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Bosak S, Yazdani S, Ayati MH. Approaches and Components of Health Workforce Planning Models: A Systematic Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:358-369. [PMID: 37456211 PMCID: PMC10349158 DOI: 10.30476/ijms.2022.94662.2600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/13/2022] [Accepted: 06/25/2022] [Indexed: 07/18/2023]
Abstract
Background To date, there is still no uniformity in forecasting models for health workforce planning (HWFP). Different countries use various HWFP models, some of which are context-specific. The objective of this systematic review is to determine approaches and components of HWFP models. Methods A systematic review of studies published in English and Persian between 2004 and 2021 was performed by searching PubMed Central, MEDLINE, Web of Science, Scopus, Eric, and Elmnet databases. Articles that assessed HWFP models, focused on health service delivery, used input-output models, and a clear formulation process were included. Articles that scored ≥20 points on the "strengthening the reporting of observational studies in epidemiology" checklist were considered of acceptable quality for inclusion. Results Twenty articles were included for qualitative synthesis based on the inclusion and exclusion criteria. Most studies used the mixed method approach "supply and demand", whereas target- and needs-based approaches were used less frequently. The number of components used to estimate supply, demand, needs, and targets were 42, 32, 11, and 6, respectively. In addition, several unique factors used in the various HWFP models were identified. Conclusion Different approaches are used in HWFP models, which is indicative of the lack of consensus on this topic. High diversity in the identified factors is related to the approach used and the context in which the model is applied.
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Affiliation(s)
- Somaieh Bosak
- Department of Medical Education, School of Virtual Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Yazdani
- Department of Medical Education, School of Virtual Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Ayati
- Department of Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
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State Scope of Practice Laws: An Analysis of Physician Assistant Programs and Graduates. J Physician Assist Educ 2021; 31:179-184. [PMID: 33136717 DOI: 10.1097/jpa.0000000000000331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to understand the association between physician assistant (PA) state scope of practice (SOP) laws and (1) PA program growth and (2) PA graduate demographics. METHODS Scope of practice laws were categorized as ideal, average, and restrictive. Descriptive statistics by year and SOP categories were determined for the number of states, population density, PA programs, and PA graduate number, gender, race, and mean age. The Mann-Whitney U test was used to analyze demographic data by SOP categories. Adjusted risk ratios were generated for the number of PA programs and SOP categories. RESULTS The number of PA programs is not associated with ideal SOP states. As of 2017, only 10 states have restrictive SOP laws. A minority of PA students now graduate from states with restrictive SOP laws. CONCLUSION There is heterogeneity in PA SOP laws throughout the United States but only a minority of PA graduates now come from restrictive SOP states. This study provides foundational information prior to the implementation of optimal team practice.
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Advancing the Population Needs-Based Health Workforce Planning Methodology: A Simulation Tool for Country Application. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042113. [PMID: 33671553 PMCID: PMC7926568 DOI: 10.3390/ijerph18042113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 12/02/2022]
Abstract
Although the conceptual underpinnings of needs-based health workforce planning have developed over the last two decades, lingering gaps in empirical models and lack of open access tools have partly constrained its uptake in health workforce planning processes in countries. This paper presents an advanced empirical framework for the need-based approach to health workforce planning with an open-access simulation tool in Microsoft® Excel to facilitate real-life health workforce planning in countries. Two fundamental mathematical models are used to quantify the supply of, and need for, health professionals, respectively. The supply-side model is based on a stock-and-flow process, and the need-side model extents a previously published analytical frameworks using the population health needs-based approach. We integrate the supply and need analyses by comparing them to establish the gaps in both absolute and relative terms, and then explore their cost implications for health workforce policy and strategy. To illustrate its use, the model was used to simulate a real-life example using midwives and obstetricians/gynaecologists in the context of maternal and new-born care in Ghana. Sensitivity analysis showed that if a constant level of health was assumed (as in previous works), the need for health professionals could have been underestimated in the long-term. Towards universal health coverage, the findings reveal a need to adopt the need-based approach for HWF planning and to adjust HWF supply in line with population health needs.
