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1.
Emerg Med Clin North Am ; 38(2): 353-361, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336330

RESUMO

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 Riscos
2.
Medicine (Baltimore) ; 99(16): e19633, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32311933

RESUMO

How medical inter-professional (IP) education should be introduced to students is still a matter of research. We evaluated IP student attitudes before and after a busy "hands-on" clinical experience.During 3 separate trips, first/second year medical and physician assistant students and third/fourth year nursing students traveled to Central America to work together for 1 week in an underserved clinical setting. Student opinions on inter-professional education were obtained before and after Brigade-1 using the Readiness for Inter-professional Learning Scale validated questionnaire. From these results, a modified version of the survey was developed that included quantitative and qualitative responses. For brigades-2 and -3, students received this modified version of the survey pre and post brigade. Quantitative data was analyzed via paired student t test, and qualitative data was analyzed to identify emerging themes using constant comparative methodology by three separate investigators.No significant quantitative differences between IP student groups were observed in their evaluation of the importance of inter-professional education either before or after the brigades. Qualitative data noted pre-brigade expectations of positive IP, experiential and patient-centered cultural learning. Pre- and post-brigade student perspectives maintained a strong belief that high functioning IP care benefited the patient. Post-brigade perspectives revealed a shift in attitude from purely positive expectations to more practical aspects of teamwork, respect, and interpersonal relationships.Students believe that patient care benefits from IP collaboration. After a busy clinical experience requiring collaboration, students realized that functional teams require appropriate skills, roles, and respectful interpersonal relationships.


Assuntos
Atitude do Pessoal de Saúde , Relações Interprofissionais , Assistentes Médicos/psicologia , Estudantes de Medicina/psicologia , Estudantes de Enfermagem/psicologia , Educação de Graduação em Medicina/métodos , Bacharelado em Enfermagem/métodos , Feminino , Humanos , Masculino , Assistência Centrada no Paciente , Assistentes Médicos/educação , Inquéritos e Questionários , Adulto Jovem
3.
PLoS One ; 15(2): e0228372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027686

RESUMO

Social media is increasingly utilized as a resource in healthcare. We sought to identify perceptions of using social media as an educational tool among healthcare practitioners. An electronic survey was distributed to healthcare administrators, nurses, nurse practitioners, pharmacists, physicians, and physician assistants f hospital systems and affiliated health science schools in Georgia, Maryland, South Carolina, and Wisconsin. Survey questions evaluated respondents' use and views of social media for educational purposes and workplace accessibility using a Likert scale (1 = strongly disagree, 5 = strongly agree). Nurses (75%), pharmacists (11%), and administrators (7%) were the most frequent respondents. Facebook® (27%), Pinterest® (17%), and Instagram® (17%) were the most frequently accessed social media platforms. Nearly 85% agreed or strongly agreed that social media can be an effective tool for educational purposes. Among those who had social media platforms, 43.0% use them for educational purposes. Pinterest® (30%), Facebook® (22%), LinkedIn® (16%), and Twitter® (14%) were most frequently used for education. About 50% of respondents had limited or no access to social media at work. Administrators, those with unlimited and limited work access, and respondents aged 20-29 and 30-39 years were more likely to agree that social media is an educational tool (OR: 3.41 (95% CI 1.31 to 8.84), 4.18 (95% CI 2.30 to 7.60), 1.66 (95% CI 1.22 to 2.25), 4.40 (95% CI 2.80 to 6.92), 2.14 (95% CI 1.53 to 3.01) respectively). Residents, physicians, and those with unlimited access were less likely to agree with allowing social media access at work for educational purposes only. Healthcare practitioners frequently utilize social media, and many believe it can be an effective educational tool in healthcare.


Assuntos
Educação Continuada/métodos , Pessoal de Saúde , Percepção , Mídias Sociais , Adulto , Feminino , Georgia/epidemiologia , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Disseminação de Informação/métodos , Internato e Residência/estatística & dados numéricos , Masculino , Maryland/epidemiologia , Profissionais de Enfermagem/educação , Profissionais de Enfermagem/psicologia , Profissionais de Enfermagem/estatística & dados numéricos , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Assistentes Médicos/educação , Assistentes Médicos/psicologia , Assistentes Médicos/estatística & dados numéricos , Médicos/psicologia , Médicos/estatística & dados numéricos , Mídias Sociais/normas , South Carolina/epidemiologia , Inquéritos e Questionários , Wisconsin/epidemiologia , Adulto Jovem
4.
JAMA ; 323(6): 538-547, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044941

