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Kozikowski A, Morton-Rias D, Quella A, Puckett K, Jeffery C, Mauldin S, Goodman J. Public experience with and perspectives on medical care provided by PAs. JAAPA 2023; 36:1-10. [PMID: 37751262 DOI: 10.1097/01.jaa.0000977684.35719.f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE We sought to assess public experiences with and perspectives about physician associates/assistants (PAs), who are taking on increasingly important roles in healthcare. METHODS We conducted a survey using a Qualtrics panel assessing whether participants (N = 1,388) received care from PAs, their perceptions of the care received, and their intentions of seeking care from PAs in the future. RESULTS About 67% of participants reported receiving care from PAs; 61.7% believed PAs have more time to communicate with patients. Most respondents were satisfied with the care received, said they were likely to see a PA again, and recommended PAs. Of those not treated by PAs, 30.6% were willing to receive care from PAs, 43.8% were willing to receive care from PAs for minor medical needs, 21.3% were unsure, and 4.3% were unwilling. Older participants and those with more education had consistently more favorable views. CONCLUSIONS Public experiences with and perceptions of PAs are positive. Future research should employ longitudinal designs to assess trends as the PA workforce continues to grow.
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Affiliation(s)
- Andrzej Kozikowski
- At the National Commission on Certification of Physician Assistants in Johns Creek, Ga., Andrzej Kozikowski is senior research director, Dawn Morton-Rias is president and chief executive officer, Alicia Quella is director of PA relations, Kasey Puckett is a research analyst, Colette Jeffery is a senior research analyst, Sheila Mauldin is a senior advisor, and Joshua Goodman is vice president of research and exam programs. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Koster F, Kok MR, van der Kooij J, Waverijn G, Weel-Koenders AEAM, Barreto DL. Dealing with Time Estimates in Hospital Cost Accounting: Integrating Fuzzy Logic into Time-Driven Activity-Based Costing. PHARMACOECONOMICS - OPEN 2023; 7:593-603. [PMID: 37129793 PMCID: PMC10152001 DOI: 10.1007/s41669-023-00413-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Time-driven activity-based costing (TDABC) can support value-based healthcare (VBHC) programs by providing insights into the actual relationships between time spent by the medical staff and the costs associated with specific care cycles. However, the robustness of time estimates (time variation) as well as the effort required to obtain these estimates are major challenges of the TDABC methodology, given the heterogeneity in patients' needs and the presence of (multi)morbidity. To allow for the variation in time estimates in an efficient manner, this study uses fuzzy logic (FL) to estimate the TDABC model parameters (FL-TDABC). METHODS A standardized care path was used to calculate the annual costs (per patient) and cost drivers of the Rheumatoid arthritis (RA) care cycle following the FL-TDABC methodology. Cost information (2018) was derived from hospital reports concerning financial, human resource and business intelligence data from a Dutch top clinical research hospital, Maasstad Hospital. Time estimates of procedures were obtained by interviewing the medical staff and relevant care activities were extracted from electronic health records. For analytical and validation purposes, FL-TDABC estimates were compared with TDABC and ABC cost estimates. RESULTS The RA care cycle annual costs totaled €1497 per patient (2018 prices) based on the FL-TDABC methodology. Maximum RA cycle costs (€1684) were some 22% higher than minimum costs (€1317) observed from FL-TDABC. Cost drivers explaining the cost variation are predominantly the number of consultations with rheumatologists and pharmacy costs related to RA. Based on TDABC and ABC, annual costs per patient were €1609 and €1604, respectively. CONCLUSIONS The FL-TDABC methodology offers a more precise and efficient estimate of care cycle costs, allowing for the subjective (fuzzy) nature of healthcare time estimates made by the medical staff. As a result, the FL-TDABC provides insight into the practice variation, and hence it can promote the transition from a volume-based system to a VBHC system.
