Nurse practitioners and physician assistants in primary care: An update of changes since 2008

Aitchison, Robert; Ruiz, A.; Bednar, Susan

doi:10.1016/j.disamonth.2016.01.002

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…However, knowledge about the PA/NP profession, legislation and role definitions in general practice is often lacking. Just as in other studies there are preconceived notions about PAs’/NPs’ roles and training and the difference between a PA and an NP is not clear [ 30 , 37 , 38 ]. GPs from practices without prior experience working with PAs/NPs felt hesitant about the changes in caseload and whether their workload actually decreases when they employ a PA/NP.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study

Biezen

Derckx²,

Wensing

et al. 2017

BMC Fam Pract

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BackgroundDue to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation.MethodsA qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP.ResultsEmployment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs’ caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs.In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees’ motivation to start the master’s programme and GPs’ prior experience with PAs/NPs. Knowledge about the PA/NP profession and legislations was often lacking.ConclusionsRole standardisations, long-term political planning and support from professional associations are needed to support policy makers in implementing skill mix in primary care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0587-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study

Biezen

Derckx²,

Wensing

et al. 2017

BMC Fam Pract

View full text Add to dashboard Cite

show abstract

“…5 , 8 However, studies have predominantly examined only one clinic format and provider type. Given that advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs), are increasingly becoming utilized by healthcare systems, 9 , 10 it is useful to understand how their referral patterns compare with physicians with an Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. In addition, with the current rise of walk-in clinic utilization, the referral pattern from this type of practice setting, compared with office visits, should be explored.…”

Section: Introductionmentioning

confidence: 99%

Store-and-forward teledermatology impact on diagnosis, treatment and dermatology referrals: Comparison between practice settings

et al. 2020

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Introduction Store-and-forward (SAF) teledermatology involves non-dermatologists sending clinical images to dermatologists. This improves patient care while reducing unwarranted face-to-face (FTF) specialist office visits. Comparisons between dermatologist diagnostic concordance with referring provider, treatment change recommendations, and FTF referrals have yet to be compared by type of provider and practice setting. Methods This retrospective chart review examined SAF teledermatology eConsults from four practice settings: Doctor of Medicine (MD)/Doctor of Osteopathic Medicine (DO) office visits, MD/DO walk-in clinics, nurse practitioner (NP)/physician assistant (PA) office visits and NP/PA walk-in clinics. The most recent 100 MD/DO office- and 100 NP/PA walk-in-referred patient charts were reviewed. There were only 71 NP/PA office and 47 MD/DO walk-in eConsults to review. Results Teledermatologists agreed with referring provider diagnoses 50% of the time for MD/DO office visits, 29.8% for MD/DO walk-in clinics, 33.8% for NP/PA office visits and 34% for NP/PA walk-in clinics. Diagnostic concordance was significantly higher for eConsults from MD/DO office visits than MD/DO walk-in clinics ( p = 0.021), NP/PA office visits ( p = 0.035) or NP/PA walk-in clinics ( p = 0.022). There were significantly more treatment changes recommended after walk-in eConsults than office visits (67 versus 44%, p < 0.0001). FTF visits were recommended more after office visits than walk-in clinics (46 versus 27%, p = 0.001). Overall, 21% (68/318) of patients ultimately attended FTF appointments. Discussion SAF teledermatology improves diagnosis, reducing barriers to specialty care. Overall, potential FTF visit reduction was 79%. Expanding eConsult programmes, particularly in walk-in settings, and for use by NP/PAs or early career internists, may render dermatological care more expeditiously and avoid unnecessary FTF visits.

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“…1,2,4 Advanced practice providers (APPs), including physician assistants and nurse practitioners, increasingly provide primary care in the United States. 5 Reports of APP participation in teledermatology are limited.…”

Section: Store-and-forward Teledermatology Improves Care and Reduces mentioning

confidence: 99%

Store-and-forward teledermatology improves care and reduces dermatology referrals from walk-in clinics: A retrospective descriptive study

McAfee

Vij

Warren

2020

Journal of the American Academy of Dermatology

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Nurse practitioners and physician assistants in primary care: An update of changes since 2008

Cited by 8 publications

References 20 publications

Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study

Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study

Store-and-forward teledermatology impact on diagnosis, treatment and dermatology referrals: Comparison between practice settings

Store-and-forward teledermatology improves care and reduces dermatology referrals from walk-in clinics: A retrospective descriptive study

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