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Fournier M, Neel R, Spence D, Sawyer J, Sheffer B, Kelly D. Initial Evaluation by a Non-Surgeon Provider Does Not Delay the Surgical Care of Pediatric Forearm and Elbow Trauma in a Walk-In Orthopaedic Clinic. Cureus 2020; 12:e8139. [PMID: 32550059 PMCID: PMC7294849 DOI: 10.7759/cureus.8139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Walk-in and after-hours clinics are being increasingly utilized in orthopedics and are especially beneficial for patients with simple sprains, fractures, or overuse injuries that might otherwise require an emergency room visit. To meet the increased patient load, additional staffing often is required, which might include a family medicine physician, nurse practitioner, or physician assistant. Few studies have evaluated the performance of these non-surgeon providers in an orthopedic clinical setting. This study compared the time to definitive care of pediatric patients with forearm and elbow injuries between non-surgeon providers in a walk-in clinic, orthopedic surgeons in a walk-in clinic, and a pediatric orthopedic surgeon in a regular clinic. Methods Children who had closed reduction and fixation of an elbow or forearm injury from January 2010 to December 2017 were identified. The patients were divided into groups: patients initially evaluated in a walk-in clinic by a non-surgeon provider; patients initially evaluated in a walk-in clinic by an orthopedic surgeon; and patients initially seen by a fellowship-trained, pediatric orthopedic surgeon in a regular clinic (control group). Neither type of provider (non-surgeon or surgeon) in the walk-in clinics definitively treated any injury but rather transferred care of the patient to a pediatric orthopedic surgeon. The number of clinic visits until surgery, the number of providers seen, the days before evaluation by a pediatric orthopedic surgeon, and the number of days before definitive surgical treatment were documented. Results Of the 162 patients identified, 36 (22%) were initially seen by an orthopedic surgeon and 62 (38%) by a non-surgeon provider in a walk-in clinic. The remaining 64 (40%) (control group) were initially seen in a regular office visit by a pediatric orthopedic surgeon. There were no significant differences noted for patients treated by orthopedic surgeon and non-surgeon providers in days before a referral visit to the pediatric orthopedic surgeon (3.7 vs. 3.9, respectively; p = 0.63) or days to surgery for definitive treatment (5.2 vs. 4.8, respectively; p = 0.62). The average number of providers seen (1.58 vs. 1.63, respectively; p = 0.69) and average number of clinic visits before surgery (2.08 vs. 2.06, respectively; p = 0.76) also were similar when comparing the two groups. The control group had significantly fewer days from evaluation to surgical treatment than the surgeon walk-in group (3.3 days vs. 5.2 days, p < 0.05) and the non-surgeon walk-in group (3.3 days vs. 4.8 days, p < 0.05). Conclusion There was no difference in the number of days to transfer patient care to a pediatric orthopedic surgeon between non-surgeon providers and orthopedic surgeons in the walk-in clinic. However, there was a one-day delay reaching definitive treatment when initial evaluation occurred in a walk-in clinic, regardless of whether the patient was initially seen by a surgeon or non-surgeon, when compared to an initial evaluation by a pediatric orthopedic surgeon.
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Affiliation(s)
- Matthew Fournier
- Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, USA
| | - Robert Neel
- Orthopaedics, University of Tennessee Health Science Center, Memphis, USA
| | - David Spence
- Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, USA
| | - Jeffrey Sawyer
- Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, USA
| | - Benjamin Sheffer
- Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, USA
| | - Derek Kelly
- Orthopaedic Surgery, University of Tennessee, Memphis, USA
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Fournier MN, Cline JT, Seal A, Smith RA, Throckmorton TW, Mauck BM. Operative Distal Radial Fractures: A Comparison of Time to Surgery After Evaluation by Surgical and Nonsurgical Providers in a Walk-in Clinic. Orthop Clin North Am 2020; 51:235-239. [PMID: 32138861 DOI: 10.1016/j.ocl.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To determine if orthopedic surgeons are more efficient than nonsurgical providers at care of operative injuries in walk-in clinics, patients in a walk-in clinic for evaluation of acute injury who subsequently had surgical treatment of isolated distal radial fracture were compared based on whether the initial visit was with a surgical or nonsurgical provider. Initial evaluation in a walk-in orthopedic clinic setting versus a conventional hand surgeon's clinic was associated with longer delay between initial evaluation and surgical treatment, but this difference may not be significant. Evaluation by a nonsurgical provider was not associated with increased duration to definitive treatment.