RESUMO

Importance: Privately insured patients who receive care from in-network physicians may receive unexpected out-of-network bills ("surprise bills") from out-of-network clinicians they did not choose. In elective surgery, this can occur if patients choose in-network surgeons and hospitals but receive out-of-network bills from other involved clinicians. Objective: To evaluate out-of-network billing across common elective operations performed with in-network primary surgeons and facilities. Design, Setting, and Participants: Retrospective analysis of claims data from a large US commercial insurer, representing 347 356 patients who had undergone 1 of 7 common elective operations (arthroscopic meniscal repair [116 749]; laparoscopic cholecystectomy [82 372]; hysterectomy [67 452]; total knee replacement [42 313]; breast lumpectomy [18 018]; colectomy [14 074]; coronary artery bypass graft surgery [6378]) by an in-network primary surgeon at an in-network facility between January 1, 2012, and September 30, 2017. Follow-up ended November 8, 2017. Exposure: Patient, clinician, and insurance factors potentially related to out-of-network bills. Main Outcomes and Measures: The primary outcome was the proportion of episodes with out-of-network bills. The secondary outcome was the estimated potential balance bill associated with out-of-network bills from each surgical procedure, calculated as total out-of-network charges less the typical in-network price for the same service. Results: Among 347 356 patients (mean age, 48 [SD, 11] years; 66% women) who underwent surgery with in-network primary surgeons and facilities, 20.5% of episodes (95% CI, 19.4%-21.7%) had an out-of-network bill. In these episodes, the mean potential balance bill per episode was $2011 (95% CI, $1866-$2157) when present. Out-of-network bills were associated with surgical assistants in 37% of these episodes; when present, the mean potential balance bill was $3633 (95% CI, $3384-$3883). Out-of-network bills were associated with anesthesiologists in 37% of episodes; when present, the mean potential balance bill was $1219 (95% CI, $1049-$1388). Membership in health insurance exchange plans, compared with nonexchange plans, was associated with a significantly higher risk of out-of-network bills (27% vs 20%, respectively; risk difference, 6% [95% CI, 3.9%-8.9%]; P < .001). Surgical complications were associated with a significantly higher risk of out-of-network bills, compared with episodes with no complications (28% vs 20%, respectively; risk difference, 7% [95% CI, 5.8%-8.8%]; P < .001). Among 83 021 procedures performed at ambulatory surgery centers with in-network primary surgeons, 6.7% (95% CI, 5.8%-7.7%) included an out-of-network facility bill and 17.2% (95% CI, 15.7%-18.8%) included an out-of-network professional bill. Conclusions and Relevance: In this retrospective analysis of commercially insured patients who had undergone elective surgery at in-network facilities with in-network primary surgeons, a substantial proportion of operations were associated with out-of-network bills.


Assuntos
Procedimentos Cirúrgicos Eletivos/economia , Honorários Médicos , Financiamento Pessoal/economia , Cobertura do Seguro/economia , Seguro Saúde/economia , Anestesiologistas/economia , Dedutíveis e Cosseguros , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistentes Médicos/economia , Estudos Retrospectivos , Cirurgiões/economia , Estados Unidos
5.
J Oncol Pharm Pract ; 26(1): 116-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31096855

RESUMO

PURPOSE: Nurse practitioners, physician assistants, and pharmacists are advanced practice providers who are highly trained and qualified healthcare professionals that can help support traditional demands on oncologists' increased time in direct patient care. The purpose of this study was to detail and assess the creation of a privileging process for this group of medical professionals within an academic medical center. Obtaining the designation of limited oncology practice provider (LOPP) gives the right to modify chemotherapy orders and to order supportive care medications. METHODS: An interdisciplinary team developed a comprehensive training process inclusive of required educational domains, knowledge goals, and educational activities to become an LOPP. In 2018, five years after the implementation of the privileging process, a survey was distributed to assess perceptions of the training process and integration of LOPPs within oncology practice. RESULTS: Most oncologists noted that working with LOPPs is beneficial to oncology practice (94%) and that they make modifying chemotherapy orders more efficient (87%). Greater than 82% of LOPPs also reported that their privileges streamline the chemotherapy process and make them feel valuable. CONCLUSION: The creation of the LOPP designation is an effective way to integrate nurse practitioners, physician assistants, and pharmacists within oncology practice. The inclusion of a focused privileging process ensures the safety of cancer care provided and has created a streamlined process for chemotherapy modifications and supportive care.


