University of Surrey

Test tubes in the lab Research in the ATI Dance Research

Contribution of physician assistants/associates to secondary care: a systematic review

Halter, Mary, Wheeler, Carly, Pelone, Ferruccio, Gage, Heather, de Lusignan, Simon, Parle, Jim, Grant, Robert, Gabe, Jonathan, Nice, Laura and Drennan, Vari M (2018) Contribution of physician assistants/associates to secondary care: a systematic review BMJ Open, 8 (6), e019573. e019573-1.

[img]
Preview
Text
Contribution of physician assistants.pdf - Version of Record
Available under License Creative Commons Attribution.

Download (1MB) | Preview

Abstract

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.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Halter, Mary
Wheeler, Carly
Pelone, Ferruccio
Gage, HeatherH.Gage@surrey.ac.uk
de Lusignan, SimonS.Lusignan@surrey.ac.uk
Parle, Jim
Grant, Robert
Gabe, Jonathan
Nice, Laura
Drennan, Vari M
Date : 19 June 2018
DOI : 10.1136/bmjopen-2017-019573
Copyright Disclaimer : This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Depositing User : Clive Harris
Date Deposited : 16 Jul 2018 13:53
Last Modified : 16 Jul 2018 13:53
URI: http://epubs.surrey.ac.uk/id/eprint/848716

Actions (login required)

View Item View Item

Downloads

Downloads per month over past year


Information about this web site

© The University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom.
+44 (0)1483 300800