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Schneider S, Stengel D, Seifert J, Ekkernkamp A, Ludwig J. [Perceived utility of the inclusion of physician assistants in the surgical process quality and continuing education in Germany : Results of an interprofessional online survey]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:457-468. [PMID: 38668769 DOI: 10.1007/s00113-024-01431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Compared to Anglo-American countries, physician assistants (PA) remain an underrepresented professional group within the German healthcare system. In the surgical disciplines, PAs may relieve the administrative burden of doctors by taking on delegable routine tasks, thus creating time and resources for advanced surgical training. OBJECTIVE According to interprofessional experts, can the use of PA lead to an optimization of surgical training and a gain in time for surgical qualification in Germany? MATERIAL AND METHODS After searching for systematic reviews of the current state of knowledge, an online survey was initiated among surgeons and PAs via social networks to determine current and desired clinical areas of activity for PAs in surgery and their future influence on specialist training in Germany. RESULTS A total of nine systematic reviews were identified, suggesting a beneficial impact of PAs on length of stay, direct costs, and treatment outcomes in surgical scenarios. The online survey included 234 surgeons and 114 PAs. Hospitals with ≥ 90 surgical beds employed PAs far more frequently (65%) than smaller institutions (40%). Although both professional groups are generally highly satisfied with the integration of PAs into clinical workflows, there are gradually different opinions about the preferred spectrum of tasks and duties. DISCUSSION PAs would like to have greater responsibility in ordering and interpreting diagnostic tests, communicating with patients, and working in the operating theater. Surgeons are concerned that PAs could replace surgical interns and residents. PAs may enrich healthcare in Germany on various levels and can also improve surgical training. The voice and needs of all professional groups must be considered and respected during the upcoming health system reform.
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Affiliation(s)
- Stephanie Schneider
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Deutschland.
| | - Dirk Stengel
- Ressort Medizin, BG Kliniken - Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Leipziger Pl. 1, 10117, Berlin, Deutschland
| | - Julia Seifert
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Deutschland
| | - Axel Ekkernkamp
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Deutschland
- Ressort Medizin, BG Kliniken - Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Leipziger Pl. 1, 10117, Berlin, Deutschland
| | - Johanna Ludwig
- Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683, Berlin, Deutschland
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Muth BL, Krieger D, Domingo H, Yoo J, Frank A, Paolini K, Mayfield A, Borth A, Siegfried M, McDade H, McCormick N, Hoy H. The current state of transplant advanced practice providers: results of the advanced practice provider practice survey. Am J Transplant 2023; 23:408-415. [PMID: 36695692 DOI: 10.1016/j.ajt.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 01/09/2023]
Abstract
Advanced practice providers (APPs) are trained, licensed health care providers. The American Society of Transplant APP community of practice developed an electronic survey to investigate transplant APP demographics, scope of practice, and academic activities. We defined the top of scope of practice as delivering health care to the fullest extent of APP education and training as allowed by state laws and regulations. From July 11, 2020, to August 31, 2020, 307 invitations were e-mailed and survey links were distributed electronically on the community of practice hub and social media. Two hundred fifty-three APPs responded. APPs practice in inpatient and outpatient settings. Among the respondent APPs, 11.5% assist in the operating room (OR), 46.3% of inpatient and 46.6% of outpatient APPs perform procedures, and 17.8% run specialized APP clinics. 26.2% feel they do not function at the top of their scope of practice and 29.7% were expected to function as a coordinator some or all of the time. Forty-three percent gave invited lectures, 41.5% have published, and 69.2% teach physician trainees. 74.7% and 35.1%, respectively, would like to participate in research and teach but are limited by time, opportunity, and experience. APPs should practice at the top of their scope of practice. Clinical workloads and lack of time limit the ability of APP to teach and contribute to evidence-based practice.
