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Zhao Y, Quadros W, Nagraj S, Wong G, English M, Leckcivilize A. Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review. BMC Med 2024; 22:286. [PMID: 38978070 PMCID: PMC11232288 DOI: 10.1186/s12916-024-03509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams. METHODS We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level). RESULTS We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained. CONCLUSIONS We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.
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Affiliation(s)
- Yingxi Zhao
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK.
| | | | - Shobhana Nagraj
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mike English
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Attakrit Leckcivilize
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
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Smith MA, Zelenetz P, Kim A, Donaghy H, Gould JS, McLeod-Sordjan R. Curriculum and Competency Guidelines for the Advanced Care Practitioner in Infectious Disease. Open Forum Infect Dis 2024; 11:ofad589. [PMID: 38304731 PMCID: PMC10831324 DOI: 10.1093/ofid/ofad589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024] Open
Abstract
Background Changes in the health care delivery system have altered the way internal medicine (IM) is practiced, with inclusion of subspecialty advanced care practitioners (ACPs) as vital members of the health care team. Methods ACPs are provided the clinical settings and educational resources within an academic center to become competent in recognizing and managing common and complicated infectious diseases (ID). The ID ACP will be given progressive responsibility with expectations for achievement of milestones as they develop into competent practitioners. We seek to ensure quality, cost-effective, and comprehensive patient-centered care on the ID service in the inpatient and ambulatory settings in compliance with national standards and scope of practice recommendations and regulations. Results In recognition of the expanding role of ACPs, we developed a curriculum and guidelines in the subspecialty of ID. Conclusions Our proposal greatly adds to the available literature for ACPs to provide the full spectrum of ID practice.
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Affiliation(s)
- Miriam A Smith
- Daytonand Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NewYork, USA
| | - Paul Zelenetz
- Daytonand Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NewYork, USA
| | - Angela Kim
- Daytonand Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NewYork, USA
| | - Henry Donaghy
- Daytonand Karen Brown Division of Infectious Diseases, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NewYork, USA
| | - J Scott Gould
- Hofstra/Northwell School of Nursing and Physician Assistant Studies, 160 Hofstra University, Hempstead, NewYork, USA
| | - Renee McLeod-Sordjan
- Hofstra/Northwell School of Nursing and Physician Assistant Studies, 160 Hofstra University, Hempstead, NewYork, USA
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Misurka J, Lajkosz K, Kenk M, Finelli A, Fleshner NE. Quantitative and qualitative impact of physician assistants in a Canadian urology setting. Can Urol Assoc J 2023; 17:337-340. [PMID: 37494320 PMCID: PMC10581721 DOI: 10.5489/cuaj.8287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Physician assistants (PAs) are healthcare professionals who act as physician extenders. PAs are being used more and more in a wide variety of clinic settings throughout Canada to increase access to healthcare and reduce cost. We set out to determine the impact of PAs on a tertiary care center urologic oncology practice. METHODS We reviewed Ontario Health Insurance Plan (OHIP) billing codes since the introduction of PAs for two attending urologists at Princess Margaret Cancer Centre. Data were grouped into early experience and established experience. In addition, questionnaires were electronically distributed among nurses, physicians, residents, and fellows who work with PAs in clinic. Patient visits conducted by PAs were tracked for one quarter to estimate the amount of annual patients seen by PAs. The costs associated with PAs are presented as recommendations for a new graduate PA hire. RESULTS On average, PAs increased clinic volume by 11.3 patient visits per day. Furthermore, they individually care for an average of 24 patients per day. PAs did not represent a financial burden on the urology practice plan (revenue gain of $16 800). Our questionnaire demonstrated that PAs were capable healthcare professionals, who decreased workload and contributed to resident/fellow education. CONCLUSIONS PAs in a Canadian urology practice allow for more patient visits, decrease in physician workload, and positively impact trainee education. PAs saw more patients in clinic than clinic growth, thereby decreasing physician, fellow, and resident workload. The offset of the increase in patient visits made the PAs a cost-neutral investment.
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Affiliation(s)
- James Misurka
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Katherine Lajkosz
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Miran Kenk
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- University Health Network, University of Toronto, Toronto, ON, Canada
- Princess Margret Cancer Centre, Toronto, ON, Canada
| | - Neil E. Fleshner
- University Health Network, University of Toronto, Toronto, ON, Canada
- Princess Margret Cancer Centre, Toronto, ON, Canada
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van den Brink GTWJ, Hooker RS, Van Vught AJ, Vermeulen H, Laurant MGH. The cost-effectiveness of physician assistants/associates: A systematic review of international evidence. PLoS One 2021; 16:e0259183. [PMID: 34723999 PMCID: PMC8559935 DOI: 10.1371/journal.pone.0259183] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The global utilization of the physician assistant/associate (PA) is growing. Their increasing presence is in response to the rising demands of demographic changes, new developments in healthcare, and physician shortages. While PAs are present on four continents, the evidence of whether their employment contributes to more efficient healthcare has not been assessed in the aggregate. We undertook a systematic review of the literature on PA cost-effectiveness as compared to physicians. Cost-effectiveness was operationalized as quality, accessibility, and the cost of care. METHODS AND FINDINGS Literature to June 2021 was searched across five biomedical databases and filtered for eligibility. Publications that met the inclusion criteria were categorized by date, country, design, and results by three researchers independently. All studies were screened with the Risk of Bias in Non-randomised Studies-of Interventions (ROBIN-I) tool. The literature search produced 4,855 titles, and after applying criteria, 39 studies met inclusion (34 North America, 4 Europe, 1 Africa). Ten studies had a prospective design, and 29 were retrospective. Four studies were assessed as biased in results reporting. While most studies included a small number of PAs, five studies were national in origin and assessed the employment of a few hundred PAs and their care of thousands of patients. In 34 studies, the PA was employed as a substitute for traditional physician services, and in five studies, the PA was employed in a complementary role. The quality of care delivered by a PA was comparable to a physician's care in 15 studies, and in 18 studies, the quality of care exceeded that of a physician. In total, 29 studies showed that both labor and resource costs were lower when the PA delivered the care than when the physician delivered the care. CONCLUSIONS Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care. Sometimes this efficiency was due to their reduced labor cost and sometimes because they were more effective as producers of care and activity.