Assuntos
Centros Médicos Acadêmicos/normas , Prática Avançada de Enfermagem/normas , Oncologia/normas , Profissionais de Enfermagem/normas , Farmacêuticos/normas , Assistentes Médicos/normas , Centros Médicos Acadêmicos/métodos , Prática Avançada de Enfermagem/métodos , Antineoplásicos/administração & dosagem , Feminino , Humanos , Masculino , Oncologia/métodos , Inquéritos e Questionários
6.
J Opioid Manag ; 15(6): 455-468, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31850507

RESUMO

OBJECTIVE: The goal of the study was to assess knowledge gaps and practice patterns of US-based addiction specialists, primary care physicians (PCPs), nurse practitioners (NPs), and physician assistants (PAs) who treat patients with opioid use disorder (OUD). DESIGN: As part of a prospective study, the authors developed a survey tool consisting of case-vignettes and questions designed to reveal practice patterns and highlight gaps in clinician knowledge. SETTING: The primary study setting included clinicians practicing in outpatient care. PARTICIPANTS: The surveys were distributed via email between August and September 2017 to a national sample of addiction specialists, PCPs, and NPs/PAs that see at least one patient per week and at least 1 percent of their patient population had to be diagnosed with OUD. RESULTS: The knowledge assessment results varied among the clinicians surveyed. Addiction specialists saw more patients with OUD than PCPs, NPs, or PAs. They also demonstrated a higher level of understanding and knowledge of the various domains assessed. CONCLUSIONS: There are multiple educational intervention strategies that can support the clinicians; including reducing restrictions to access treatment for OUD, care coordination programs for patients to improve early access to treatment and education, and frequent chart audit and feedback programs to support clinician decision making and education.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides , Humanos , Profissionais de Enfermagem/psicologia , Transtornos Relacionados ao Uso de Opioides/terapia , Assistentes Médicos/psicologia , Médicos de Atenção Primária/psicologia , Padrões de Prática Médica , Estudos Prospectivos
7.
JAAPA ; 32(12): 1, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31770311
8.
Medicine (Baltimore) ; 98(45): e17747, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702625

RESUMO

BACKGROUND AND OBJECTIVE: Colonoscopy is the most important method for the diagnosis and treatment of intestinal diseases, and there are many factors affecting the quality of examination. Although the assistant is one of the factors influencing the quality of colonoscopy, there are few studies on the effect of different assistants with different experiences on the quality of colonoscopy. Therefore, the study was aimed to research the correlation between different assistants with different experiences and the quality of water-injection colonoscopy. METHOD: In this study, a single-center randomized controlled trial was conducted to analyze the key quality indicators (the rate to arrive cecum, time to arrive cecum, total operation time, detection rate of polyps, detection rate of adenoma, pain score, operation satisfaction, and the pressure on abdomen) of patients who underwent water-injection colonoscopy under non-sedation from January 2018 to June 2018 in the center. Patients were randomly assigned to different assistant groups based on the actual working period of 6 months (0∼6 months inexperienced assistant group and assistant group with more than 6 months of experience). Through fitting the bivariate and multivariate logistic regression models, the differences between the two groups and the effects on the key quality indicators of colon examination were analyzed. RESULTS: A total of 331 patients who were eligible for non-sedation colonoscopy were randomly assigned to the experienced assistant group (n = 179) and the inexperienced assistant group (n = 152). Among them, 103 cases of polyp and 70 cases of adenoma were detected. The rate to arrive cecum, polyp detection rate and adenoma detection rate were compared between the two groups during operation (P > 0.05). However, there were significant differences in the time to arrive cecum, patients' satisfaction with operation, pain score and abdominal pressure (P < .05). In the inexperienced assistant group, 20% of the operation time was one standard deviation higher than the mean value, while the experienced assistant group was 12% (339 s vs 405s, OR 0.541, 95% 0.295-0.990). Compared with the inexperienced assistant group, patients in the experienced assistant group had higher operational satisfaction (98.32% vs 92.11%, OR 0.199, 95% 0.055-0.718) and lower pain score (0.3 vs 0.49, OR 1.993, 95% 1.52-3.775). All relations remained unchanged after adjusting for potential confounders. CONCLUSION: The assistant is a key factor in the quality of colonoscopy, especially in the case of non-sedating colonoscopy. The experience of the assistant is related to the time to arrive cecum, the degree of pain and the overall satisfaction of patient with the operation. The assistant should be subject to the quality supervision of the endoscopic inspector. Proof of human Clinical Trial Registration: The institutional review board of Fifth Affiliated Hospital of Wenzhou Medical College, Zhejiang Province, China approved the study. The study is registered on. Chinese Clinical Trial Registry (ChiCTR1800015650).


