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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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Piquer-Martinez C, Urionagüena A, Benrimoj SI, Calvo B, Dineen-Griffin S, Garcia-Cardenas V, Fernandez-Llimos F, Martinez-Martinez F, Gastelurrutia MA. Theories, models and frameworks for health systems integration. A scoping review. Health Policy 2024; 141:104997. [PMID: 38246048 DOI: 10.1016/j.healthpol.2024.104997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/23/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Celia Piquer-Martinez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain.
| | - Amaia Urionagüena
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Shalom I Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain
| | - Begoña Calvo
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
| | - Sarah Dineen-Griffin
- College of Health, Medicine and Wellbeing, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Newcastle, Australia
| | - Victoria Garcia-Cardenas
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain
| | - Fernando Fernandez-Llimos
- Center for Health Technology and Services Research (CINTESIS), Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Fernando Martinez-Martinez
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain
| | - Miguel Angel Gastelurrutia
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Campus de Cartuja s/n, Granada 18071, Spain; Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain
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McAllister MS, Olagunju AT. Revisiting the unmet mental health needs in Canada: Can PAs be part of the solution? JAAPA 2023; 36:42-45. [PMID: 37989170 DOI: 10.1097/01.jaa.0000991376.73809.27] [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: 11/23/2023]
Abstract
ABSTRACT In Canada, unmet mental health care needs remain a major issue despite mental disorders ranking as the second largest source of years lost to disability. As discussions continue on alternative models of healthcare to reduce the long waiting times for mental health treatment, leveraging the skills and resources available from physician associates/assistants (PAs) and NPs becomes imperative. Relatively few PAs in Canada work in psychiatry, despite widespread acceptance in other medical disciplines. Sustainable funding models for the training, recruitment, and retention of PAs in mental health care are vital. More research, policy development, and interprofessional collaboration can enhance the effective integration of PAs into mental health care.
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Affiliation(s)
- Matthew S McAllister
- Matthew S. McAllister practices in addiction medicine in Ontario, Canada. Andrew T. Olagunju is an assistant professor and psychiatrist in the Department of Psychiatry and Behavioral Neurosciences at McMaster University/St. Joseph's Healthcare Hamilton in Ontario and a research fellow in psychiatry at the University of Adelaide in Australia. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Moschella A, Burrows K. Patient Experience With Primary Care Physician Assistants in Ontario, Canada: Impact of Trust, Knowledge, and Access to Care. J Patient Exp 2023; 10:23743735231211782. [PMID: 37928961 PMCID: PMC10623992 DOI: 10.1177/23743735231211782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Physician assistants (PAs) have been integrated into primary care settings to reduce wait times and to optimize continuity of care. Though previous studies suggest that PA utilization leads to improved healthcare access, few studies have investigated patient experience with primary care PAs in Canada. The objective of this study is to explore patient perspectives on primary care PAs in Ontario. A patient survey was developed and distributed to patients seen by PAs in 4 family medicine practices across Ontario, Canada. Results demonstrate that many patients are highly satisfied with their experience including the PA's ability to address their medical needs, establish rapport, and provide fast access to care (including same-day and after-hours appointments). Despite preferring to see a physician for more complex concerns, participants felt that PAs demonstrate similar medical knowledge, competencies, and scope of practice as family physicians. Patients demonstrated a solid understanding of the PA role and recognized the collaborative PA-physician relationship. These findings describe successful patient awareness and acceptance of the PA profession, largely due to positive PA-patient interactions in family medicine settings.
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Affiliation(s)
- Alexa Moschella
- Physician Assistant Education Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kristen Burrows
- Physician Assistant Education Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Burrows K, Nickell L, Krueger P. Physician ratings of physician assistant competencies and their experiences and satisfaction working with physician assistants: Results from the supervising physician survey in Ontario, Canada. Healthc Manage Forum 2023; 36:311-316. [PMID: 37236782 PMCID: PMC10447582 DOI: 10.1177/08404704231173612] [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: 05/28/2023]
Abstract
Physician Assistants (PAs) are a relatively new addition to the Ontario healthcare system. To understand the impact of the PA role, this study investigated supervising physician satisfaction and perception of PA roles, interprofessional team integration, pandemic supports, and barriers and enablers to PA employment. A web-based survey was conducted of 118 physician supervisors of Ontario PA education program alumni. PAs were employed in a variety of community and hospital settings. In addition to patient care, PAs were involved teaching (65.6%), quality improvement (52.7%), and mentorship (40.0%). Overall, 92.9% of physicians indicated they were satisfied with their PAs. Important barriers to hiring PAs included maintaining PA salaries, billing limitations, and PA shortages. PAs have established themselves as valuable and competent members of healthcare teams. By continuing to explore the enablers and barriers to PA employment from the physician perspective, health leaders can continue to optimize and support role integration.
