Maintaining Ambulatory Patient Care in the Army: A Study Utilizing Physician Assistants

1977 ◽  
Vol 142 (12) ◽  
pp. 951-954
Author(s):  
J. D. Fitterer ◽  
Charles R. Cochrane
Keyword(s):  
Patient Care ◽  
Physician Assistants ◽  
Ambulatory Patient

scholarly journals An activity analysis of Dutch hospital-based physician assistants and nurse practitioners

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
G. T. W. J. van den Brink ◽  
A. J. Kouwen ◽  
R. S. Hooker ◽  
H. Vermeulen ◽  
M. G. H. Laurant
Keyword(s):  
The Netherlands ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Hospital Management ◽  
Physician Assistants ◽  
Added Value ◽  
Direct Patient Care ◽  
Patient Scheduling ◽  
Dutch Hospital ◽  
Medical Specialties

Abstract Background The physician assistant (PA) and the nurse practitioner (NP) were introduced into The Netherlands in 2001 and 1997 respectively. By the second decade, national policies had accelerated the acceptance and development of these professions. Since 2015, the PA and NP have full practice authority as independent health professionals. The aim of this research was to gain a better understanding of the tasks and responsibilities that are being shifted from Medical Doctors (MD) to PAs and NPs in hospitals. More specifically in what context and visibility are these tasks undertaken by hospital-based PAs and NPs in patient care. This will enable them to communicate their worth to the hospital management. Study design A descriptive, non-experimental research method design was used to collect and analyze both quantitative and qualitative data about the type of tasks performed by a PA or NP. Fifteen medical departments across four hospitals participated. Methods The patient scheduling system and hospital information system were probed to identify and characterize a wide variety of clinical tasks. The array of tasks was further verified by 108 interviews. All tasks were divided into direct and indirect patient care. Once the tasks were cataloged, then MDs and hospital managers graded the PA- or NP-performed tasks and assessed their contributions to the hospital management system. Findings In total, 2883 tasks were assessed. Overall, PAs and NPs performed a wide variety of clinical and administrative tasks, which differed across hospitals and medical specialties. Data from interviews and the hospital management systems revealed that over a third of the tasks were not properly registered or attributed to the PA or NP. After correction, it was found that the NP and PA spent more than two thirds of their working time on direct patient care. Conclusions NPs and PAs performed a wide variety of clinical tasks, and the consistency of these tasks differed per medical specialty. Despite the fact that a large part of the tasks was not visible due to incorrect administration, the interviews with MDs and managers revealed that the use of an NP or PA was considered to have an added value at the quality of care as well to the production for hospital-based medical care in The Netherlands.

scholarly journals Ambulatory patient care

1966 ◽  
Vol 41 (7) ◽  
pp. 707-9
Author(s):  
A W Snoke
Keyword(s):  
Patient Care ◽  
Ambulatory Patient

Kansas Physician Assistants’ Attitudes and Beliefs Regarding Spirituality and Religiosity in Patient Care

2011 ◽  
Vol 52 (3) ◽  
pp. 864-876 ◽  
Author(s):  
Gina M. Berg ◽  
Robin E. Crowe ◽  
Ginny Budke ◽  
Jennifer Norman ◽  
Valerie Swick ◽  
...  
Keyword(s):  
Patient Care ◽  
Physician Assistants ◽  
Attitudes And Beliefs

scholarly journals Board-Certified Oncology Pharmacists: Their Potential Contribution to Reducing a Shortfall in Oncology Patient Visits

2016 ◽  
Vol 12 (4) ◽  
pp. e359-e368 ◽  
Author(s):  
Robert Ignoffo ◽  
Katherine Knapp ◽  
Mitchell Barnett ◽  
Sally Yowell Barbour ◽  
Steve D’Amato ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Treatment ◽  
Patient Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Delphi Panel ◽  
Potential Contribution ◽  
Oncology Patient ◽  
Care Services ◽  
Number Of Patients

