Assuntos
Técnicas Cosméticas/tendências , Profissionais de Enfermagem/organização & administração , Assistentes Médicos/organização & administração , Papel Profissional , Cirurgia Plástica/tendências , Técnicas Cosméticas/economia , Técnicas Cosméticas/estatística & dados numéricos , Estética , Humanos , Medicare/economia , Profissionais de Enfermagem/estatística & dados numéricos , Profissionais de Enfermagem/tendências , Assistentes Médicos/estatística & dados numéricos , Assistentes Médicos/tendências , Cirurgia Plástica/economia , Cirurgia Plástica/organização & administração , Cirurgia Plástica/estatística & dados numéricos , Estados UnidosAssuntos
Gastroenterologia/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Profissionais de Enfermagem/organização & administração , Assistentes Médicos/organização & administração , Papel Profissional , Competência Clínica , Prestação Integrada de Cuidados de Saúde/organização & administração , Gastroenterologia/educação , Humanos , Modelos Organizacionais , Profissionais de Enfermagem/educação , Assistentes Médicos/educaçãoRESUMO
PURPOSE: To evaluate the impact of a collaborative intervention by pharmacists and primary care clinicians on total cost of care, including costs of inpatient readmissions, emergency department visits, and outpatient care, at 30, 60, and 180 days after hospital discharge in a population of patients at high risk for readmission due to polypharmacy. METHODS: A retrospective study of cost outcomes in a cohort of adult patients discharged from a single institution from July 1, 2013 to March 25, 2016, was conducted. All patients had at least 10 medications listed on their discharge list, including at least 1 drug frequently associated with adverse events leading to hospital readmission. About half of the cohort (n = 496) attended a postdischarge visit involving both a pharmacist and a primary care clinician (a physician, physician assistant, or licensed nurse practitioner); this was designated the pharmacist/clinician collaborative (PCC) group. The remainder of the cohort (n = 500) attended a visit without pharmacist involvement; this was designated as the usual care (UC) group. Costs were compared using a quantile regression to assess the potential heterogeneous impacts of the PCC intervention across different parts of the cost distribution. All outcomes were adjusted for differences in baseline characteristics. RESULTS: At 30 days post index discharge, there was a significant decrease in total costs in the 10th and 90th cost quantiles in the PCC cohort vs the UC cohort, without a statistically significant decrease in the 25th, 50th or 75th quantiles. The difference was significant in the 75th and 90th quantiles at 60 days and in the 25th, 50th, and 75th quantiles at 180 days. There was a nonsignificant cost reduction in all other quantiles. CONCLUSION: Medically complex patients had a significantly lower total cost of care in approximately half of the adjusted cost quantiles at 30, 60, and 180 days after hospital discharge when they had a PCC visit. PCC visits can improve patient clinical outcomes while improving cost metrics.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Reconciliação de Medicamentos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Assistência ao Convalescente/economia , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Análise Custo-Benefício/estatística & dados numéricos , Serviço Hospitalar de Emergência , Feminino , Humanos , Técnicos de Enfermagem/organização & administração , Masculino , Reconciliação de Medicamentos/economia , Reconciliação de Medicamentos/estatística & dados numéricos , Pessoa de Meia-Idade , Alta do Paciente , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Farmacêuticos/organização & administração , Assistentes Médicos/organização & administração , Médicos de Atenção Primária/organização & administração , Polimedicação , Avaliação de Programas e Projetos de Saúde , Estudos RetrospectivosRESUMO
OBJECTIVES: Mental Health First Aid (MHFA) is designed to help the general public acquire the knowledge and skills needed to respond to a person in a mental health emergency and offer support to someone in emotional distress. Through the PA Foundation's Mental Health Outreach Fellowship, 16 physician assistants (PAs) were selected to become MHFA instructors and teach the course to members of their local communities over 1 year. METHODS: MHFA course evaluations, completed by course participants, were reviewed to determine the effectiveness of the PA fellows as instructors. RESULTS: The fellows' mean evaluation instructor presentation score was 4.82 and the mean course content score was 4.75. The national mean for instructor presentation was 4.72 for presentation and 4.66 for course content. The maximum possible score in each category was a 5. CONCLUSIONS: The PAs selected for the Mental Health Outreach Fellowship were effective MHFA instructors. Benefits to having a PA serve as the instructor include positively affecting communities by increasing the public's mental health literacy, reducing the stigma associated with mental illness, increasing visibility and promotion of the PA profession, and enhancement of a PA's individual career through education and service.
Assuntos
Competência Clínica , Serviços Médicos de Emergência , Bolsas de Estudo , Primeiros Socorros , Conhecimentos, Atitudes e Prática em Saúde , Transtornos Mentais/terapia , Saúde Mental/educação , Assistentes Médicos/educação , Assistentes Médicos/organização & administração , Avaliação de Programas e Projetos de Saúde , Angústia Psicológica , Currículo , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Sistemas de Apoio Psicossocial , Estigma Social , Estudantes de Ciências da Saúde/psicologiaRESUMO
This article describes the 10-year journey of a research group helping to build the research evidence base for physician assistants (PAs), known as physician associates in the United Kingdom, in the National Health Service in England. It draws out some key issues that may be of interest to those developing PA research programs in different specialties and different countries. PA research also can help healthcare policy makers address growing demand, issues of quality, and cost.