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Affiliation(s)
- G. T. W. J. van den Brink
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands
| | - R. S. Hooker
- Adjunct Professor, Health Policy, Northern Arizona University, United States of America
| | - A. J. Van Vught
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands
| | - H. Vermeulen
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands
| | - M. G. H. Laurant
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, School of Health Studies, Nijmegen, The Netherlands
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Lack A, Saddik M, Engels P, Lethbridge S, Nenshi R. The emergence of the physician assistant role in a Canadian acute care surgery setting. Can J Surg 2020. [PMID: 33026310 DOI: 10.1503/cjs.002119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The role of physician assistants (PAs) in surgical care in Canada is expanding. Similarly, the acute care surgery (ACS) model continues to evolve, and PAs are increasingly being considered as members of ACS teams. However, their exact impact and contribution has not been well studied. Our study describes the contribution of a PA who worked full time on weekdays on an ACS team in a Canadian academic tertiary hospital. METHODS To quantify the PA's contributions, an ACS database was created in September 2016. Data on the number of ACS patient encounters, the number of ACS surgical consults, the number of ACS admissions, the PA's involvement in the operating room, the number of PA patient encounters and the number of multidisciplinary meetings were prospectively collected. We report data for 365 consecutive days from Dec. 30, 2016, to Dec. 29, 2017. RESULTS The ACS team had 11 651 patient encounters during the year, with a mean of 31.92 per day. The mean number of surgical consults per day was 5.89, and a mean of 2.08 surgical procedures were performed per day. The PA was involved in 53.5% of all patient encounters, despite working only during daytime hours on weekdays. Multidisciplinary meetings were conducted by the PA 94.9% of the time. Alternate level of care patients were seen by the PA 96.2% of the time. The PA was directly involved in 2.0% of the operating room procedures during the study period. CONCLUSION Integrating a PA on an ACS team adds value to patient care by providing consistency and efficient management of ward issues and patient care plans, including multidisciplinary discharge planning, timely emergency department consultations and effective organization of the ACS team members.
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Affiliation(s)
- Andrea Lack
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
| | - Maisa Saddik
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
| | - Paul Engels
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
| | - Sara Lethbridge
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
| | - Rahima Nenshi
- From Halton Healthcare, Oakville, Ont. (Lack); the Department of Surgery, McMaster University, Hamilton, Ont. (Saddik, Engels, Lethbridge, Nenshi); the Department of Surgery, Hamilton General Hospital, Hamilton, Ont. (Engels); and the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi)
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Making the Consult Interaction More Than a Transaction: Helping Fellows Be Better Teachers and Residents Be Better Learners. J Pediatr 2019; 209:3-4.e2. [PMID: 31128730 DOI: 10.1016/j.jpeds.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 11/22/2022]
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Dies NF, Taylor MT. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:249-251. [PMID: 30979754 PMCID: PMC6467675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Natalie F Dies
- Adjointe au médecin à la Division d'otorhinolaryngologie et de chirurgie tête et cou de l'Hôpital de l'Université de l'Alberta à Edmonton.
| | - Maureen T Taylor
- Adjointe au médecin à la Division des maladies infectieuses de l'Hôpital Michael Garron à Toronto (Ontario)
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Dies NF, Taylor MT. Ontario physician assistants: Decision time. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:243-245. [PMID: 30979752 PMCID: PMC6467679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Natalie F Dies
- Physician assistant in the Division of Otolaryngology Head and Neck Surgery at the University of Alberta Hospital in Edmonton.
| | - Maureen T Taylor
- Physician assistant in the Division of Infectious Diseases at Michael Garron Hospital in Toronto, Ont
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Abstract
OBJECTIVES Educational demands coupled with restricted hours reduce residents' availability to provide care at academic hospitals. Physician assistants (PAs) may address this issue. This study assessed the effect of PAs on patient discharges, resident workload, and resident perceptions of PAs on a surgical team. METHODS Two PAs were employed on teams caring for complex surgical patients. Measures included time of discharge order entry, hours residents spent on the electronic medical record (EMR), and resident opinions of PA effectiveness. RESULTS The teams with PAs had a 0.5% late discharge and 16% early discharge rate. Junior residents with a PA on the team spent fewer hours on the EMR. Residents reported PAs significantly improved their rotation and quality care. CONCLUSIONS PAs reduce resident workload and improve care on surgical teams in a tertiary hospital.
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Abstract
Physician assistants (PAs) have been used for decades in the Canadian military. Now, PAs are being introduced in various clinical settings to provide patient care for the general population. This article reviews major developments in the PA profession across Canada over the last decade. Nearly 541 PAs are employed in Canada or work for a Canadian agency. Growing evidence demonstrates the positive effect of PAs; however, key issues challenge the extent to which the PA movement will continue to build momentum.
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Commentaries on health services research. JAAPA 2016. [DOI: 10.1097/01.jaa.0000480581.46616.8f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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