Purpose: With an aging US population, the number of patients who need cancer treatment will increase significantly by 2020. On the basis of a predicted shortage of oncology physicians, nonphysician health care practitioners will need to fill the shortfall in oncology patient visits, and nurse practitioners and physician assistants have already been identified for this purpose. This study proposes that appropriately trained oncology pharmacists can also contribute. The purpose of this study is to estimate the supply of Board of Pharmacy Specialties–certified oncology pharmacists (BCOPs) and their potential contribution to the care of patients with cancer through 2020. Methods: Data regarding accredited oncology pharmacy residencies, new BCOPs, and total BCOPs were used to estimate oncology residencies, new BCOPs, and total BCOPs through 2020. A Delphi panel process was used to estimate patient visits, identify patient care services that BCOPs could provide, and study limitations. Results: By 2020, there will be an estimated 3,639 BCOPs, and approximately 62% of BCOPs will have completed accredited oncology pharmacy residencies. Delphi panelists came to consensus (at least 80% agreement) on eight patient care services that BCOPs could provide. Although the estimates given by our model indicate that BCOPs could provide 5 to 7 million 30-minute patient visits annually, sensitivity analysis, based on factors that could reduce potential visit availability resulted in 2.5 to 3.5 million visits by 2020 with the addition of BCOPs to the health care team. Conclusion: BCOPs can contribute to a projected shortfall in needed patient visits for cancer treatment. BCOPs, along with nurse practitioners and physician assistants could substantially reduce, but likely not eliminate, the shortfall of providers needed for oncology patient visits.

Introduction of computerized provider order entry (CPOE) and time impact in an inpatient hematology/oncology service: Serial time and motion studies

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17507-e17507
Author(s):  
D. A. Hanauer ◽  
R. W. Beasley ◽  
J. Schumacher ◽  
M. G. Duck ◽  
D. W. Blayney
Keyword(s):  
Patient Care ◽  
Physician Assistants ◽  
House Staff ◽  
Direct Patient Care ◽  
Care Providers ◽  
Order Entry ◽  
Time And Motion ◽  
Oncology Service ◽  
The Impact ◽  
Productive Time

e17507 Background: The impact of CPOE on inpatient hematology/oncology care is not well studied. CPOE has many benefits, but concerns exist about increased time required to enter electronic orders compared to handwritten orders. We hypothesized that CPOE would require more order-related time from caregivers, and reduce the amount of time for direct patient care. Methods: Physician assistants (PAs) enter all patient orders (except those for chemotherapy) and are the dedicated and exclusive care providers on this non-house staff service at the main Hospital of the University of Michigan Health System. We chose the PA service for observation as we could eliminate potential biases introduced by rotating house staff we observed in earlier studies. PAs were directly observed at -1, +3 and +8 months post implementation of a CPOE system (Sunrise Clinical Manager, Eclypsis, Atlanta GA). Dedicated observers used a data entry tool with a modified database (available on the Health IT Tools section at healthit.ahrq.gov) on a tablet computer. For analysis, the 60 individual activities were grouped into 6 major categories, as well as an ordering category. We observed the same three PAs for 82.5 hours pre-CPOE, for 75.0 hours at 3 months post and for 70.5 hours 8 months post. Productive time was all non-personal and non-administrative time. The faculty entered chemotherapy orders and supervised the PAs, but were not studied. Results: Overall time for order-related activities was unchanged during the three observation periods, requiring 10.3, 10.6 and 11.4% of productive time, respectively. Time spent on direct patient care (as a percentage of productive time) was also unchanged once CPOE was implemented (50.7% pre vs. 49.8% and 47.8% post). Conclusions: We could not detect differences in order-entry time by well-trained PAs using standardized order sets before and after CPOE implementation on an inpatient hematology/oncology service. The decision to adopt CPOE should not be based on the hypothesis that there will be less (or more) time spent on order entry tasks. No significant financial relationships to disclose.

scholarly journals Ambulatory patient care

1966 ◽  
Vol 41 (7) ◽  
pp. 712-21 ◽  
Author(s):  
E R Weinerman
Keyword(s):  
Patient Care ◽  
Ambulatory Patient

scholarly journals Multidisciplinary Cancer Care: Development of an Infectious Diseases Physician Assistant Workforce at a Comprehensive Cancer Center

2010 ◽  
Vol 6 (6) ◽  
pp. e31-e34 ◽  
Author(s):  
Candice N. White ◽  
Roy A. Borchardt ◽  
Mary L. Mabry ◽  
Kathleen M. Smith ◽  
Victor E. Mulanovich ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Patient Care ◽  
Cancer Care ◽  
Physician Assistant ◽  
Physician Assistants ◽  
Physician Satisfaction ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Services ◽  
Care Development

The authors outline the process through which the infectious diseases department at The M. D. Anderson Cancer Center successfully integrated physician assistants into patient care services, as judged by an overall increase in departmental productivity, broadened patient care coverage, and physician satisfaction with midlevel services.