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Affiliation(s)
- Fiona Koster
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - Jaco van der Kooij
- Department of Finance and Control, Maasstad Hospital, Rotterdam, The Netherlands
| | - Geeke Waverijn
- Department of Business Intelligence, Maasstad Hospital, Rotterdam, The Netherlands
| | - Angelique E A M Weel-Koenders
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Deirisa Lopes Barreto
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
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Dwyer T, Craswell A, Browne M. Predictive factors of the general public's willingness to be seen and seek treatment from a nurse practitioner in Australia: a cross-sectional national survey. HUMAN RESOURCES FOR HEALTH 2021; 19:21. [PMID: 33596928 DOI: 10.1186/s12960-021-00562-711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Health care delivery in Australia is experiencing challenges with services struggling to keep up with the increasing demands of an aging population, rising levels of chronic disease and limited funding for care. Where adjunct models of health care such as the Nurse Practitioner (NP) have the potential to address this gap, in Australia, they remain an underutilised service. Clarifying the nature of the consumers 'willingness' to be seen by NPs warrants further investigation. METHODS Australia-wide, cross-sectional population-based survey was undertaken using computer-assisted telephone interviewing technique. RESULTS While just over 53% of the general public participants (n = 1318) had heard of an NP, once they became aware of their scope of practice, the majority agreed or strongly agreed they were willing to be seen by an NP in the community (91.6%), the emergency department 88.2%), to manage chronic conditions (86%), to have scrips written and referrals made (85.3%), and if they did not have to wait so long to see a medical doctor (81%). Factors significantly predicting willingness were being: female, less than 65 years of age, native English speakers, or residents from town/regional and rural settings. CONCLUSION Despite limited awareness of the NP role, a large proportion of the Australian population, across different demographic groups, are willing to be seen and treated by an NP. Expansion of this role to support medical services in areas of need could improve healthcare delivery.
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Affiliation(s)
- Trudy Dwyer
- CQUniversity Australia, Building 18 Rockhampton Campus, Bruce Highway, Rockhampton, Q 4702, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q 4556, Australia
| | - Matthew Browne
- CQUniversity Australia, University Drive, Building 8/G.47, Branyan Australia, Bundaberg, Qld, 4670, Australia
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Dwyer T, Craswell A, Browne M. Predictive factors of the general public's willingness to be seen and seek treatment from a nurse practitioner in Australia: a cross-sectional national survey. HUMAN RESOURCES FOR HEALTH 2021; 19:21. [PMID: 33596928 PMCID: PMC7890991 DOI: 10.1186/s12960-021-00562-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Health care delivery in Australia is experiencing challenges with services struggling to keep up with the increasing demands of an aging population, rising levels of chronic disease and limited funding for care. Where adjunct models of health care such as the Nurse Practitioner (NP) have the potential to address this gap, in Australia, they remain an underutilised service. Clarifying the nature of the consumers 'willingness' to be seen by NPs warrants further investigation. METHODS Australia-wide, cross-sectional population-based survey was undertaken using computer-assisted telephone interviewing technique. RESULTS While just over 53% of the general public participants (n = 1318) had heard of an NP, once they became aware of their scope of practice, the majority agreed or strongly agreed they were willing to be seen by an NP in the community (91.6%), the emergency department 88.2%), to manage chronic conditions (86%), to have scrips written and referrals made (85.3%), and if they did not have to wait so long to see a medical doctor (81%). Factors significantly predicting willingness were being: female, less than 65 years of age, native English speakers, or residents from town/regional and rural settings. CONCLUSION Despite limited awareness of the NP role, a large proportion of the Australian population, across different demographic groups, are willing to be seen and treated by an NP. Expansion of this role to support medical services in areas of need could improve healthcare delivery.
