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What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study

Drennan, Vari M, Halter, Mary, Wheeler, Carly, Nice, Laura, Brearley, Sally, Ennis, James, Gabe, Jonathan, Gage, Heather, Levenson, Ros, de Lusignan, Simon , Begg, Phil and Parle, James (2019) What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study BMJ Open, 9 (1), e027012. pp. 1-9.

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Abstract

Objectives To investigate the deployment of physician associates (PAs); the factors supporting and inhibiting their employment and their contribution and impact on patients’ experience and outcomes and the organisation of services.

Design Mixed methods within a case study design, using interviews, observations, work diaries and documentary analysis.

Setting Six acute care hospitals in three regions of England in 2016–2017.

Participants 43 PAs, 77 other health professionals, 28 managers, 28 patients and relatives.

Results A key influencing factor supporting the employment of PAs in all settings was a shortage of doctors. PAs were found to be acceptable, appropriate and safe members of the medical/surgical teams by the majority of doctors, managers and nurses. They were mainly deployed to undertake inpatient ward work in the medical/surgical team during core weekday hours. They were reported to positively contribute to: continuity within their medical/surgical team, patient experience and flow, inducting new junior doctors, supporting the medical/surgical teams’ workload, which released doctors for more complex patients and their training. The lack of regulation and attendant lack of authority to prescribe was seen as a problem in many but not all specialties. The contribution of PAs to productivity and patient outcomes was not quantifiable separately from other members of the team and wider service organisation. Patients and relatives described PAs positively but most did not understand who and what a PA was, often mistaking them for doctors.

Conclusions This study offers new insights concerning the deployment and contribution of PAs in medical and surgical specialties in English hospitals. PAs provided a flexible addition to the secondary care workforce without drawing from existing professions. Their utility in the hospital setting is unlikely to be completely realised without the appropriate level of regulation and authority to prescribe medicines and order ionising radiation within their scope of practice.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Drennan, Vari M
Halter, Mary
Wheeler, Carly
Nice, Laura
Brearley, Sally
Ennis, James
Gabe, Jonathan
Gage, HeatherH.Gage@surrey.ac.uk
Levenson, Ros
de Lusignan, SimonS.Lusignan@surrey.ac.uk
Begg, Phil
Parle, James
Date : 1 January 2019
Funders : National Institute for Health Research (NIHR)
DOI : 10.1136/bmjopen-2018-027012
Grant Title : Health Services and Delivery Research Programme
Copyright Disclaimer : © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https:// creativecommons. org/ licenses/ by/ 4. 0/.
Depositing User : Clive Harris
Date Deposited : 25 Mar 2019 10:13
Last Modified : 25 Mar 2019 10:13
URI: http://epubs.surrey.ac.uk/id/eprint/850853

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