scholarly journals Acceptability of physician associate interns in primary care: results from a service evaluation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Elizabeth Cottrell ◽  
Victoria Silverwood ◽  
Alex Strivens-Joyce ◽  
Lucy Minshull ◽  
John J. Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
Analysis Data ◽  
Service Evaluation ◽  
Full Potential ◽  
Patient Acceptability ◽  
Practice Characteristics ◽  
Primary Care Workforce ◽  
Data Collection And Analysis ◽  
Or Practice ◽  
Five Practices

Abstract Background Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner (GP) recruitment and retention crisis. However, they are novel to the primary care workforce and have limitations, for example, they cannot prescribe. The novel 1 year Staffordshire PA Internship (SPAI) scheme, introduced in 2017, was established to support the integration of PAs into primary care. PA interns concurrently worked in primary and secondary care posts, with protected weekly primary care focussed education sessions. This evaluation established the acceptability of PA interns within primary care. Methods All ten PAs from the first two SPAI cohorts, the nine host practices (supervising GPs and practice managers) and host practice patients were invited to participate in the evaluation. A conceptual framework for implementing interventions in primary care informed data collection and analysis. Data were gathered at three time points over the internship from practices, through discussions with the supervising GP and/or practice manager, and from the PAs via discussion groups. To enrich discussion data, PA and practices were sent brief surveys requesting information on PA/practice characteristics and PA primary care roles. Patient acceptability data were collected by the host practices. Participation at every stage was optional. Results By evaluation end, eight PAs had completed the internship. Seven PAs and six practices provided data at every time point. Five practices provided patient acceptability data. Overall PA interns were acceptable to practices and patients, however ambiguity about the PA role and how best to communicate and operationalise PA roles was revealed. An expectation-preparedness gap resulted in PAs needing high levels of supervision early within the internship. SPAI facilitated closure of the expectation-preparedness gap and its funding arrangements made the high supervision requirements more acceptable to practices. Conclusions The test-of-concept SPAI successfully integrated new PAs into primary care. However, the identified challenges risk undermining PAs roles in primary care before they have attained their full potential. Nationally, workforce leaders should develop approaches to support new PAs into primary care, including commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision.

scholarly journals Acceptability of Physician Associate Interns in Primary Care: Results from a Service Evaluation

2020 ◽  
Author(s):  
Elizabeth Cottrell ◽  
Victoria Silverwood ◽  
Alex Strivens-Joyce ◽  
Lucy Minshull ◽  
John J Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Secondary Care ◽  
Service Evaluation ◽  
Full Potential ◽  
Primary Care Workforce ◽  
Form Part ◽  
Care Practices ◽  
One Year ◽  
Primary Care Practices

Abstract Background: Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner recruitment and retention crisis. However, they are novel to the primary care workforce, have limitations such as being unable to prescribe and order ionising radiation investigations, and there are very limited directly-relevant data to guide the integration of PAs into primary care. To address this, a novel internship scheme was established in Staffordshire to support PAs entering primary care. This evaluation was designed to establish the acceptability of Physician Associate (PA) Interns within primary care.Methods: The Staffordshire PA Internship (SPAI) scheme was introduced in Staffordshire in 2017. PAs were concurrently working in primary and secondary care posts for one year, with protected weekly education sessions to equip them for work in primary care. Within the nine primary care practices hosting 10 PA interns in the first two cohorts, the PA interns, supervising GPs and practice managers, and patients who attended an appointment with a PA intern were invited to participate in the evaluation.Results: By evaluation end, eight of the ten PAs had completed the internship. Overall PA interns were acceptable to practices and patients, however there was ambiguity about the PA role itself, and how best to communicate this, as well as how to operationalise their roles. An expectation-preparedness gap was identified for PAs working in primary care. This resulted in high levels of supervision required for PA interns early within the internship. The internship provided a platform upon which the expectation-preparedness gap could be closed and made the high supervision requirements more acceptable to practices.Conclusions: This test-of-concept SPAI has highlighted that, to ensure successful integration of new PAs into primary care and to support them to reach their full potential, commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision, need to be delivered. Without such investment, there is a risk that acceptability of PAs in primary care, and PAs’ views of primary care careers, will be undermined before the profession has attained its full potential.

scholarly journals Setting the scene for paramedics in general practice: What can we expect?