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Jones IW. Where are Canada's PAs in 2023? JAAPA 2023; 36:1-6. [PMID: 37229590 DOI: 10.1097/01.jaa.0000923588.97421.cf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
ABSTRACT The physician assistant/associate (PA) role in Canada is slowly expanding from two provinces and 301 PAs in 2012 to five provinces with 959 PAs and 119 clinical assistants in 2022. This article reviews Canadian PA education, healthcare challenges, and future growth, providing a brief look at where in 2023 the 1,215 members of the Canadian Association of Physician Assistants are found, and some anticipated directions.
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Affiliation(s)
- Ian W Jones
- Ian W. Jones is an associate professor and former PA education program director at the University of Manitoba in Winnipeg, Canada. He is a former president of the Canadian Association of Physician Assistants and managing editor of the Journal of Canada's Physician Assistants . The author has disclosed no potential conflicts of interest, financial or otherwise
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Carroll Á, Collins C, McKenzie J, Stokes D, Darley A. Application of complexity theory in health and social care research: a scoping review. BMJ Open 2023; 13:e069180. [PMID: 36921939 PMCID: PMC10030763 DOI: 10.1136/bmjopen-2022-069180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Complexity theory has been chosen by many authors as a suitable lens through which to examine health and social care. Despite its potential value, many empirical investigations apply the theory in a tokenistic manner without engaging with its underlying concepts and underpinnings. OBJECTIVES The aim of this scoping review is to synthesise the literature on empirical studies that have centred on the application of complexity theory to understand health and social care provision. METHODS This scoping review considered primary research using complexity theory-informed approaches, published in English between 2012 and 2021. Cochrane Database of Systematic Reviews, MEDLINE, CINAHL, EMBASE, Web of Science, PSYCHINFO, the NHS Economic Evaluation Database, and the Health Economic Evaluations Database were searched. In addition, a manual search of the reference lists of relevant articles was conducted. Data extraction was conducted using Covidence software and a data extraction form was created to produce a descriptive summary of the results, addressing the objectives and research question. The review used the revised Arksey and O'Malley framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR). RESULTS 2021 studies were initially identified with a total of 61 articles included for extraction. Complexity theory in health and social care research is poorly defined and described and was most commonly applied as a theoretical and analytical framework. The full breadth of the health and social care continuum was not represented in the identified articles, with the majority being healthcare focused. DISCUSSION Complexity theory is being increasingly embraced in health and care research. The heterogeneity of the literature regarding the application of complexity theory made synthesis challenging. However, this scoping review has synthesised the most recent evidence and contributes to translational systems research by providing guidance for future studies. CONCLUSION The study of complex health and care systems necessitates methods of interpreting dynamic prcesses which requires qualitative and longitudinal studies with abductive reasoning. The authors provide guidance on conducting complexity-informed primary research that seeks to promote rigor and transparency in the area. REGISTRATION The scoping review protocol was registered at Open Science Framework, and the review protocol was published at BMJ Open (https://bit.ly/3Ex1Inu).