Assuntos
Competência Clínica , Colonoscopia/métodos , Enteropatias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Colonoscopia/efeitos adversos , Feminino , Humanos , Enteropatias/cirurgia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor , Assistentes Médicos , Projetos Piloto , Adulto Jovem
9.
Med Care ; 57(11): 905-912, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31568165

RESUMO

BACKGROUND: It is unclear whether Medicare data can be used to identify type and degree of collaboration between primary care providers (PCPs) [medical doctors (MDs), nurse practitioners, and physician assistants] in a team care model. METHODS: We surveyed 63 primary care practices in Texas and linked the survey results to 2015 100% Medicare data. We identified PCP dyads of 2 providers in Medicare data and compared the results to those from our survey. Sensitivity, specificity, and positive predictive value (PPV) of dyads in Medicare data at different threshold numbers of shared patients were reported. We also identified PCPs who work in the same practice by Social Network Analysis (SNA) of Medicare data and compared the results to the surveys. RESULTS: With a cutoff of sharing at least 30 patients, the sensitivity of identifying dyads was 27.8%, specificity was 91.7%, and PPV 72.2%. The PPV was higher for MD-nurse practitioner/physician assistant pairs (84.4%) than for MD-MD pairs (61.5%). At the same cutoff, 90% of PCPs identified in a practice from the survey were also identified by SNA in the corresponding practice. In 5 of 8 surveyed practices with at least 3 PCPs, about ≤20% PCPs identified in the practices by SNA of Medicare data were not identified in the survey. CONCLUSIONS: Medicare data can be used to identify shared care with low sensitivity and high PPV. Community discovery from Medicare data provided good agreement in identifying members of practices. Adapting network analyses in different contexts needs more validation studies.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Interpretação Estatística de Dados , Assistência à Saúde/métodos , Humanos , Colaboração Intersetorial , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Texas , Estados Unidos
10.
JAAPA ; 32(2): 52, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31579253

RESUMO

PAs and NPs have broad prescribing authority in the United States, yet little is known about how the quality of their prescribing practices compares with that of physicians. The quality of prescribing practices of physicians, PAs, and NPs was investigated through a serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Ambulatory care services in physician offices, hospital EDs, and outpatient departments were evaluated using a nationally representative sample of patient visits to physicians, PAs, and NPs. Main outcome measures were 13 validated outpatient quality indicators focused on pharmacologic management of chronic diseases and appropriate medication use. The study sampled 701,499 patient visits during the study period, representing about 8.3 billion visits nationwide. Physicians were the primary provider for 96.8% of all outpatient visits examined; PAs and NPs each accounted for 1.6% of these visits. The proportion of eligible visits in which quality standards were met ranged from 34.1% (angiotensin-converting enzyme inhibitor use for patients with heart failure) to 89.5% (avoidance of inappropriate medications in older adults). The median overall performance across all indicators was 58.7%. On unadjusted analyses, differences in quality of care between PAs, NPs, and physicians for each indicator did not consistently favor one practitioner type over others. After adjustment for potentially confounding patient and provider characteristics, the quality of prescribing by PAs and NPs was similar to the care delivered by physicians for 10 of the 13 indicators evaluated, and no consistent directional association was found between provider type and indicator fulfillment for the remaining measures. Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by PAs, NPs, and physicians was generally comparable.1.


Assuntos
Profissionais de Enfermagem , Assistentes Médicos , Médicos , Idoso , Assistência Ambulatorial , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Humanos , Estados Unidos
12.
Iowa Orthop J ; 39(1): 211-216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413696