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Affiliation(s)
- Brenda L Muth
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | - Danielle Krieger
- Division of Nephrology, Department of Medicine, University of California, San Francisco, California, USA
| | - Hazel Domingo
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Chicago, Illinois, USA
| | - Jongwon Yoo
- Division of Nephrology, Loyola University Medical Center, Chicago, Illinois, USA
| | - Anna Frank
- Division of Abdominal Transplant Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Karen Paolini
- Department of Surgery, Renal Transplant Division, Erie County Medical Center, Buffalo, New York, USA
| | - Allison Mayfield
- Department of Solid Organ Transplantation, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Amy Borth
- Department of Solid Organ Transplantation, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Margaret Siegfried
- Division of Nephrology and Transplantation, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Heather McDade
- Department of Solid Organ Transplantation, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Nicole McCormick
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Haley Hoy
- Department of Nursing, University of Alabama Huntsville, Huntsville, AL, USA
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Mayer J, Selim MA, Mahaffey JJ, Martin A, Hong JC. Assessment of Patient Knowledge of the Role of Advanced Practice Providers in Transplantation Surgical Care: A Single-Center Prospective Study. Transplant Proc 2022; 54:2616-2620. [DOI: 10.1016/j.transproceed.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022]
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Sastre L, García R, Viñals C, Amor AJ, Yago G, Hervás A, Sánchez L, Trabal J, Molero J, Escudé L, Pagano G, Blasco M, Gilabert R, Ruiz P, Colmenero J, Navasa M, Ortega E, Crespo G. Results of a multidisciplinary strategy to improve the management of cardiovascular risk factors after liver transplantation. Liver Transpl 2022; 28:1332-1344. [PMID: 35224857 DOI: 10.1002/lt.26443] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 02/07/2023]
Abstract
Although liver transplantation (LT) recipients are at high cardiovascular risk (CVR), the management of CVR factors (CVRF) after LT is far from optimal and needs to be improved. For this reason, we developed a multidisciplinary protocol to standardize the identification, risk stratification, management, and targets of therapy of CVRF during the first post-LT year. The grade of identification and control of CVRF 12 months after LT in the postintervention cohort (LT January 2018-January 2020, n = 150) were compared with a control cohort who underwent LT between July 2015 and December 2016 (n = 100). Before LT, the prevalence of metabolic-associated fatty liver disease as the indication of LT and the presence of obesity were significantly higher in the postintervention cohort, whereas the prevalence of other CVRF and renal dysfunction tended to be higher. Cyclosporine A was used less frequently in the postintervention cohort, whereas everolimus tended to increase. At 12 months after LT, the proportion of patients with measured blood pressure (88% vs. 56%), glycosilated hemoglobin (HbA1c; 96% vs. 72%), and high-density lipoprotein/low-density lipoprotein cholesterol (67% vs. 33%) was higher in the postintervention than in the control cohort (all p < 0.001). Blood pressure (64% vs. 36%, p = 0.02) and HbA1c (85% vs. 70%, p = 0.1) were within target in more individuals with hypertension and diabetes mellitus, respectively, in the postintervention cohort. Median total cholesterol levels were lower in the postintervention (184 mg/dl; interquartile range [IQR], 160-210 mg/dl) than in the control cohort (212 mg/dl; IQR, 186-240 mg/dl; p = 0.02). At 2 years after LT, the incidence of cardiovascular events was 14% in the control cohort and 6% in the postintervention cohort (p = 0.063). In conclusion, a multidisciplinary, multiprofessional strategy can achieve a higher grade of assessment and management of post-LT CVR despite a worsening metabolic profile of LT recipients.
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Affiliation(s)
- Lydia Sastre
- Hepatology and Liver Transplant Unit, Hospital Clinic, Barcelona, Spain.,Department of Gastroenterology and Hepatology, Hospital Son Espases, Palma de Mallorca, Spain
| | - Raquel García
- Hepatology and Liver Transplant Unit, Hospital Clinic, Barcelona, Spain
| | - Clara Viñals
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Antonio J Amor
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Gema Yago
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Alicia Hervás
- Hepatology and Liver Transplant Unit, Hospital Clinic, Barcelona, Spain
| | - Lorena Sánchez
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Joan Trabal
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Judit Molero
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Laia Escudé
- Hepatology and Liver Transplant Unit, Hospital Clinic, Barcelona, Spain
| | - Giulia Pagano
- Hepatology and Liver Transplant Unit, Hospital Clinic, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Kidney Transplant Department, Hospital Clinic, Barcelona, Spain
| | - Rosa Gilabert
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - Pablo Ruiz
- Hepatology and Liver Transplant Unit, Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Jordi Colmenero
- Hepatology and Liver Transplant Unit, Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,University of Barcelona, Barcelona, Spain
| | - Miquel Navasa
- Hepatology and Liver Transplant Unit, Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,University of Barcelona, Barcelona, Spain
| | - Emilio Ortega
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición (CIBERobn), Madrid, Spain
| | - Gonzalo Crespo
- Hepatology and Liver Transplant Unit, Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red-Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,University of Barcelona, Barcelona, Spain
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Chambers HE, Reinschmidt K, Smith G, Agudelo E, Brodahl K, Herriman E, Hoy H, Pont K, Seawright A, Stearns E, Torres AM, Weldon E, Blackstock DM. Examining the critical role of advanced practice providers on a multidisciplinary transplant team. Am J Transplant 2021; 21:3840-3846. [PMID: 34101989 DOI: 10.1111/ajt.16715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 01/25/2023]
Abstract
It is well documented that Physician Assistants (PAs) and Nurse Practitioners (NPs), collectively known as Advanced Practice Providers (APPs), have a beneficial role beyond the field of primary care. APPs broad spectrum of knowledge make them particularly well suited for specializing in complex fields such as transplant. Variations in practice across transplant centers lead to questions regarding optimal use of APPs. Using job descriptions from transplant centers currently employing APPs, we sought to examine the critical role of transplant APPs beyond clinical care alone. In this review, we explore not only the general training of APPs and current utilization of APPs in transplant, but also safety, cost effectiveness, and comparison of APPs to other transplant providers. We aimed to highlight the importance of recruitment and retention of transplant specific trained APPs to provide continuity in transplant programs. Additionally, APPs expansion into transplant research, quality improvement, leadership, and management must be considered. We challenge transplant centers utilizing APPs to consider these important aspects when seeking ways to expand and optimize the critical role APPs provide on the transplant team.