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Affiliation(s)
- Áine Carroll
- School of Medicine, University College Dublin, Dublin, Ireland
- Academic Department, National Rehabilitation University Hospital, Dublin, Ireland
| | - Claire Collins
- Henley Business School, University of Reading, Reading, UK
| | - Jane McKenzie
- Henley Business School, University of Reading, Reading, UK
| | - Diarmuid Stokes
- College of Health Sciences, University College Dublin, Dublin, Ireland
| | - Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
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Umaefulam V, Gómez-Díaz IC, Uribe-Calderón LM, Pedrozo-Araque E, Premkumar K, Maldonado-Molina E, Basualdo ML, Bidonde J. Critical perspectives on rehabilitation education, practice and process: northern Honduras case study. BMC Health Serv Res 2022; 22:1561. [PMID: 36544144 PMCID: PMC9768948 DOI: 10.1186/s12913-022-08875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rehabilitation services are an integral part of patient care, but in many developing countries, they are not prioritized and either unavailable or easily accessible to those who need them. Although the need for rehabilitation services is increasing in Honduras, rehabilitation workers are not included in the health care model that guides the care provided to communities, particularly in rural and remote areas. To understand the need for providing impactful rehabilitation services in disadvantaged communities, we explored the education and perception of the community relating to rehabilitation, investigated training available for rehabilitation workers, and examined the rehabilitation processes and practices in Northern Honduras from stakeholders' experiences. METHODS We utilized a qualitative descriptive and interpretive approach grounded in case study methodology to understand rehabilitation education, process, and practice in Northern Honduras. Three rehabilitation centres were purposefully selected as the cases, and participants consisted of rehabilitation workers and managers from these centres. We collected data via interviews and focus group sessions. We analyzed the data via thematic analysis using NVivo version 12. RESULTS In Northern Honduras, rehabilitation workers' limited training and continuing education, along with awareness about rehabilitation by community members and other health providers influence rehabilitation care. Although policies and initiatives to support people with disabilities and the broader community in need of rehabilitation exist, most policies are not applied in practice. The sustainability of rehabilitation services, which is rooted in charity, is challenged by the small range of funding opportunities strongly affecting rehabilitation care processes and clinical practices. The lack of trust and awareness from the medical profession towards rehabilitation workers sets a major barrier to referrals, interdisciplinary work, and quality of life for individuals in need of rehabilitation. CONCLUSION This study advances knowledge of the need to increase understanding of rehabilitation care among community members and health providers, improve care processes and resources, and foster interprofessional practice, to enhance the quality of care and promote equitable care delivery, especially in rural and remote communities.
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Affiliation(s)
- Valerie Umaefulam
- grid.25152.310000 0001 2154 235XDepartment of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK Canada
| | - Isabel Cristina Gómez-Díaz
- grid.442204.40000 0004 0486 1035Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Neurotrauma Centre, Bucaramanga, Santander Colombia
| | - Laura Marcela Uribe-Calderón
- grid.442204.40000 0004 0486 1035Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Santander Colombia
| | - Eliany Pedrozo-Araque
- grid.442204.40000 0004 0486 1035Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Bucaramanga, Santander Colombia
| | - Kalyani Premkumar
- grid.25152.310000 0001 2154 235XDepartment of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK Canada
| | - Ethel Maldonado-Molina
- grid.10601.360000 0001 2297 2829Universidad Nacional Autónoma de Honduras, Departamento de Rehabilitación, Facultad de Ciencias Médicas, Tegucigalpa, M.D.C. Honduras
| | - Maria Laura Basualdo
- grid.28046.380000 0001 2182 2255Ontario Public Interest Research Group, University of Ottawa, Ottawa, ON Canada
| | - Julia Bidonde
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway ,grid.25152.310000 0001 2154 235XSchool of Rehabilitation Science, College of Medicine, University of Saskatchewan, Suite 3400, 3Rd Floor, 104 Clinic Pl, Saskatoon, SK S7N 2Z4 Canada
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Correia RH, Grierson L, Allice I, Siu HYH, Baker A, Panday J, Vanstone M. The impact of care of the elderly certificates of added competence on family physician practice: results from a pan-Canadian multiple case study. BMC Geriatr 2022; 22:840. [DOI: 10.1186/s12877-022-03523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Family physicians serve an important role in the care of older adults, and have variable levels of training and comfort navigating this complex patient population. The Care of the Elderly (COE) Certificate of Added Competence offered by The College of Family Physicians of Canada recognizes family physicians with advanced expertise in older adult healthcare. We explored how COE training and certification impacts primary care delivery to older patients, including factors that impact group practice.
Methods
We conducted a secondary analysis of multiple case study data to explore similarities and differences within and across cases. We defined cases as a practice or collective of family physicians working within a defined group of patients in an interconnected community. We analyzed semi-structured interview transcripts (n = 48) from six practice groups of family physicians across Canada using conventional (unconstrained, inductive) content analysis.
Results
We identified similarities and differences in how COE family physicians function within their group practice and the broader healthcare system. In some cases, COE certifications increased patients’ access to geriatric resources by reducing travel and wait times. Some physicians observed minimal changes in their role or group practice after earning the COE designation, including continuing to largely function as a generalist. While family physicians tended to highly value their COE CAC, this designation was differentially recognized by others.
Conclusions
Our findings highlight the impacts and limitations of COE training and certification, including an opportunity for COE family physicians to fill knowledge and practice gaps. As the number of older adults in Canada continues to grow and increasingly rely on primary care services, COE family physicians are uniquely positioned to strengthen the health system’s capacity to deliver specialized geriatric care.