RESUMO

Background: Midlevel providers (i.e. physician assistants [PAs] and nurse practitioners [NPs]) are being integrated into systems of care due to the exponentially increasing demand for orthopaedic care. There is a lack of studies which investigate orthopaedic patients' perspectives regarding midlevel providers. Methods: An anonymous questionnaire was administered to 538 first-time patients of four orthopaedic surgeons before their new patient visit. Content included patient perspectives regarding: optimal scope of practice, midlevel provider importance in physician selection, and reimbursement equity with physicians. Results: Of 538 consecutive patients, 415 (77%) responded. 57% were female with an average age of 63.9 ± 11.4 years. Most patients (68%) considered the training background of the surgeon's midlevel provider when initially choosing an orthopaedic surgeon. 34% of all patients perceived PAs to be more highly trained than NPs while 17% perceived the opposite. Patients had specific preferences regarding which services should be surgeon-provided: follow-up for abnormal tests (82%), initial postoperative appointment (81%), new patient visits (81%), and determining the need for advanced diagnostic studies (e.g. MRI) (76%). Patients had specific preferences regarding which services could be midlevel-provided: preoperative teaching (73%), minor in-office procedures (65%), long term postoperative appointments (61%), and prescriptions (61%). Patients lacked a consensus on reimbursement equity for midlevel providers and orthopaedic surgeons, despite most patients (78%) reporting the surgeon provides a higher-quality consultation. Conclusions: As health care becomes increasingly consumer-centric and value-driven, a databased utilization of midlevel staff will allow orthopaedic physicians to optimize efficiency and patient satisfaction. Surgeons may consider our results in division of clinical duties among midlevel staff since patients had specific preferences regarding which services should be physician-provided or midlevel-provided. Orthopaedic surgeons may also consider including the midlevel provider in marketing efforts, as most patients considered the midlevel provider's training background when initially choosing a surgeon and perceived PAs to be more highly trained than NPs. Patients lacked a consensus towards reimbursement equity for orthopaedic surgeons and midlevels, despite reporting that the surgeon provides a higher quality consultation. These findings are important as the midlevel workforce grows in response to the rising demand for orthopaedic care.Level of Evidence: IV.


Assuntos
Competência Clínica , Profissionais de Enfermagem/estatística & dados numéricos , Cirurgiões Ortopédicos/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Preferência do Paciente , Inquéritos e Questionários , Estados Unidos
14.
Int J Health Care Qual Assur ; 32(7): 1072-1080, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31411096

RESUMO

PURPOSE: The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital. DESIGN/METHODOLOGY/APPROACH: A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes. FINDINGS: In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases. PRACTICAL IMPLICATIONS: Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals. ORIGINALITY/VALUE: While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistentes Médicos/organização & administração , Atenção Primária à Saúde/organização & administração , Telemedicina/organização & administração , Adulto , Fatores Etários , Idoso , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Comorbidade , Eficiência Organizacional , Feminino , Hospitais de Ensino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Fatores de Risco , Escleroterapia/efeitos adversos , Escleroterapia/métodos
15.
BMC Health Serv Res ; 19(1): 603, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455342

RESUMO

BACKGROUND: Physician assistants/associates (PAs) are a recent innovation in acute hospital teams in England and many other countries worldwide. Although existing evidence indicates generally high levels of patient satisfaction with their PA hospital encounters, little is known about the factors associated with this outcome. There is a lack of evidence on the process of PA-patient communication in hospital encounters and how this might influence satisfaction. This study therefore aimed to understand patients' satisfaction with PA acute hospital encounters through PA-patient communication experiences. METHODS: A qualitative study was conducted among patients and representatives of patients seen by or receiving care from one of the PAs working in acute hospital services in England. Semi-structured interviews were undertaken face-to-face with study participants in the hospital setting and shortly after their PA encounter. Data were coded and analysed using thematic analysis. The study was framed within a theoretical model of core functions of medical encounter communication. RESULTS: Fifteen patients and patient representatives who had experienced a PA encounter participated in interviews, across five hospitals in England. Four interrelated communication experiences were important to participants who were satisfied with the encounter in general: feeling trust and confidence in the relationship, sharing relevant and meaningful information, experiencing emotional care and support, and sharing discussion on illness management and treatment. However, many participants misconceived PAs to be doctors, raising a potential risk of reduced trust in the PA relationship and negative implications for satisfaction with their PA encounter. Participants considered it beneficial that patients be informed about the PA role to prevent confusion. CONCLUSIONS: PA encounters offer a constructive example of successful clinician-patient communication experiences in acute hospital encounters from the patient's perspective. Study participants were generally naïve to the PA role. Hospital services and organisations introducing these mid-level or advanced care practitioner roles should consider giving attention to informing patients about the roles.