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Affiliation(s)
- Matthew N Fournier
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
| | - Joseph T Cline
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Adam Seal
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Richard A Smith
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Thomas W Throckmorton
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | - Benjamin M Mauck
- University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
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Assessing the Impact of a Professional Development Program for Physician Assistant Program Directors. J Physician Assist Educ 2018; 29:138-143. [PMID: 30086118 DOI: 10.1097/jpa.0000000000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The growth of physician assistant (PA) programs nationally has stretched the available capacity of experienced PA program directors. To address this need, a professional developmental program was designed to provide new program directors with the knowledge, skills, and resources necessary to succeed in the role. This study sought to characterize the impact of program attendance over time. Data were collected from individuals representing 5 cohorts that participated in the annual Physician Assistant Education Association New Program Directors Retreat between 2011 and 2015. METHODS An electronic survey was developed and sent to all 5 cohorts (n = 139). Anonymous responses were collected and quantitative data were analyzed in the aggregate and also by year of participation. Qualitative data were analyzed, and a thematic analysis was conducted. Results were compared with baseline data collected during the program registration process and with published national data on program director characteristics. RESULTS Seventy-five program participants completed the survey, for a response rate of 57%. Program director stability, educational achievement, and involvement in leadership and service activities were found to be positive outcomes for individuals who had participated in the professional development program. CONCLUSION Survey respondents reported positive outcomes after attending a professional development program; these outcomes are consistent with research on similar programs published in the literature. Our findings suggest that new program directors who participated in this professional development program not only derived career-stabilizing benefits but also succeeded in creating supportive peer networks while gaining greater confidence in their new academic role.
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Cepeda MS, Coplan PM, Kopper NW, Maziere JY, Wedin GP, Wallace LE. ER/LA Opioid Analgesics REMS: Overview of Ongoing Assessments of Its Progress and Its Impact on Health Outcomes. PAIN MEDICINE 2017; 18:78-85. [PMID: 27373304 PMCID: PMC5283702 DOI: 10.1093/pm/pnw129] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective. Opioid abuse is a serious public health concern. In response, the Food and Drug Administration (FDA) determined that a risk evaluation and mitigation strategy (REMS) for extended-release and long-acting (ER/LA) opioids was necessary to ensure that the benefits of these analgesics continue to outweigh the risks. Key components of the REMS are training for prescribers through accredited continuing education (CE), and providing patient educational materials. Methods. The impact of this REMS has been assessed using diverse metrics including evaluation of prescriber and patient understanding of the risks associated with opioids; patient receipt and comprehension of the medication guide and patient counseling document; patient satisfaction with access to opioids; drug utilization and changes in prescribing patterns; and surveillance of ER/LA opioid misuse, abuse, overdose, addiction, and death. Results and Conclusions. The results of these assessments indicate that the increasing rates of opioid abuse, addiction, overdose, and death observed prior to implementation of the REMS have since leveled off or started to decline. However, these benefits cannot be attributed solely to the ER/LA opioid analgesics REMS since many other initiatives to prevent abuse occurred contemporaneously. These improvements occurred while preserving patient access to opioids as a large majority of patients surveyed expressed satisfaction with their access to opioids.
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Affiliation(s)
- M Soledad Cepeda
- Department of Epidemiology, Janssen Research and Development, Titusville, New Jersey, NJ, USA
| | - Paul M Coplan
- Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, Connecticut, CT, USA.,Adjunct, Department of Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Nathan W Kopper
- Department of Drug Safety, Mallinckrodt Pharmaceuticals, Inc., Hazelwood, Missouri, MO, USA
| | - Jean-Yves Maziere
- REMS, Labeling, Drug Safety, Boehringer Ingelheim Roxane, Inc./Roxane Laboratories, Inc. Columbus, Ohio, OH, USA
| | - Gregory P Wedin
- Department of Drug Safety, Upsher-Smith Laboratories, Inc., Maple Grove, Minnesota, USA
| | - Laura E Wallace
- Department of Risk Management and Epidemiology, Purdue Pharma L.P., Stamford, Connecticut, CT, USA
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NP or PA? What influences student choice. JAAPA 2017; 30:10. [DOI: 10.1097/01.jaa.0000516356.96502.3d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Greater use of physician assistants (PAs) and nurse practitioners (NPs) to meet growing demand for healthcare in the United States is an increasingly common strategy to improve access to care and control costs. Evidence suggests that payment for services differs depending on the type of provider. This study sought to determine if the source of payment for a medical visit varies based on whether care is provided by a physician, PA, or NP. Data from the National Hospital Ambulatory Medical Care Survey (2006 through 2010) were analyzed. Physicians were proportionally more likely than NPs or PAs to provide care for medical visits compensated by private insurance or Medicare. Conversely, PAs and NPs were more likely to serve as providers of care for services with other payment sources such as Medicaid and out-of-pocket.