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Burns J, Agarwal V, Jordan SG, Dallaghan GLB, Byerley JS. Interprofessional Education - A Mandate for Today's Radiology Curriculum. Acad Radiol 2022; 29 Suppl 5:S89-S93. [PMID: 34210613 DOI: 10.1016/j.acra.2021.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
Interprofessional education (IPE) brings educators and learners from two or more health professions together in a collaborative learning environment, specifically assuring that learners function as a team to provide patient-centered care, with each team member contributing a unique perspective. The Liaison Committee on Medical Education, the Accreditation Council for Graduate Medical Education, and the American Board of Radiology have endorsed interprofessional and team communication as essential core competencies. Radiology educators must understand, include, and optimize IPE in their pedagogy; as a specialty, radiology must innovate more interprofessional experiences for medical students, residents and other allied health professions.
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Sibbald SL, Paciocco S, Fournie M, Van Asseldonk R, Scurr T. Continuing to enhance the quality of case study methodology in health services research. Healthc Manage Forum 2021; 34:291-296. [PMID: 34227408 PMCID: PMC8392758 DOI: 10.1177/08404704211028857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Case study methodology has grown in popularity within Health Services Research (HSR). However, its use and merit as a methodology are frequently criticized due to its flexible approach and inconsistent application. Nevertheless, case study methodology is well suited to HSR because it can track and examine complex relationships, contexts, and systems as they evolve. Applied appropriately, it can help generate information on how multiple forms of knowledge come together to inform decision-making within healthcare contexts. In this article, we aim to demystify case study methodology by outlining its philosophical underpinnings and three foundational approaches. We provide literature-based guidance to decision-makers, policy-makers, and health leaders on how to engage in and critically appraise case study design. We advocate that researchers work in collaboration with health leaders to detail their research process with an aim of strengthening the validity and integrity of case study for its continued and advanced use in HSR.
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Affiliation(s)
- Shannon L. Sibbald
- Faculty of Health Sciences, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stefan Paciocco
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Meghan Fournie
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | | | - Tiffany Scurr
- Faculty of Health Sciences, Western University, London, Ontario, Canada
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Malone R. The role of the physician associate: an overview. Ir J Med Sci 2021; 191:1277-1283. [PMID: 34351601 DOI: 10.1007/s11845-021-02661-9] [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: 02/06/2021] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
The physician assistant role in healthcare delivery was first introduced during the 1960s in the USA as a solution to doctor shortages, greater population healthcare needs and increasing healthcare provision costs. Since then, many countries worldwide have utilized the successful USA physician assistant model as a benchmark to guide both physician assistant training and the incorporation of the role into their healthcare systems. While the USA retained the title physician assistant, Ireland and the UK use the title physician associate. Physician assistants/associates are trained in the generalist medical model and function under the supervision of a doctor. Tasks relating to the role include the following: taking patient's medical histories, performing examinations, making diagnosis, requesting tests, analysing results and the initiation of treatment. They practice across a broad range of specialities and settings. Physician assistants in the USA and the Netherlands have prescribing privileges. Statutory regulation for physician assistants/associates lays the groundwork for prescribing privileges and such regulation is under consideration by the government in the UK. Studies indicate that doctors and patients are largely satisfied with the contribution of this profession to healthcare services and physician assistants/associates report good job satisfaction.
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Affiliation(s)
- Rachel Malone
- Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
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Sheringham J, King A, Plackett R, Khan A, Cornes M, Kassianos AP. Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review. BMC Health Serv Res 2021; 21:644. [PMID: 34217265 PMCID: PMC8254243 DOI: 10.1186/s12913-021-06667-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral. This review sought to summarise findings from observational studies conducted in high income countries on PAs' competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care. METHOD A rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009-2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation. RESULTS From 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs' competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis. CONCLUSION This review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs' roles, including outcomes of the diagnostic process.
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Affiliation(s)
- Jessica Sheringham
- Department of Applied Health Research, UCL, 1-19 Torrington Place, 14, London, WC1E 7HB, UK.
| | - Angela King
- NIHR Cancer Awareness, Screening and Early Diagnosis Policy Research Unit, Queen Mary University of London, London, UK
| | - Ruth Plackett
- Department of Applied Health Research, UCL, 1-19 Torrington Place, 14, London, WC1E 7HB, UK
| | | | - Michelle Cornes
- NIHR Health & Social Care Workforce Research Unit, King's College London, London, UK
| | - Angelos P Kassianos
- Department of Applied Health Research, UCL, 1-19 Torrington Place, 14, London, WC1E 7HB, UK
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