Understanding patients’ satisfaction with physician assistant/associate encounters through communication experiences: a qualitative study in acute hospitals in England

Abstract

Background Physician assistants/associates (PAs) are a recent innovation in acute hospital teams in England and many other countries worldwide. Although existing evidence indicates generally high levels of patient satisfaction with their PA hospital encounters, little is known about the factors associated with this outcome. There is a lack of evidence on the process of PA-patient communication in hospital encounters and how this might influence satisfaction. This study therefore aimed to understand patients’ satisfaction with PA acute hospital encounters through PA-patient communication experiences. Methods A qualitative study was conducted among patients and representatives of patients seen by or receiving care from one of the PAs working in acute hospital services in England. Semi-structured interviews were undertaken face-to-face with study participants in the hospital setting and shortly after their PA encounter. Data were coded and analysed using thematic analysis. The study was framed within a theoretical model of core functions of medical encounter communication. Results Fifteen patients and patient representatives who had experienced a PA encounter participated in interviews, across five hospitals in England. Four interrelated communication experiences were important to participants who were satisfied with the encounter in general: feeling trust and confidence in the relationship, sharing relevant and meaningful information, experiencing emotional care and support, and sharing discussion on illness management and treatment. However, many participants misconceived PAs to be doctors, raising a potential risk of reduced trust in the PA relationship and negative implications for satisfaction with their PA encounter. Participants considered it beneficial that patients be informed about the PA role to prevent confusion. Conclusions PA encounters offer a constructive example of successful clinician-patient communication experiences in acute hospital encounters from the patient’s perspective. Study participants were generally naïve to the PA role. Hospital services and organisations introducing these mid-level or advanced care practitioner roles should consider giving attention to informing patients about the roles. Electronic supplementary material The online version of this article (10.1186/s12913-019-4410-9) contains supplementary material, which is available to authorized users.

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

“…[13] Developing an outline of the broadly defined Irish PA scope of practice for a given team could be helpful, serving as something the PAs could "fall back on" if their activity is questioned by staff less familiar with the role. One qualitative study in the UK found that although patient participants had poor understanding of the PA role, they were still generally satisfied with their medical encounter with the PA. [26] Similar findings were shown in an Irish study. [20] PAs in the present study expressed how their patients welcomed care provided by a PA.…”

Validation and adjustment of the Patient Experience Questionnaire (PEQ) based on a Norwegian hospital study.

“…Criterion-related validity was ascertained for the overall measure as well as the dimensions in predicting at least 1 of the 3 outcome variables: satisfaction, health bene ts, and health level, which is consistent with previous studies (e.g. 33,34,35). Lastly, a model with a second-order factor, "treatment services", for 4 of the dimensions was proposed based on the results of the validity and reliability analyses: "nurse services", "doctor services", "information", and "organisation".…”

Introducing physician associates to hospital patients: Development and feasibility testing of a patient experience‐based intervention

“…Patient confusion with new mid‐level practitioner titles and roles has been well documented, 8‐11 alongside evidence that the novel terminology can be difficult to interpret and is sometimes misleading 8,10 . Existing studies in England report poor recognition and comprehension of the PA role among hospital patients 12,13 . They are often confused by the title; its meaning is not immediately obvious and needs explanation.…”

“…Furthermore, patients can mistakenly perceive PAs to be doctors and express concerns when made aware of the misconception. To prevent confusion, explanatory patient information about the role was considered necessary and beneficial 13 . A study in the Netherlands, where the role is also unfamiliar, similarly identified that hospital staff thought patients were unaware whether they had seen a PA or doctor 14 .…”

“…Moreover, a US study undertaken over 30 years after the introduction of PAs found that emergency department inpatients needed better information about the role; patient confusion as to provider identity was reportedly associated with often covert physician substitution 15 . There is also evidence of the potential for patients’ trust and confidence in the PA to be affected by lack of transparency, 13 with possible adverse implications for the PA‐patient relationship 16 …”