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Affiliation(s)
- Heather E Chambers
- Infectious Diseases Program, Alegent Immanuel Medical Center, Omaha, Nebraska, USA
| | - Kristi Reinschmidt
- Transplant Surgery Division, Intermountain Health Care Inc, Salt Lake City, Utah, USA
| | - Georgeine Smith
- Transplant Surgery Division, Penn Transplant Institute, Philadelphia, Pennsylvania, USA
| | - Eliana Agudelo
- Transplant Surgery Division, UCSF, San Francisco, California, USA
| | - Katherine Brodahl
- Transplant Surgery Division, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Herriman
- Transplant Surgery Division, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Haley Hoy
- Transplant Surgery Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kylie Pont
- Transplant Surgery Division, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ashley Seawright
- Transplant Surgery Division, University of Mississippi, Oxford, Mississippi, USA
| | - Elizabeth Stearns
- Transplant Surgery Division, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ana-Marie Torres
- Transplant Surgery Division, UCSF, San Francisco, California, USA
| | - Elaina Weldon
- Transplant Surgery Division, NYU Langone Health, New York, New York, USA
| | - Daryle M Blackstock
- Transplant Surgery Division, New York Presbyterian Hospital, New York, New York, USA
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Nargiso S, Tristan V, Ramos L, Muriel JA, Sachs RE. The evolving role of advanced practice providers in transplantation: a literature review. Curr Opin Organ Transplant 2021; 26:482-487. [PMID: 34369400 DOI: 10.1097/mot.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Solid organ transplantation is a life-saving procedure, often performed in critically ill patients, and advanced practice providers (APPs) have increasingly been incorporated into the multidisciplinary transplant team. A literature review was performed and reinforces the value of transplant APPs, details their evolving roles and responsibilities, and highlights innovative solutions created to address complex problems. RECENT FINDINGS The literature review revealed a deficit of quality quantitative data supporting the utilization of APPs in transplantation. Thus, data regarding the value of APPs in critical care was also analyzed. SUMMARY The limited data despite decades long integration of transplant APPs into the multidisciplinary team, suggests there are likely positive outcomes and innovations that go undocumented. Thus, there are missed opportunities for learning and improvement. Transplant programs investing time and mentorship to support APP research will identify strengths and weaknesses within our existing care models, discover cost saving innovations, and continue to optimize the role of APPs in delivering high quality care that is efficient and evidence based.
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Affiliation(s)
| | | | | | - Jaira A Muriel
- Department of Hepatobiliary and Abdominal Transplant Surgery
| | - Robert E Sachs
- Department of Cardiothoracic Surgery, Keck Hospital of USC, Los Angeles, California, USA
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Gajos A, Tapper EB. The Role of Advanced Practice Providers in the Care of Nonalcoholic Fatty Liver Disease. Clin Ther 2020; 43:518-523. [PMID: 33388173 DOI: 10.1016/j.clinthera.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/13/2020] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the United States. NAFLD presents unique challenges to conventional health care delivery. Patients require accurate, efficient risk stratification to both individualize clinical management plans and optimize subspecialty resource allocation The hepatology workforce is grossly outmatched by the demand for NAFLD referrals, however. Advanced practice providers (APPs) may be best suited to meeting the challenges of NAFLD care. This article reviews the nature and scope of APP practice, the specific needs posed by NAFLD, and the evidence supporting the comparative advantages of APPs in optimizing the outcomes of patients with NAFLD. Our goal is to show how APPs are uniquely suited to addressing the needs of patients with NAFLD who are seen in hepatology practice, with an emphasis on training philosophy and behavioral intervention.
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Affiliation(s)
- Andrea Gajos
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Elliot B Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA; Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
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