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Affiliation(s)
- Trudy Dwyer
- CQUniversity Australia, Building 18 Rockhampton Campus, Bruce Highway, Rockhampton, Q 4702, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q 4556, Australia
| | - Matthew Browne
- CQUniversity Australia, University Drive, Building 8/G.47, Branyan Australia, Bundaberg, Qld, 4670, Australia
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Berkowitz O, Hooker RS, Nissanholtz-Gannot R, Zigdon A. Israeli Willingness to be Treated by a Physician Assistant. J Community Health 2020; 45:1283-1290. [DOI: 10.1007/s10900-020-00835-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Maoz-Breuer R, Berkowitz O, Nissanholtz-Gannot R. Integration of the first physician assistants into Israeli emergency departments - the physician assistants' perspective. Isr J Health Policy Res 2019; 8:4. [PMID: 30764865 PMCID: PMC6376766 DOI: 10.1186/s13584-018-0275-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A new role of Physician Assistant (PA) was introduced into Emergency Departments (ED) in Israel in 2016, as part of a larger effort to improve the quality of service in the EDs. When the new role was introduced, there was a fair amount of uncertainty about whether it would succeed, in light of ambivalence on the part of many ED nurses, and lack of clarity among ED directors about the necessity of a PA role, and about the extent to which PAs would be allowed to take on professionally meaningful tasks. The first class to train PAs was run by the Ministry Of Health between May 2016 and August 2017, with 34 PA trainees participating. 17 out of 24 EDs across Israel partook in the integration of the new PAs. This study assessed how this initial phase of integration is proceeding, from the perspective of the PA trainees themselves. METHODS New PA trainees were surveyed at the beginning and end of their training. Likert scale responses were collected (using a scale of 1 to 6). Respondents were asked about difficulties in their previous profession, their motives for choosing the PA profession and their expectations for the new position. The follow-up survey included additional questions about their clinical activities. Descriptive and correlational statistics were performed. RESULTS In the first survey, PA trainees reported that their main difficulties as paramedics were lack of options for professional advancement and burnout. New PA trainees had initially very high expectations for professional challenge, professional status upgrade, personal fulfillment, career prospects and an increase in wages (average mean score 5.7). In the follow-up survey there was a large drop in all of their ratings (average mean score 3.8). In the second survey, PA trainees reported spending the majority of their time evaluating, diagnosing and managing patients as opposed to preforming clinical procedures, such as inserting an IV, administrating medicine or applying casts. Despite their decreased expectations, they still felt that they were intellectually stimulated (5.3 average), given high levels of responsibility (4.8 average), and making significant contributions to the healthcare team and patients (average score of 5.5). All of the above were correlated with overall satisfaction. The main difficulties they reported were related to limited authority and further career advancement. CONCLUSIONS The new Israeli PA role has officially been launched in emergency medicine. The first group of PA trainees report a positive, productive integration, and overall satisfaction levels with their new career are high. However, the PA trainees reported having experienced some difficulties along the way, and there was a large decrease in their overall expectations from the new position during their first year on the job. Since the subject of limited authority was found to be a substantial difficulty for the new PA trainees, the Ministry of Health should explore this issue and create a uniform policy on it.
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Affiliation(s)
- Rina Maoz-Breuer
- Myers-JDC-Brookdale Institute, JDC Hill, P.O.B. 3886, 91037, Jerusalem, Israel.
| | - Oren Berkowitz
- Department of Health System Management, Ariel University, University Hill, 40700, Ariel, Israel
| | - Rachel Nissanholtz-Gannot
- Myers-JDC-Brookdale Institute, JDC Hill, P.O.B. 3886, 91037, Jerusalem, Israel.,Department of Health System Management, Ariel University, University Hill, 40700, Ariel, Israel
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Hains T, Turner C, Strand H. Practice audit of the role of the Non-medical surgical assistant in Australia, an online survey. Int J Nurs Pract 2016; 22:546-555. [PMID: 27492643 DOI: 10.1111/ijn.12462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 06/03/2016] [Accepted: 06/05/2016] [Indexed: 11/29/2022]
Abstract
The term Non-Medical Surgical Assistant (NMSA) encompasses all roles where healthcare clinicians without a medical degree provide clinical services during the perioperative cycle. The role of NMSA is gaining momentum within Australia. It is timely to ascertain who is preforming the role and quantify the practice setting and scope of practice to enable a nationally recognised platform for role evolution. For two months in 2015 a NMSA Practice Audit was available online. Sampling was initially of a convenience modality. A total of 83 clinicians responded. The majority of NMSAs were experienced RNs [>11yrs]; held post-graduate qualifications [80%], practiced predominantly in metropolitan areas [65%] and had been performing the role for 8 years or less. The specialty with the highest uptake of the NMSAs is orthopaedic surgery. This paper provides an overview of NMSAs practicing in Australia and provides cost effective evidence of the need for this service in Australian healthcare.