Assuntos
Prática Clínica Baseada em Evidências , Assistentes Médicos , Desenvolvimento de Programas , Pesquisa/tendências , Atenção à Saúde , Inglaterra , Custos de Cuidados de Saúde , Política de Saúde , Mão de Obra em Saúde , Humanos , Assistentes Médicos/organização & administração , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Atenção Secundária à Saúde , Fatores de TempoRESUMO
As the number of advanced practice providers has grown in emergency medicine, establishment of guidelines and policies governing their practice has become increasingly important. This article addresses the scope of practice of physician assistants and nurse practitioners working in the emergency department, including the various forms of supervision and the effect on billing, credentialing, and medicolegal considerations in patients' care.
Assuntos
Serviço Hospitalar de Emergência/organização & administração , Profissionais de Enfermagem/organização & administração , Assistentes Médicos/organização & administração , Medicina de Emergência/organização & administração , Humanos , Gestão de RiscosRESUMO
INTRODUCTION: Advanced practice providers (APPs), including nurse practitioners and physician assistants, have been deployed in children's hospital-based academic pediatric otolaryngology practices for many years. However, this relationship in terms of prevalence, roles, financial consequences and satisfaction has not been examined. The objective of this study is to explore how APPs impact healthcare delivery in this setting. METHODS: Pediatric otolaryngology chiefs of all academic children's hospitals in the US were electronically surveyed about the ways APPs intersected clinically and financially in their respective practice. RESULTS: A total of 29 of 36 children's hospital-based pediatric otolaryngology practices completed the survey, of which 26 practices (90%) utilized APP. There were large variances within the APP practice cohort in faculty size (mean/median/rangeâ¯=â¯9.4/8.5/3-29); annual patient visits (mean/medianâ¯=â¯18,373/17,600); number of practice site (mean/median/rangeâ¯=â¯4.3/4/2-9) and number of outpatient APP (mean/median/rangeâ¯=â¯6.3/5/1-30). No factors (faculty size, annual visits and number of practice sites) differentiated between the APP and non-APP practices. Among APP practices, significant correlation (p<.00001) was observed between size of APP cohort to faculty size and annual visits. 69% of the practices did not differentiate job functions of nurse practitioners and physician assistants. 85% of the practices utilized APPs in all practice sites and 19% utilized APPs in the operating room. 77% of APPs billed independently and 46% had on-site supervision. The most prevalent APP salary bracket based on 0-5, 6-10 andâ¯>â¯11 years of tenure were $76-100K (65%), $100-150K (77%) and $100-150K (86%), respectively. In 46% of the practices, APPs were able to generate enough revenue to cover more than 75% of their salary and 23% of practices generated a profit. 81% of the chiefs ranked the effectiveness of APPs as high (4 and 5) on a 5-point Likert scale. DISCUSSION: The majority of academic pediatric otolaryngology practices employed APPs. Despite the diversity seen in practice complexity, APP functionality and financial impact, most found the APP model to be beneficial in improving patient care, patient access and faculty productivity.
Assuntos
Profissionais de Enfermagem/estatística & dados numéricos , Otolaringologia/organização & administração , Otolaringologia/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Papel Profissional , Docentes de Medicina/estatística & dados numéricos , Hospitais Pediátricos , Humanos , Renda/estatística & dados numéricos , Profissionais de Enfermagem/organização & administração , Otolaringologia/economia , Otolaringologia/educação , Assistentes Médicos/organização & administração , Inquéritos e QuestionáriosRESUMO
BACKGROUND: We examined and compared APP versus surgical resident perceptions of the role of APPs in surgical subspecialty teams. METHODS: Residents/first year surgical critical care fellows and inpatient service-specific APPs responded to a survey that examined perceptions about the APP-resident/fellow relationship. Statistical analysis compared responses using a Pearson chi-square test. RESULTS: Thirty-two resident/fellows (48%) and 10 APPs (42%) responded. There was consensus that having an APP on service decreases workload, contributes to continuity of care and enhances resident-patient coordination education and agreement that there was clear communication and adequate collaboration. Both groups differed with respect to APPs contribution to resident/fellow clinical education, role definition and chain of command. The majority of trainees felt that APPs function at a PGY2 level (51.7%) compared to APPs, who felt that they functioned at a PGY4/5 (22%) or Fellow (44%) level. CONCLUSION: APPs and resident/fellows agree that APPs impact resident workload, continuity of care and patient-coordination education.
