Integration and retention of American physician assistants/associates working in English hospitals: A qualitative study

Summary Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required.

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What Do Clinicians Who Deliver Maternity Services Think Patient-Centered Care Is and How Is That Different for Vulnerable Women? A Qualitative Study

Journal of Pregnancy ◽

10.1155/2018/5853235 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Ted Adams ◽

Dana Sarnak ◽

Joy Lewis ◽

Jeff Convissar ◽

Scott S. Young

Keyword(s):

Qualitative Study ◽

Primary Care Physicians ◽

Health Management ◽

Physician Assistants ◽

Patient Centered Care ◽

Fee For Service ◽

Institute Of Medicine ◽

Patient Centered ◽

Maternity Services ◽

Centered Care

Background. Patient-centered care is said to have a myriad of benefits; however, there is a lack of agreement on what exactly it consists of and how clinicians should deliver it for the benefit of their patients. In the context of maternity services and in particular for vulnerable women, we explored how clinicians describe patient-centered care and how the concept is understood in their practice. Methods. We undertook a qualitative study using interviews and a focus group, based on an interview guide developed from various patient surveys focused around the following questions: (i) How do clinicians describe patient-centered care? (ii) How does being patient-centered affect how care is delivered? (iii) Is this different for vulnerable populations? And if so, how? We sampled obstetricians and gynecologists, midwives, primary care physicians, and physician assistants from a health management organization and fee for service clinician providers from two states in the US covering insured and Medicaid populations. Results. Building a relationship between clinician and patient is central to what clinicians believe patient-centered care is. Providing individually appropriate care, engaging family members, transferring information from clinician to patient and from patient to clinician, and actively engaging with patients are also key concepts. However, vulnerable women did not benefit from patient-centered care without first having some of their nonmedical needs met by their clinician. Discussion. Most providers did not cite the core concepts of patient-centered care as defined by the Institute of Medicine and others.

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Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study

Journal of General Internal Medicine ◽

10.1007/s11606-015-3505-1 ◽

2015 ◽

Vol 31 (1) ◽

pp. 93-99 ◽

Cited By ~ 48

Author(s):

Elizabeth Dzeng ◽

Alessandra Colaianni ◽

Martin Roland ◽

David Levine ◽

Michael P. Kelly ◽

...

Keyword(s):

Qualitative Study ◽

End Of Life ◽

Moral Distress ◽

American Physician

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Determinants of the sustained employment of physician assistants in hospitals: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2016-011949 ◽

2016 ◽

Vol 6 (11) ◽

pp. e011949 ◽

Cited By ~ 7

Author(s):

Marijke J C Timmermans ◽

Anneke J A H van Vught ◽

Irma T H M Maassen ◽

Lisette Draaijer ◽

Anton G M Hoofwijk ◽

...

Keyword(s):

Qualitative Study ◽

Physician Assistants

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Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study

Nursing and Health Sciences ◽

10.1111/nhs.12601 ◽

2019 ◽

Vol 21 (3) ◽

pp. 282-290 ◽

Cited By ~ 1

Author(s):

Marleen H. Lovink ◽

Anneke (J.A.H.) Vught ◽

Anke Persoon ◽

Raymond T.C.M. Koopmans ◽

Miranda G.H. Laurant ◽

...

Keyword(s):

Nursing Homes ◽

Qualitative Study ◽

Nurse Practitioners ◽

Physician Assistants ◽

Skill Mix

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Physician assistants in English general practice: A qualitative study of employers’ viewpoints

Journal of Health Services Research & Policy ◽

10.1258/jhsrp.2010.010061 ◽

2011 ◽

Vol 16 (2) ◽

pp. 75-80 ◽

Cited By ~ 17

Author(s):

Vari Drennan ◽

Ros Levenson ◽

Mary Halter ◽

Chris Tye

Keyword(s):

General Practice ◽

Qualitative Study ◽

Physician Assistants

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Barriers and facilitators to learn and improve through morbidity and mortality conferences: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2017-018833 ◽