2018 ◽  
Author(s):  
Kamal Mahtani ◽  
Georgette Eaton ◽  
Matthew Catterall ◽  
Alice Ridley
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Models Of Care ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Workforce ◽  
Clinical Complexity ◽  
Or Practice ◽  
General Practices ◽  
Gp Care

Primary care services in England may be reaching saturation point. Demands to see a GP or practice nurse have increased substantially. Clinical complexity has also increased; patients are living longer, but with more multimorbidity.(1) These demands are mirrored by a decline in the GP workforce, despite political pledges to reverse this.(2) New strategies are needed to tackle the current pressures in general practice and reduce the risks of harm to patients. The NHS England GP Forward View advocates investing and developing new models of care, including expansion of a multidisciplinary, integrated primary care team.(3) These recommendations reflect the findings of the Primary Care Workforce Commission, who highlighted the potential roles for clinical pharmacists, physician associates, and physiotherapists, all substituting into current GP care pathways.(4) The Commission also recommended that general practices should consider more opportunities to use the skills of paramedics in primary care. Specific roles may include running clinics, triaging and managing minor illnesses, as well as provide continuity for patients with complex health needs. Further roles may include assessment and management of requests for same-day urgent home visits, as well as regular visits to homebound patients with long-term conditions.The commision highlighted that these innovative roles should be subject to further evaluation. Nevertheless, historical and current perspectives allow us to model how the role could be fully used.

scholarly journals Setting the scene for paramedics in general practice: What can we expect?

2018 ◽  
Author(s):  
Kamal Mahtani ◽  
Georgette Eaton ◽  
Matthew Catterall ◽  
Alice Ridley
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Models Of Care ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Workforce ◽  
Clinical Complexity ◽  
Or Practice ◽  
General Practices ◽  
Gp Care

Primary care services in England may be reaching saturation point. Demands to see a GP or practice nurse have increased substantially. Clinical complexity has also increased; patients are living longer, but with more multimorbidity.(1) These demands are mirrored by a decline in the GP workforce, despite political pledges to reverse this.(2) New strategies are needed to tackle the current pressures in general practice and reduce the risks of harm to patients. The NHS England GP Forward View advocates investing and developing new models of care, including expansion of a multidisciplinary, integrated primary care team.(3) These recommendations reflect the findings of the Primary Care Workforce Commission, who highlighted the potential roles for clinical pharmacists, physician associates, and physiotherapists, all substituting into current GP care pathways.(4) The Commission also recommended that general practices should consider more opportunities to use the skills of paramedics in primary care. Specific roles may include running clinics, triaging and managing minor illnesses, as well as provide continuity for patients with complex health needs. Further roles may include assessment and management of requests for same-day urgent home visits, as well as regular visits to homebound patients with long-term conditions.The commision highlighted that these innovative roles should be subject to further evaluation. Nevertheless, historical and current perspectives allow us to model how the role could be fully used.

scholarly journals Using routinely collected primary care records to identify and investigate severe asthma: a scoping review

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Jonathan Stewart ◽  
Frank Kee ◽  
Nigel Hart
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Severe Asthma ◽  
Scoping Review ◽  
Asthma Severity ◽  
Data Sources ◽  
Full Potential ◽  
High Risk Disease ◽  
Asthma Outcomes ◽  
Disease Variant

AbstractShielding during the coronavirus pandemic has highlighted the potential of routinely collected primary care records to identify patients with ‘high-risk’ conditions, including severe asthma. We aimed to determine how previous studies have used primary care records to identify and investigate severe asthma and whether linkage to other data sources is required to fully investigate this ‘high-risk’ disease variant. A scoping review was conducted based on the Arksey and O’Malley framework. Twelve studies met all criteria for inclusion. We identified variation in how studies defined the background asthma cohort, asthma severity, control and clinical outcomes. Certain asthma outcomes could only be investigated through linkage to secondary care records. The ability of primary care records to represent the entire known asthma population is unique. However, a number of challenges need to be overcome if their full potential to accurately identify and investigate severe asthma is to be realised.

scholarly journals African Primary Care Research: Performing a programme evaluation

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Lilian Dudley
Keyword(s):  
Primary Care ◽  
Qualitative Data ◽  
Developmental Process ◽  
Programme Evaluation ◽  
Primary Care Research ◽  
Qualitative Interviewing ◽  
Care Research ◽  
Data Collection And Analysis ◽  
Different Types ◽  
African Context

