Physician assistants in the Netherlands

Driesschen, Quinten van den; Roo, Frank de

doi:10.1097/01.jaa.0000453240.00098.83

Cited by 23 publications

(13 citation statements)

References 4 publications

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“…To overcome the imbalance between the demand and supply of medical care, new professions such as nurse practitioners (NPs) and physician assistants (PAs) were introduced. In the Netherlands, both NPs and PAs are trained at a Master's degree level and are employed in all medical specialties, including general practice (van den Driesschen & de Roo, ; van Vught, van den Brink, & Wobbes, ; Zwijnenberg & Bours, ). The NP and PA program lasted for 24 and 30 months respectively and enrolment requires an undergraduate degree in nursing or any paramedical science, besides having at least 2 years of clinical experience.…”

Section: Introductionmentioning

confidence: 99%

Moral reasoning explained by personality traits and moral disengagement: A study among Dutch nurse practitioners and physician assistants

Kuilman

Jansen

Middel

et al. 2019

Journal of Advanced Nursing

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Aim To explore the direct and indirect effect of the personality meta‐traits ‘Stability’ and ‘Plasticity’ on moral reasoning among nurse practitioners (NPs) and physician assistants (PAs). Background Moral reasoning is influenced by being prone to moral disengagement and personality traits. Moral disengagement is observed among professionals in many fields, including healthcare providers. Moral disengagement is known to be provoked by environmental stressors and influenced by certain personality traits. Design A cross‐sectional approach was used including self‐report questionnaires. Methods A convenience sample of Dutch NPs (N = 67) and PAs (N = 88) was surveyed via online questionnaires between January and March 2015, using (a) the Defining Issues Test; (b) the BIG five inventory; and (c) the Moral Disengagement Scale. Structural equation modelling (SEM) was employed for estimating the construct validity of two meta‐traits of personality and to test unidirectional influences on moral reasoning. Results Only the Stability trait was a direct predictor of moral reasoning whereas both Stability and Plasticity were precursors of moral disengagement. Both personality meta‐traits had statistically significant indirect effects on moral reasoning through a low level of moral disengagement. The influence of both personality traits on the level of moral reasoning was increased by strong self‐censure on entering into morally disengaged interactions. Conclusion The personality meta‐trait ‘Stability’ is an indicator of moral reasoning and is explained by a lower propensity to morally disengage among highly stable people. Although the meta‐trait Plasticity exerts an indirect effect through moral disengagement on moral reasoning, it is not a direct indicator of moral reasoning.

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Section: Introductionmentioning

confidence: 99%

Moral reasoning explained by personality traits and moral disengagement: A study among Dutch nurse practitioners and physician assistants

Kuilman

Jansen

Middel

et al. 2019

Journal of Advanced Nursing

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“…Other European countries such as the Netherlands, Sweden, and the UK have successfully introduced new care models involving nurse practitioners and APN in PC and have documented positive experiences [1][2][3][4]. International literature has shown that APN can provide an equivalent or higher level of care compared to physicians in PC [11,[38][39][40].…”

Section: Discussionmentioning

confidence: 99%

“…In light of the current shortage of general practitioners (GPs), countries such as the Netherlands, Sweden, and the UK have successfully introduced Advanced Practice Nurses (APNs) into interprofessional PC teams to fulfill defined tasks and relieve GPs [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Advanced Practice Nurses in Primary Care in Switzerland: An Analysis of Interprofessional Collaboration

Josi

Bianchi

Brandt

2020

Preprint

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Background: The increase in the number of chronically ill patients due to ageing is calling existing models of primary care (PC) into question. New care models have recently been implemented in Swiss PC and involve interprofessional teams. This paper aimed to investigate the practice of interprofessional collaboration between advanced practice nurses, registered nurses, and medical practice assistants within new models of PC in Switzerland using the National Interprofessional Competency Framework. Methods: An ethnographic design comprising semi-structured interviews and non-participant observations was conducted. Sixteen interviews were conducted with care providers at their PC practice. Interviewees included four advanced practice nurses, two registered nurses, six medical practice assistants, and four general practitioners. Nine other health professionals were subsequently observed in their practice. Interviews and observations were conducted by the first author from February to April 2019. Results: Our analysis of interview and observational data confirmed that role clarification, team functioning, collaborative leadership, interprofessional conflict resolution, patient-centered care, and interprofessional communication have a significant influence on the interprofessional collaboration among health professionals in Swiss PC. Among these domains, role clarification and team functioning were the most frequently raised issues. Both were found to have the potential to negatively influence and, therefore, hinder efficient interprofessional collaboration within PC. Conclusion: From the analysis, it emerged that role clarification is crucial for effective interprofessional collaboration within new care delivery models in the Swiss PC context. Our study results may inform international health policymakers and practitioners about six important domains of interprofessional care when implementing new care models. Practical experience with new models of care involving advanced practice nurses and medical practice assistants may also influence the regulation of the scope of practice of these health professionals in Switzerland.

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“…Acceptance of PAs by physician collaborators shows promise for the profession in The Netherlands. [34] Research is proving that it is advantageous for Dutch physicians to hire PAs to improve and extend the care of the populations they serve. With greater visibility of the success of PAs in practice, more positions are made available for the graduates of the five PA programs.…”

Section: Israelmentioning

confidence: 99%

Determinants of the physician assistant/associate concept in global health systems

Cawley

Hooker

2018

IJH

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Introduction: A global shortage of doctors has led to strategies to improve access to care. The physician assistant/associate (PA) was established in North America and Africa in the 1960s in response to medical shortages. PA activity was cataloged to understand what determines their utilization in a country’s health system.Methods: A mixed-method study design began with searching the available literature regarding the development of PAs worldwide. Key words included “physician assistants”, “non-physicians”, “physician associates”, and “advanced practice providers”. Additional data was through an online search of reports; personal communications with researchers, policymakers, government officials, and practitioners in each country; visits by the authors to a number of the countries; and a review of official documents. In each country interviews included educators, policymakers and government officials who had direct involvement with the introduction of the PA concept, and clinically active PAs. Domain analyses were based on stratification of differences among countries: global region, income, physician to population ratio, attitudes of medical professionals, and practice/regulatory authority. Countries were segmented into two categories: well resourced and less well resourced.Results: The history and status of the PA concept into the health systems of 15 states were reviewed. The determinants for the successful incorporation of PAs include prevailing medical needs, a shortage of physicians or an aging physician workforce; support and sponsorship by physician organizations and government agencies; the ability to mobilize and establish a legal and regulatory framework to accommodate PAs; and evidence that their introduction is acceptable to patients, physicians, and other health professionals.Discussion: The introduction of PAs into health systems occurs because their education is less expensive and time intensive than physicians. In addition, graduates are more likely to occupy roles where there is scarcity of doctors such as in rural and underserved areas. In most instances, a physician-dependent role permits their introduction into health systems in a non-threatening manner to doctors and their practices. The utilization of PAs, particularly in primary healthcare roles, increases access to services, is cost-beneficial, and shows a physician-equivalent quality of care.Conclusion: The PA has been a remarkable health workforce policy development that has spread among countries’ health systems and is likely to continue.

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Physician assistants in the Netherlands

Cited by 23 publications

References 4 publications

Moral reasoning explained by personality traits and moral disengagement: A study among Dutch nurse practitioners and physician assistants

Moral reasoning explained by personality traits and moral disengagement: A study among Dutch nurse practitioners and physician assistants

Advanced Practice Nurses in Primary Care in Switzerland: An Analysis of Interprofessional Collaboration

Determinants of the physician assistant/associate concept in global health systems

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