Effect of Edmonton Symptom Assessment Scale (ESAS) on symptom data collection in a radiation oncology department.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 83-83 ◽  
Author(s):  
Bansi Savla ◽  
Puja Venkat ◽  
Michael Yu
Keyword(s):  
Patient Care ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Symptom Burden ◽  
Improve Patient Care ◽  
Physician Assistants ◽  
Clinical Team ◽  
Clinical Interventions ◽  
Patient Reported ◽  
Edmonton Symptom Assessment Scale

83 Background: ESAS has been used to examine quality of life and symptom burden of patients undergoing cancer treatment. The purpose of this study is to examine attitudes towards ESAS among patients in a Radiation Oncology clinic in conjunction with the perspective of cancer care professionals, to establish ideal implementation of this tool to improve patient care. Methods: Routine use of ESAS in a single Radiation Oncology Department was initiated in July 2015. Six months after implementation, an anonymous, electronic survey was administered to 50 healthcare providers within this department, including attending physicians, resident physicians, advanced practice nurses, physician assistants, and registered nurses. The survey collected information regarding the value of ESAS with regards to patient care, the numerical value at which an intervention is made, which clinical interventions had been implemented due to patient-reported scores on ESAS, which patient populations benefit from ESAS administration, and how frequently ESAS should be administered. Closed and open questions were included. Results: Out of 50 providers, 36 completed the survey. Of these, 31 reported finding ESAS useful. The most common intervention was questioning the patient further about symptoms (29/36.) ESAS data are being reviewed by clinical teams and stored as part of the patient’s medical record in order to compile longitudinal data. An anonymous paper survey is currently being administered to 50 patients at the end of their radiation treatment or at their first follow-up. The survey will collect information about how well symptoms are being communicated with the clinical team, if symptoms should be added to ESAS, how often ESAS should be administered, which specific clinical interventions were provided due to ESAS, and if ESAS improved the overall patient experience. Conclusions: Our survey from the clinical team supports that ESAS is a useful modality to assess patient symptoms and to improve management for patient symptoms effectively. Our ongoing patient survey will validate these findings. These two surveys will be used to improve systematic collection of symptom data for radiation oncology patients.

Time driven activity-based costing methods used in radiation oncology clinics.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 79-79
Author(s):  
Shalini Moningi ◽  
Shane Mesko ◽  
Amy Catherine Moreno ◽  
Matthew S. Ning ◽  
Thomas A. Aloia ◽  
...  
Keyword(s):  
Patient Care ◽  
Radiation Oncology ◽  
Care Delivery ◽  
Clinical Care ◽  
Physician Assistants ◽  
Cancer Center ◽  
Activity Based Costing ◽  
Process Maps ◽  
Clinical Patient

79 Background: Since 2010 The University of Texas MD Anderson Cancer Center (UTMDACC) has been using Time Driven Activity Based Costing (TDABC) to assist in tracking and quantifying changes made to clinical processes to improve efficiency of patient care delivery. Radiation Oncology (RO) providers have recently utilized this method to assist in the growing clinical patient volumes and increasing enrollment in clinical trials. UTMDACC contains disease specific multi-disciplinary centers with separate clinics for different disciplines. Resources are limited which can affect clinical providers’ ability to meet the needs of increasing patient volumes. Implementing efficient clinic work flow models will allow clinicians to provide excellent quality of clinical care even with limited resources. Methods: Standard disease-site specific note templates were created and implemented throughout the entire RO department. Additionally, standardized roles for medical assistants, residents, physician assistants (PAs), attending physicians and nurses were implemented to minimize duplication of responsibilities. Using TDABC methodology, process maps for pre and post implementation pathways were created to illustrate areas of change and possible benefit. Results: Process maps were compared for new consult and follow up and on treatment patient visits. Process times for these patient care visits were compared pre- and post-implementation of templates and clinical roles. Time savings of 110, 18 and 34 minutes were observed for consult visits, follow up visits and on-treatment visits when comparing current to baseline process maps. Conclusions: Standardization of note templates and roles for all members of the care team has led to improvements in process flow and efficiency in the RO clinic setting. Our findings suggest that further implementation of TDABC methodology by having all providers work at the top of their license could can improve clinical efficiency and patient care. Further metrics with a larger sample size is recommended to validate our results. [Table: see text]

Outpatient Care: Planning a Satellite Laboratory for Ambulatory Patient Care

1970 ◽  
Vol 48 (3) ◽  
pp. 53-60
Author(s):  
Allen L. Pusch ◽  
Bettina G. Martin ◽  
John Bernard Henry
Keyword(s):  
Patient Care ◽  
Outpatient Care ◽  
Care Planning ◽  
Ambulatory Patient
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