Nurse practitioners and physician assistants working in ambulance care: A systematic review

Abstract

Background: This review aims to describe the activities of nurse practitioners (NPs) and physician assistants (PAs) working in ambulance care, and the effect of these activities on patient outcomes, process of care, provider outcomes, and costs. Methods: PubMed, MEDLINE (EBSCO), EMBASE (OVID), Web of Science, the Cochrane Library (Cochrane Database of Systematic Review), CINAHL Plus, and the reference lists of the included articles were systematically searched in November 2019. All types of peer-reviewed designs on the three topics were included. Pairs of independent reviewers performed the selection process, the quality assessment, and the data extraction. Results: Four studies of moderate to poor quality were included. Activities in medical, communication and collaboration skills were found. The effects of these activities were found in process of care and resource use outcomes, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact Conclusions: This review shows that there is limited evidence on activities of NPs and PAs in ambulance care. Results show that NPs and PAs in ambulance care perform activities that can be categorized into the Canadian Medical Education Directives for Specialists (CanMED) roles of Medical Expert, Communicator, and Collaborator. The effects of NPs and PAs are minimally reported in relation to process of care and resource use, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact. No evidence on patient outcomes of the substitution of NPs and PAs in ambulance care exists. PROSPERO registration: CRD42017067505 (07/07/2017)

Impact of State Nurse Practitioner Regulations on Potentially Inappropriate Medication Prescribing Between Physicians and Nurse Practitioners

“…Future studies should examine the variance in prescribing safety and patient outcomes between NPs as sole PCPs and NPs in a team-based primary care model. A comparison of NPs and physician assistants working in ambulatory care is needed 38…”

Quality of solo ambulance care by physician assistants versus ambulance nurses for non-conveyed patients in the Netherlands: An observational study

“…Additionally, the effect of the PA on quality of ambulance care should be further assessed. Future research on the impact of the PA within ambulance care should be assessed by using the six dimensions of quality of healthcare: (1) effectiveness, (2) efficiency, (3) patient safety, (4) accessibility, (5) timeliness and ( 6) target population directed 15 . The effects on these dimensions should be measured in all phases of the ambulance process, from initial call and dispatch triage, to handover or referral.…”

“…Despite the introduction of the PA in ambulance care, little is known about the effects. A recent systematic review showed limited available evidence on the introduction of master's level educated professionals in ambulance care, with lacking evidence on patient outcomes 15 . This underpins the need for further research on effectiveness, efficiency, patient safety, and accessibility of the introduction of PAs in ambulance care.…”

Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews

“…Disagreements between reviewers were noted for some elements of the AMSTAR 2 assessment tool (see Discussion). Nineteen studies were assessed to be at low risk of bias with four or fewer criteria that were not met and no critical domains missing [11,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. Four studies were deemed to be at high risk of bias [46][47][48][49].…”