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Gentili M, Harati P, Serban N. Projecting the Impact of the Affordable Care Act Provisions on Accessibility and Availability of Primary Care Providers for the Adult Population in Georgia. Am J Public Health 2016; 106:1470-6. [PMID: 27310340 PMCID: PMC4940646 DOI: 10.2105/ajph.2016.303222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate how met need for accessibility and availability of primary care among nonelderly individuals in Georgia will be affected by the Patient Protection and Affordable Care Act (ACA) over the next 10 years. METHODS We used a stock-and-flow model to predict the number of available visits from 2013 to 2025, regression models to project needed visits, and an optimization model to estimate met need. The outputs of these models were used to estimate unmet need and the availability and accessibility of primary care. RESULTS Our findings showed that the number of primary care providers will increase by 9.2% to 11.7% by 2025 and that the number of needed visits will increase by 20%. Under Medicaid expansion, the percentage of met need will increase from 67% to 80%. Accessibility will improve by 20% under expansion, and availability will decrease by 13% to 19% under expansion. CONCLUSIONS The ACAs' provisions will reduce unmet need and positively affect accessibility while reducing availability in some communities. Increased need because of a larger Medicaid population under Medicaid expansion will not be a significant burden on the privately insured population.
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Affiliation(s)
- Monica Gentili
- Monica Gentili is with the Industrial Engineering Department, University of Louisville, Louisville, KY. Pravara Harati and Nicoleta Serban are with the Industrial and System Engineering Department, Georgia Institute of Technology, Atlanta
| | - Pravara Harati
- Monica Gentili is with the Industrial Engineering Department, University of Louisville, Louisville, KY. Pravara Harati and Nicoleta Serban are with the Industrial and System Engineering Department, Georgia Institute of Technology, Atlanta
| | - Nicoleta Serban
- Monica Gentili is with the Industrial Engineering Department, University of Louisville, Louisville, KY. Pravara Harati and Nicoleta Serban are with the Industrial and System Engineering Department, Georgia Institute of Technology, Atlanta
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Brock DM, Nicholson JG, Hooker RS. Physician Assistant and Nurse Practitioner Malpractice Trends. Med Care Res Rev 2016; 74:613-624. [PMID: 27457425 DOI: 10.1177/1077558716659022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Trends in malpractice awards and adverse actions (e.g., revocation of provider license) following an act or omission constituting medical error or negligence were examined. The National Practitioner Data Bank was used to compare rates of malpractice reports and adverse actions for physicians, physician assistants (PAs), and nurse practitioners (NPs). During 2005 through 2014, there ranged from 11.2 to 19.0 malpractice payment reports per 1,000 physicians, 1.4 to 2.4 per 1,000 PAs, and 1.1 to 1.4 per 1,000 NPs. Physician median payments ranged from 1.3 to 2.3 times higher than PAs or NPs. Diagnosis-related malpractice allegations varied by provider type, with physicians having significantly fewer reports (31.9%) than PAs (52.8%) or NPs (40.6%) over the observation period. Trends in malpractice payment reports may reflect policy enactments to decrease liability.
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Abstract
The physician assistant (PA) profession emerged nearly 50 years ago to leverage the healthcare experience of Vietnam-era military trained medics and corpsmen to fill workforce shortages in medical care. In 2009, the American Recovery and Reinvestment Act Primary Care Training and Enhancement program was established to improve access to primary care. Training military veterans as PAs was again identified as a strategy to meet provider access shortages. However, fewer than 4% of veterans with military healthcare training are likely to apply to PA school and little is known regarding the factors that predict acceptance to training. In 2012, we surveyed all veteran applicants and a stratified random sample of nonveterans applying to PA training. We compare the similarities and differences between veteran and nonveteran applicants, application barriers, and the factors predicting acceptance. We conclude with a discussion of the link between modern veterans and the PA profession.
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