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2012;:41-4. [PMID: 23033578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The article presents the materials based on the statistical data and results of sociological survey. They characterize the condition of feldsher-midwife stations, their field of services, personnel issues and certain issues of everyday life of feldshers of Perm kray. The proposals concerning the development of feldsher-midwife stations functioning are analyzed. The comparative analysis with the data of similar survey of 1982 is done. The study results support the necessity to maintain and develop feldsher-midwife stations in the system of primary medical sanitary care of rural population, especially on the territories with low population density.
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Ford J. Employer revolt? Convenient care rescue. Adv NPs PAs 2012; 3:13. [PMID: 22530545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Dahring R. Contract negotiation: don't be afraid. Adv NPs PAs 2012; 3:18. [PMID: 22685836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Pedersen DM, Pedersen KJ, Santitamrongpan V. The Burmese medic: an international physician assistant analogue. J Physician Assist Educ 2012; 23:51-55. [PMID: 23072072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although there have been recent democratic reforms in Myanmar (formerly known as Burma), for nearly 60 years there has been a consistent history of human rights violations as part of a civil war waged by the Myanmar military, known as the Tatmadaw. Approximately 3,500 villages have been destroyed by the Tatmadaw during the half-century of civil war. Oppression against minority groups, including the Karen, Karenni, Kachin, Mon, Shan, Chin, and Muslims has adversely affected the health outcomes of these vulnerable populations. Since the mid 1990s, medics have been providing care for the ethnic minorities who were displaced from their homes by the civil war and who live in the jungles of eastern Burma as well as in the refugee camps and towns in the border areas of Thailand. This article will look at how these medics are providing care similar to that provided by physician assistants in the United States.
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Affiliation(s)
- Donald M Pedersen
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Division of Physician Assistant Studies, USA.
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Pronsati MP. A year of records, resignations and respect. Adv NPs PAs 2011; 2:6. [PMID: 25693256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Gerchufsky M. Going green (and saving greenbacks) in practice. Adv NPs PAs 2011; 2:19. [PMID: 22128675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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