The New Health Professionals: Three Examples

Yankauer, Alfred; Sullivan, Judith A.

doi:10.1146/annurev.pu.03.050182.001341

Cited by 13 publications

(2 citation statements)

References 30 publications

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“…The first economic studies using a time-motion method to observe the interaction of PAs and physicians regarding patient care were in the USA and published at a time when the development of the profession was still in its infancy [ 6 , 14 ]. Early studies included some details of the PA, then known as a “new health professional,” and drew on the limited literature known at the time [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of physician assistants/associates: A systematic review of international evidence

et al. 2021

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Background The global utilization of the physician assistant/associate (PA) is growing. Their increasing presence is in response to the rising demands of demographic changes, new developments in healthcare, and physician shortages. While PAs are present on four continents, the evidence of whether their employment contributes to more efficient healthcare has not been assessed in the aggregate. We undertook a systematic review of the literature on PA cost-effectiveness as compared to physicians. Cost-effectiveness was operationalized as quality, accessibility, and the cost of care. Methods and findings Literature to June 2021 was searched across five biomedical databases and filtered for eligibility. Publications that met the inclusion criteria were categorized by date, country, design, and results by three researchers independently. All studies were screened with the Risk of Bias in Non-randomised Studies—of Interventions (ROBIN-I) tool. The literature search produced 4,855 titles, and after applying criteria, 39 studies met inclusion (34 North America, 4 Europe, 1 Africa). Ten studies had a prospective design, and 29 were retrospective. Four studies were assessed as biased in results reporting. While most studies included a small number of PAs, five studies were national in origin and assessed the employment of a few hundred PAs and their care of thousands of patients. In 34 studies, the PA was employed as a substitute for traditional physician services, and in five studies, the PA was employed in a complementary role. The quality of care delivered by a PA was comparable to a physician’s care in 15 studies, and in 18 studies, the quality of care exceeded that of a physician. In total, 29 studies showed that both labor and resource costs were lower when the PA delivered the care than when the physician delivered the care. Conclusions Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care. Sometimes this efficiency was due to their reduced labor cost and sometimes because they were more effective as producers of care and activity.

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Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of physician assistants/associates: A systematic review of international evidence

et al. 2021

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“…For two excellent reviews see Sox' and Yankauer and Sullivan. 2 In general the literature on nonphysician providers can be classified into three broad categories: description of activities; cost/efficiency comparisons; and quality of care assessments. Regarding activities, Moscovice3 and Zammuto, et al,4 discussed factors which affected the practice patterns of different types of nonphysician providers.…”

Section: Introductionmentioning

confidence: 99%

Health problems encountered by three levels of providers in a remote setting.

Dunn¹,

Higgins²

1986

Am J Public Health

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A study conducted in the Sioux Lookout Health Zone in northwestern Ontario, Canada analyzed the diagnoses and managements for 139,618 patient visits to three levels of practitioners: physicians, nurse practitioners, and minimally trained health aides. There were major differences between providers in their diagnostic and management patterns. Some of these differences were the result of administrative policy (e.g., physicians and nurses do preventive medicine) but even when adjustment had been made for these differences there was still considerable variation. The minimally IntroductionPrimary health care is becoming increasingly available to people in underdeveloped countries and remote areas. A major factor in this development is an increase in the use of nonphysician providers. These providers vary from welltrained nurse practitioners and paramedics to minimally trained indigenous workers. Valid and as yet unanswered questions relate to the practice patterns and competence of these practitioners. There is an extensive literature concerning the practice aind performance of nonphysician providers. For two excellent reviews see Sox' and Yankauer and

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