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Affiliation(s)
- Toni Hains
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Brisbane, Qld. 4072
| | - Catherine Turner
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Brisbane, Qld. 4072
| | - Haakan Strand
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Brisbane, Qld. 4072
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Drennan VM, Halter M, Brearley S, Carneiro W, Gabe J, Gage H, Grant R, Joly L, de Lusignan S. Investigating the contribution of physician assistants to primary care in England: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02160] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPrimary health care is changing as it responds to demographic shifts, technological changes and fiscal constraints. This, and predicted pressures on medical and nursing workforces, raises questions about staffing configurations. Physician assistants (PAs) are mid-level practitioners, trained in a medical model over 2 years at postgraduate level to work under a supervising doctor. A small number of general practices in England have employed PAs.ObjectiveTo investigate the contribution of PAs to the delivery of patient care in primary care services in England.DesignA mixed-methods study conducted at macro, meso and micro organisational levels in two phases: (1) a rapid review, a scoping survey of key national and regional informants, a policy review, and a survey of PAs and (2) comparative case studies in 12 general practices (six employing PAs). The latter incorporated clinical record reviews, a patient satisfaction survey, video observations of consultations and interviews with patients and professionals.ResultsThe rapid review found 49 published studies, mainly from the USA, which showed increased numbers of PAs in general practice settings but weak evidence for impact on processes and patient outcomes. The scoping survey found mainly positive or neutral views about PAs, but there was no mention of their role in workforce policy and planning documents. The survey of PAs in primary care (n = 16) found that they were mainly deployed to provide same-day appointments. The comparative case studies found that physician assistants were consulted by a wide range of patients, but these patients tended to be younger, with less medically acute or complex problems than those consulting general practitioners (GPs). Patients reported high levels of satisfaction with both PAs and GPs. The majority were willing or very willing to consult a PA again but wanted choice in which type of professional they consulted. There was no significant difference between PAs and GPs in the primary outcome of patient reconsultation for the same problem within 2 weeks, investigations/tests ordered, referrals to secondary care or prescriptions issued. GPs, blinded to the type of clinician, judged the documented activities in the initial consultation of patients who reconsulted for the same problem to be appropriate in 80% (n = 223) PA and 50% (n = 252) GP records. PAs were judged to be competent and safe from observed consultations. The average consultation with a physician assistant is significantly longer than that with a GP: 5.8 minutes for patients of average age for this sample (38 years). Costs per consultation were £34.36 for GPs and £28.14 for PAs. Costs could not be apportioned to GPs for interruptions, supervision or training of PAs.ConclusionsPAs were found to be acceptable, effective and efficient in complementing the work of GPs. PAs can provide a flexible addition to the primary care workforce. They offer another labour pool to consider in health professional workforce and education planning at local, regional and national levels. However, in order to maximise the contribution of PAs in primary care settings, consideration needs to be given to the appropriate level of regulation and the potential for authority to prescribe medicines. Future research is required to investigate the contribution of PAs to other first contact services as well as secondary services; the contribution and impact of all types of mid-level practitioners (including nurse practitioners) in first contact services; the factors and influences on general practitioner and practice manager decision-making as to staffing and skill mix; and the reliability and validity of classification systems for both primary care patients and their presenting condition and their consequences for health resource utilisation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Vari M Drennan
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Sally Brearley
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Wilfred Carneiro
- Directorate of Corporate Affairs, St George’s Healthcare NHS Trust, London, UK
| | - Jonathan Gabe
- Centre for Criminology and Sociology, Royal Holloway, University of London, London, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guildford, UK
| | - Robert Grant
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Louise Joly
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London, UK
| | - Simon de Lusignan
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
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