The Globalization of the Physician Assistant Profession

Hooker, Roderick S.; Hogan, Kathleen A.; Leeker, Elizabeth

doi:10.1097/01367895-200718030-00011

Cited by 48 publications

(35 citation statements)

References 15 publications

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“…[49][50][51] A number of other countries have PAs in their health-care systems and have developed PA educational programmes. Hooker et al 52 provide an overview of international developments. Canada introduced PAs in the military in 1984 and in the civilian health service in 1999.…”

Section: Physician Assistantsmentioning

confidence: 99%

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Investigating the contribution of physician assistants to primary care in England: a mixed-methods study

Drennan

Halter

Brearley

et al. 2014

Health Serv Deliv Res

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Background: Primary health care is changing as it responds to demographic shifts, technological changes and fiscal constraints. This, and predicted pressures on medical and nursing workforces, raises questions about staffing configurations. Physician assistants (PAs) are mid-level practitioners, trained in a medical model over 2 years at postgraduate level to work under a supervising doctor. A small number of general practices in England have employed PAs. Objective: To investigate the contribution of PAs to the delivery of patient care in primary care services in England. Design: A mixed-methods study conducted at macro, meso and micro organisational levels in two phases: (1) a rapid review, a scoping survey of key national and regional informants, a policy review, and a survey of PAs and (2) comparative case studies in 12 general practices (six employing PAs). The latter incorporated clinical record reviews, a patient satisfaction survey, video observations of consultations and interviews with patients and professionals. Results: The rapid review found 49 published studies, mainly from the USA, which showed increased numbers of PAs in general practice settings but weak evidence for impact on processes and patient outcomes. The scoping survey found mainly positive or neutral views about PAs, but there was no mention of their role in workforce policy and planning documents. The survey of PAs in primary care (n = 16) found that they were mainly deployed to provide same-day appointments. The comparative case studies found that physician assistants were consulted by a wide range of patients, but these patients tended to be younger, with less medically acute or complex problems than those consulting general practitioners (GPs). Patients reported high levels of satisfaction with both PAs and GPs. The majority were willing or very willing to consult a PA again but wanted choice in which type of professional they consulted. There was no significant difference between PAs and GPs in the primary outcome of patient reconsultation for the same problem within 2 weeks, investigations/tests ordered, referrals to secondary care or prescriptions issued. GPs, blinded to the type of clinician, judged the documented activities in the initial consultation of patients who reconsulted for the same problem to be appropriate in 80% (n = 223) PA and 50% (n = 252) GP records. PAs were judged to be competent and safe from observed consultations. The average consultation with a physician assistant is significantly longer than that with a GP: 5.8 minutes for patients of average age for this sample (38 years). Costs per consultation were £34.36 for GPs and £28.14 for PAs. Costs could not be apportioned to GPs for interruptions, supervision or training of PAs.Conclusions: PAs were found to be acceptable, effective and efficient in complementing the work of GPs. PAs can provide a flexible addition to the primary care workforce. They offer another labour pool to consider in health professional workforce and education planning at local, regional ...

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Section: Physician Assistantsmentioning

confidence: 99%

“…56 Key issues in all countries have been how to achieve recognised accreditation and regulation mechanisms as well as authority for prescribing. 52 The earliest record of GPs in the UK exploring the use of PAs was in 1980. 57 We will now describe the UK experience of PAs from 2000 to 2009.…”

Section: Physician Assistantsmentioning

confidence: 99%

Investigating the contribution of physician assistants to primary care in England: a mixed-methods study

Drennan

Halter

Brearley

et al. 2014

Health Serv Deliv Res

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“…A first pilot programme was launched in 2002. In 2007, the number of physician assistants was still very limited, at about 50 in England (Hooker et al, 2007). The tasks of physician assistants in the United Kingdom include making diagnosis, developing patient management plans, prescribing medications, undertaking patient education, counselling and health promotion (Department of Health, 2006).…”

mentioning

confidence: 99%

Nurses in Advanced Roles

Delamaire¹,

Lafortune

2010

OECD Health Working Papers

124

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All Health Working Papers are now available through the OECD's Internet Website at http:/www.oecd.org/els/health/workingpapers This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language -English or French -with a summary in the other.Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France.The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD. ABSTRACTMany countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing supply of doctors. It might also contain costs by delegating tasks away from more expensive doctors. This paper reviews the development of advanced practice nurses in 12 countries (Australia, Belgium, Canada, Cyprus, Czech Republic, Finland, France, Ireland, Japan, Poland, United Kingdom and United States), with a particular focus on their roles in primary care. It also reviews the evaluations of impacts on patient care and cost.The development of new nursing roles varies greatly. The United States and Canada established "nurse practitioners" in the mid-1960s. The United Kingdom and Finland also have a long experience in using different forms of collaboration between doctors and nurses. Although development in Australia and Ireland is more recent, these two countries have been very active in establishing higher education programmes and posts for advanced practice nurses in recent years. In other countries, the formal recognition of advanced practice nurses is still in its infancy, although unofficial advanced practices may already exist in reality.Evaluations show that using advanced practice nurses can improve access to services and reduce waiting times. Advanced practice nurses are able to deliver the same quality of care as doctors for a range of patients, including those with minor illnesses and those requiring routine follow-up. Most evaluations find a high patient satisfaction rate, mainly because nurses tend to spend more time with patients, and provide information and counselling. Some evaluations have tried to estimate the impact of advanced practice nursing on cost. When new roles involve substitution of tasks, the impact is either cost reducing or cost neutral. The savings on nurses' salaries -as opposed to doctors -can be offset by longer consultation times, higher patient referrals, and sometimes the ordering of more tests. When new roles involve supplementary tasks, some studies report that the impact is cost increasing.Keywords: nurses, advanced roles, skills, nurse practitioners, clinical nurse specialists, primary care, OECD countrie...

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“…Le Canada a aussi, ces dernières années, expérimenté l'emploi d'assistants de médecins, et leur rôle a également été testé et évalué dans certains hôpitaux, avec en général des résultats positifs (Ducharme et al, 2009 (Hooker et al, 2007). Les tâches des assistants de médecins au Royaume-Uni incluent le diagnostic, l'établissement de programmes de soins pour les patients, la prescription de médicaments, la prise en charge de l'éducation thérapeutique des patients, le conseil et la promotion de la santé (Department of Health, 2006).…”

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Delamaire¹,

Lafortune

2010

OECD Health Working Papers

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The Globalization of the Physician Assistant Profession

Cited by 48 publications

References 15 publications

Investigating the contribution of physician assistants to primary care in England: a mixed-methods study

Investigating the contribution of physician assistants to primary care in England: a mixed-methods study

Nurses in Advanced Roles

Les pratiques infirmières avancées

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