2017 ◽

Vol 7 (11) ◽

pp. e018833 ◽

Cited By ~ 3

Author(s):

Marit S de Vos ◽

Jaap F Hamming ◽

Perla J Marang-van de Mheen

Keyword(s):

Qualitative Study ◽

Physician Assistants ◽

Barriers And Facilitators ◽

Morbidity And Mortality ◽

Negative Effects ◽

Factors Affecting ◽

Surgical Department ◽

Morbidity And Mortality Conferences ◽

Case Type ◽

Organisational Factors

ObjectivesTo explore barriers and facilitators to successful morbidity and mortality conferences (M&M), driving learning and improvement.DesignThis is a qualitative study with semistructured interviews. Inductive, thematic content analysis was used to identify barriers and facilitators, which were structured across a pre-existing framework for change in healthcare.SettingDutch academic surgical department with a long tradition of M&M.ParticipantsAn interview sample of surgeons, residents and physician assistants (n=12).ResultsA total of 57 barriers and facilitators to successful M&M, covering 18 themes, varying from ‘case type’ to ‘leadership’, were perceived by surgical staff. While some factors related to M&M organisation, others concerned individual or social aspects. Eight factors, of which four were at the social level, had simultaneous positive and negative effects (eg, ‘hierarchy’ and ‘team spirit’). Mediating pathways for M&M success were found to relate to availableinformation, staffmotivationandrealisationprocesses.ConclusionsThis study provides leads for improvement of M&M practice, as well as for further research on key elements of successful M&M. Various factors were perceived to affect M&M success, of which many were individual and social rather than organisational factors, affecting information and realisation processes but also staff motivation. Based on these findings, practical recommendations were formulated to guide efforts towards best practices for M&M.

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American physician perceptions of direct-to-consumer advertising: A qualitative study

Journal of Communications In Healthcare ◽

10.1179/1753807613y.0000000034 ◽

2013 ◽

Vol 6 (2) ◽

pp. 135-141

Author(s):

Evi Germeni ◽

Grazia Orizio ◽

Kent Nakamoto ◽

Martha Wunsch ◽

Peter J Schulz

Keyword(s):

Qualitative Study ◽

Physician Perceptions ◽

Direct To Consumer ◽

American Physician ◽

Direct To Consumer Advertising

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Barriers to Use of Clinical Decision Support for the Evaluation of Pulmonary Embolism: Results of a Qualitative Study (Preprint)

10.2196/preprints.25046 ◽

2020 ◽

Author(s):

Safiya Richardson

Keyword(s):

Pulmonary Embolism ◽

Decision Support ◽

Qualitative Study ◽

Clinical Decision Support ◽

Clinical Care ◽

Clinical Decision ◽

Physician Assistants ◽

Structured Interview ◽

Barriers To Use ◽

Behavioral Barriers

BACKGROUND Providers often disregard potentially beneficial clinical decision support (CDS). Improvements in quality of care seen with CDS have been significantly limited by consistently low provider adoption, estimated at 10%. OBJECTIVE We sought to explore the psychological and behavioral barriers to use of a CDS tool. METHODS We conducted a qualitative study involving Emergency Medicine physicians and physician assistants. A semi-structured interview guide was created based on the Capability Opportunity Motivation Behavior (COM-B) model. Interviews focused on barriers to use of a CDS tool built based on Wells’ Criteria for Pulmonary Embolism to assist providers in establishing pre-test probability of pulmonary embolism (PE) before imaging. RESULTS Interviews were conducted with 12 providers. Six barriers were identified: 1. Bayesian Reasoning, 2. Fear of Missing PE, 3. Time Pressure / Cognitive Load, 4. Gestalt Includes Wells’, 5. Missed Risk Factors, and 6. Social Pressure. CONCLUSIONS Providers highlighted several important psychological and behavioral barriers to CDS use. Addressing these barriers will be paramount in developing CDS that can meet its potential to transform clinical care. CLINICALTRIAL NA

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