Assuntos
Comunicação , Serviço Hospitalar de Emergência , Satisfação do Paciente , Assistentes Médicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Defesa do Paciente , Pesquisa Qualitativa
16.
Med Educ Online ; 24(1): 1648944, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31370754

RESUMO

Background: Physician assistants (PAs) are an integral part of inpatient care teams, but many PAs do not receive formal education on authoring discharge summaries. High-quality discharge summaries can mitigate patient risk during transitions of care by improving inter-provider communication. Objective: To understand the current state of discharge summary education at our institution, and describe a novel curriculum to teach PA students to write effective discharge summaries. Design: Students completed a pre-survey to assess both knowledge and comfort levels regarding discharge summaries. They wrote a discharge summary and received feedback from two evaluators, an inpatient provider (IPP) familiar with the described patient and a simulated primary care provider (PCP). Students completed a post-survey reassessing knowledge and comfort. Results: Prior to instituting this curriculum, the majority of students (92.9%) reported rarely or never receiving feedback on discharge summaries. Eighty-four of 88 (95.5%) eligible students participated. There was discordance between IPP and simulated PCP feedback on their assessment of the quality of discharge summaries; simulated PCPs gave significantly lower global quality ratings (7.9 versus 8.5 out of 10, p = 0.006). Key elements were missing from >10% of discharge summaries. Student response was favorable. Conclusion: Clinically relevant deficiencies were common in students' discharge summaries, highlighting the need for earlier, structured training. IPPs and simulated PCPs gave discordant feedback, emphasizing differing needs of different providers during transitions of care. This novel curriculum improved students' knowledge and confidence.


Assuntos
Currículo , Alta do Paciente , Assistentes Médicos/educação , Redação , Comunicação , Feedback Formativo , Humanos , Inquéritos e Questionários , Cuidado Transicional
17.
S D Med ; 72(6): 254-259, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31461230

RESUMO

The University of South Dakota Physician Assistant Studies Program (USD PA Program) is in its 26th year of operation. The mission remains the same: to provide "a comprehensive primary care education that prepares graduates to deliver high-quality health care to meet the needs of patients in South Dakota and the surrounding region." The inaugural class graduated in 1995 making the class of 2018 our 24th. Graduates now number 462. The purpose of this article is to provide a brief historical background and to describe the evolution of the program and its contribution to the health care workforce of South Dakota and the region.


Assuntos
Educação Médica , Assistentes Médicos , Humanos , Atenção Primária à Saúde , Pesquisa , South Dakota
18.
West J Emerg Med ; 20(4): 541-548, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31316691

RESUMO

Introduction: Advanced practice providers (APP), including physicians' assistants and nurse practitioners, have been increasingly incorporated into emergency department (ED) staffing over the past decade. There is scant literature examining resource utilization and the cost benefit of having APPs in the ED. The objectives of this study were to compare resource utilization in EDs that use APPs in their staffing model with those that do not and to estimate costs associated with the utilized resources. Methods: In this five-year retrospective secondary data analysis of the Emergency Department Benchmarking Alliance (EDBA), we compared resource utilization rates in EDs with and without APPs in non-academic EDs. Primary outcomes were hospital admission and use of computed tomography (CT), radiography, ultrasound, and magnetic resonance imaging (MRI). Costs were estimated using the 2014 physician fee schedule and inpatient payments from the Centers for Medicare and Medicaid Services. We measured outcomes as rates per 100 visits. Data were analyzed using a mixed linear model with repeated measures, adjusted for annual volume, patient acuity, and attending hours. We used the adjusted net difference to project utilization costs between the two groups per 1000 visits. Results: Of the 1054 EDs included in this study, 79% employed APPs. Relative to EDs without APPs, EDs staffing APPs had higher resource utilization rates (use per 100 visits): 3.0 more admissions (95% confidence interval [CI], 2.0-4.1), 1.7 more CTs (95% CI, 0.2-3.1), 4.5 more radiographs (95% CI, 2.2-6.9), and 1.0 more ultrasound (95% CI, 0.3-1.7) but comparable MRI use 0.1 (95% CI, -0.2-0.3). Projected costs of these differences varied among the resource utilized. Compared to EDs without APPs, EDs with APPs were estimated to have 30.4 more admissions per 1000 visits, which could accrue $414,717 in utilization costs. Conclusion: EDs staffing APPs were associated with modest increases in resource utilization as measured by admissions and imaging studies.


Assuntos
Serviço Hospitalar de Emergência/economia , Profissionais de Enfermagem , Assistentes Médicos , Diagnóstico por Imagem/economia , Diagnóstico por Imagem/estatística & dados numéricos , Humanos , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
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