Assuntos
Atitude do Pessoal de Saúde , Cirurgia Geral/educação , Internato e Residência , Profissionais de Enfermagem/organização & administração , Assistentes Médicos/organização & administração , Cirurgiões/educação , Continuidade da Assistência ao Paciente , Bolsas de Estudo , Feminino , Humanos , Relações Interprofissionais , Masculino , Profissionais de Enfermagem/psicologia , Assistentes Médicos/psicologia , Papel Profissional/psicologia , Cirurgiões/organização & administração , Cirurgiões/psicologia , Inquéritos e Questionários , Estados Unidos , Carga de TrabalhoRESUMO
OBJECTIVE: To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. DESIGN: Systematic review. SETTING: Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. INCLUDED ARTICLES: Peer-reviewed articles of any study design, published in English, 1995-2017. INTERVENTIONS: Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. OUTCOME MEASURES: Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs. RESULTS: 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent. CONCLUSIONS: PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting. PROSPERO REGISTRATION NUMBER: CRD42016032895.
Assuntos
Assistentes Médicos/provisão & distribuição , Atenção Secundária à Saúde/economia , Atenção Secundária à Saúde/organização & administração , Mão de Obra em Saúde , Humanos , Assistentes Médicos/economia , Assistentes Médicos/organização & administração , Tolerância ao Trabalho ProgramadoRESUMO
INTRODUCTION: Literature in Europe regarding implementation of nurse practitioners or physician assistants in the intensive care unit (ICU) is lacking, while some available studies indicate that this concept can improve the quality of care and overcome physician shortages on ICUs. The aim of this study is to provide insight on how a Dutch ICU implemented non-physician providers (NPP), besides residents, and what this staffing model adds to the care on the ICU. METHODS: This paper defines the training course and job description of NPPs on a Dutch ICU. It describes the number and quality of invasive interventions performed by NPPs, residents, and intensivists during the years 2015 and 2016. Salary scales of NPPs and residents are provided to describe potential cost-effectiveness. RESULTS: The tasks of NPPs on the ICU are equal to those of the residents. Analysis of the invasive interventions performed by NPPs showed an incidence of central venous catheter insertion for NPPs of 20 per fulltime equivalent (FTE) and for residents 4.3 per FTE in one year. For arterial catheters the NPP inserted 61.7 per FTE and the residents inserted 11.8 per FTE. The complication rate of both groups was in line with recent literature. Regarding their salary: after five years in service an NPP earns more than a starting resident. CONCLUSION: This is the first European study which describes the role of NPPs on the ICU and shows that practical interventions normally performed by physicians can be performed with equal safety and quality by NPPs.
Assuntos
Unidades de Terapia Intensiva/organização & administração , Profissionais de Enfermagem/organização & administração , Admissão e Escalonamento de Pessoal , Assistentes Médicos/organização & administração , Qualidade da Assistência à Saúde , Idoso , Artérias , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/estatística & dados numéricos , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/estatística & dados numéricos , Análise Custo-Benefício , Humanos , Unidades de Terapia Intensiva/economia , Internato e Residência , Pessoa de Meia-Idade , Modelos Organizacionais , Profissionais de Enfermagem/economia , Profissionais de Enfermagem/educação , Assistentes Médicos/economia , Assistentes Médicos/educação , Papel Profissional , Salários e BenefíciosAssuntos
Documentação/métodos , Pessoal de Saúde/organização & administração , Pessoal de Saúde/psicologia , Atenção , Atitude do Pessoal de Saúde , Humanos , Gestão da Informação/organização & administração , Satisfação no Emprego , Profissionais de Enfermagem/organização & administração , Profissionais de Enfermagem/psicologia , Equipe de Assistência ao Paciente/organização & administração , Assistentes Médicos/organização & administração , Assistentes Médicos/psicologia , Médicos/organização & administração , Médicos/psicologia , Fatores de TempoAssuntos
Assistentes Médicos/educação , Assistentes Médicos/organização & administração , Política , Humanos , Área Carente de Assistência Médica , Grupos Minoritários/educação , Assistentes Médicos/economia , Qualidade da Assistência à Saúde/organização & administração , Mecanismo de Reembolso/organização & administraçãoRESUMO
PURPOSE: The shortage of trained health care personnel has been increasing worldwide. With the physician assistant (PA) profession, created in the United States in the 1960s, expanding globally, this study sought to ascertain whether PAs can be an innovative solution to this crisis. METHODS: We conducted a convenience sample survey to assess the need for and acceptability of future PA professionals in Guatemala. Eighty-nine doctors, nurses, and community members from rural and urban areas of Guatemala participated in the survey. RESULTS: More urban (70%) than rural (58%) respondents found it difficult to access a doctor, with cost being the major reason (34%). Access in rural areas was reportedly limited by lack of doctors and inaccessible office hours. CONCLUSIONS: Most survey respondents considered PAs to be suitable and potentially helpful providers for Guatemala, with a preference for competencies in the diagnosis of serious illnesses, drug prescription, labor and delivery attendance, and care for injuries and fractures, especially in rural locations. Belonging to the community was deemed very important for a PA who would practice in the country.