Understanding health professional role integration in complex adaptive systems: a multiple-case study of physician assistants in Ontario, Canada

Burrows, Kristen; Abelson, Julia; Miller, Patricia A.; Levine, Mitchell; Vanstone, Meredith

doi:10.1186/s12913-020-05087-8

Cited by 18 publications

(36 citation statements)

References 33 publications

(42 reference statements)

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“…Brock et al, 2017 [ 19 ] Compare rates of malpractice reports and adverse actions for physicians, physician assistants (PAs), and nurse practitioners (NPs) USA National Secondary & primary care n/a Longitudinal (claims) Diagnosis (delay or failure to diagnose) Medium 4. Burrows et al, 2020 [ 20 ] Explore PA role integration in the Ontario healthcare system through an in-depth analysis of setting and role descriptions, described outcomes, and healthcare provider perceptions Canada Ontario Secondary & primary care 19 Case study (interviews, documentary analysis) Referrals to other physicians Low 5. Drennan et al 2015 [ 21 ] Compare outcomes and costs of same-day requested consultations by PAs with those of GPs England South, East, & South West Primary care 12 Longitudinal (medical records) Diagnostic tests Referrals to other physicians Low 6.…”

Section: Resultsmentioning

confidence: 99%

Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review

Sheringham¹,

King

Plackett³

et al. 2021

BMC Health Serv Res

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Background Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from observational studies conducted in high income countries on PAs’ competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care. Method A rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009–2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation. Results From 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs’ competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis. Conclusion This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs’ roles, including outcomes of the diagnostic process.

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Section: Resultsmentioning

confidence: 99%

Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review

Sheringham¹,

King

Plackett³

et al. 2021

BMC Health Serv Res

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“…26 Burrows obtained interview data from 24 PAs, and those that worked with them (17 physicians, 2 medical residents, 2 registered nurses, and 1 family health team administrator) but there was no information on the documentary sources they used. 28…”

Section: Samplementioning

confidence: 99%

“…19 Burrows et al's qualitative study in Ontario compared physicians' perceptions of with PAs' XX in family medicine with perceptions from inpatient, outpatient and emergency settings. 28 . It found experienced PAs were often valued as experts, for example: "other consulting services [such as specialist diagnostics] …started to prefer getting consults from the PA because of the PA's understanding of the precise information that the consulting service requires".…”

Section: Pa Competence and Skillsmentioning

confidence: 99%

“…It found experienced PAs were often valued as experts, for example: "other consulting services [such as specialist diagnostics] …started to prefer getting consults from the PA because of the PA's understanding of the precise information that the consulting service requires". 28 3. PA performance as measured by processes and patient outcomes Table 3 summarises quantitative ndings in studies with medium or low risk of bias that compared processes and outcomes of care between PAs and primary care physicians.…”

Section: Pa Competence and Skillsmentioning

confidence: 99%

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Physician Associate/Assistant Impacts on Cancer Diagnosis in Primary Care: A Systematic Review

Sheringham

Kassianos

Plackett

et al. 2021

Preprint

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Background: Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 15 healthcare systems across the world, with numbers increasing to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from international observational studies on PAs’ competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care. Method: A rapid systematic review of international peer-reviewed literature was performed (PROSPERO reference: CRD42019154114). Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009-2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation. Results: From 876 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n=6) and referrals to specialists (n=4). Fewer papers reported on consultation processes, such as examinations or history taking (n=3) Six papers considered PAs’ competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis. Conclusion: This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs’ roles, including outcomes of the diagnostic process.

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“…[4][5][6] PAs have functioned in the Canadian military since the mid-1980s and in civilian settings since 2008, [7] now working in Ontario, Manitoba, Alberta, New Brunswick, and Nova Scotia. [8] The role was introduced to the UK in 2003 but has grown exponentially since about 2016, [9] and following a 2017 announcement will soon be an officially regulated profession in the UK. [10,11] PAs were introduced to Germany in 2005 but have been experiencing a spike in growth in recent years, and function to assume delegable medical tasks to help address physician shortages.…”

Section: Introductionmentioning

confidence: 99%

Experience of the Irish physician associate role: PA and supervising consultant perspectives

Hix

Fernandes

Joyce

2020

IJH

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Background: The physician associate/assistant (PA) role was introduced into the Irish healthcare system in 2015 when four PAs from North America were recruited to work in Ireland as part of a two-year pilot program. In parallel, the Royal College Surgeons in Ireland (RCSI) began its own PA program in January of 2016 and has graduated 25 PAs. To date, there is little published on the few Irish-trained PAs. This study seeks to share initial experiences with the PA profession in Ireland.Methods: This descriptive phenomenological study explores the newly implemented PA role in Ireland through semi-structured, one-to-one interviews with five PAs and their supervising consultants in Dublin, Ireland. Questions centered on the PA scope of clinical practice, satisfaction with the role, acceptance by the medical team, and integration into the Irish healthcare system.Results: Six themes were identified from the interviews: continuity of patient care, flexible scope of practice, lack of role clarity, complementary to the medical team, regulation and prescribing challenges, and the emerging role of the PA.Conclusions: The development of the PA role is in its infancy in Ireland, but this study suggests that they fill an important role by providing continuity of care to both patients and the medical team. Currently, there are significant challenges imposed by a lack of regulation of the PA profession and the inability to prescribe. However, PAs in Ireland appear to enjoy their work and have great potential to expand throughout Irish healthcare and are valued by their team members.

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Understanding health professional role integration in complex adaptive systems: a multiple-case study of physician assistants in Ontario, Canada

Cited by 18 publications

References 33 publications

Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review

Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review

Physician Associate/Assistant Impacts on Cancer Diagnosis in Primary Care: A Systematic Review

Experience of the Irish physician associate role: PA and supervising consultant perspectives

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