This article is part of a series on Primary Care Research in the African context and focuses on programme evaluation. Different types of programme evaluation are outlined: developmental, process, outcome and impact. Eight steps to follow in designing your programme evaluation are then described in some detail: engage stakeholders; establish what is known; describe the programme; define the evaluation and select a study design; define the indicators; planand manage data collection and analysis; make judgements and recommendations; and disseminate the findings. Other articles in the series cover related topics such as writing your research proposal, performing a literature review, conducting surveys with questionnaires, qualitative interviewing and approaches to quantitative and qualitative data analysis.

scholarly journals Prediction of Behavioral T/C Levels in Cochlear Implant Patients Based Upon Analysis of Electrode Impedances

2021 ◽  
Author(s):  
A. Molisz ◽  
A. Zarowski ◽  
E. Cardinael ◽  
A. Vermeiren ◽  
T. Theunen ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Cochlear Implants ◽  
Objective Measure ◽  
Analysis Data ◽  
Case Review ◽  
Data Collection And Analysis ◽  
Compound Action Potentials ◽  
Subjective Threshold ◽  
Electrode Contact ◽  
Maximum Comfort

Abstract Background Fitting cochlear implants in babies and noncooperative patients is cumbersome and time consuming. Therefore, objective parameters have been sought in order to predict the subjective threshold (T) and maximum comfort (C) levels. Measurements of the electrically evoked compound action potentials (ECAPs) have been widely used for this purpose, yet the correlation between these objective measures and the subjective T/C levels is weak to moderate. Purpose This article aims (1) to evaluate correlations between the subjective parameters of the fitting maps such as thresholds (T level) and maximum comfort levels (C level), the impedance of the electrode contacts, and the ECAP thresholds, and (2) to compare the value of the electrode impedances and the ECAP measures for prediction of the T/C levels. Research Design Case review study in a quaternary otologic referral center. Study Sample Ninety-eight consecutive CI patients were enrolled. The average age of the patients was 49 years. All patients were users of the Nucleus 24RECA (Freedom, Contour Advance-of-Stylet electrode) cochlear implant. Data Collection and Analysis Data on impedance of the electrode contacts and the behavioral T/C levels at the first fitting session (2–5 weeks after surgery) and at the 5th fitting session (4–6 months after surgery) have been retrospectively collected in 98 consecutive CI patients. Additionally, the intraoperative impedance values and the ECAP thresholds (tNRT) have been recorded. Results Impedances of electrode contacts show significant strong negative correlations with the stabilized T/C levels at 4 to 6 months after implantation and are an important predictor for the behavioral T/C levels. They can explain R 2 = 28 to 41% of the variability of the behavioral T/C levels. In multiple regression analysis electrode contact impedances can explain twice as much of the variability of the stabilized T/C levels than the tNRT values. The electrode impedances together with the tNRT values are able to explain R 2 = 37 to 40% of the global variability of the T/C levels while the tNRT thresholds solely are able to explain only R 2 = 5 to 14% of the T/C levels variability. Conclusion Impedances of electrode contacts correlate strongly with the stabilized behavioral T/C levels and may be used as an objective measure for fitting of cochlear implants.

The Primary Care Workforce: The Author Replies

2014 ◽  
Vol 33 (1) ◽  
pp. 182-182
Author(s):  
Arthur L. Kellermann
Keyword(s):  
Primary Care ◽  
Primary Care Workforce

scholarly journals P127: Paramedics perception of working in Nova Scotia’s collaborative emergency centres

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S121
Author(s):  
S. Whalen ◽  
J. Goldstein ◽  
R. Urquhart ◽  
A. Carter
Keyword(s):  
Health Care ◽  
Nova Scotia ◽  
Care Delivery ◽  
Analysis Data ◽  
Team Work ◽  
Healthcare Team ◽  
Telephone Interviews ◽  
Leadership Support ◽  
Data Collection And Analysis ◽  
Constant Comparative Analysis

Introduction: The Collaborative Emergency Centre (CEC) model of health care delivery was implemented in rural Nova Scotia in July 2011 without an identifiable, directly comparable precedent. It features interprofessional teams working under one roof with the goal of providing improved access to timely primary health care, and appropriate access to 24/7 emergency care. One important component of the CEC model is overnight staffing by a paramedic/registered nurse team consulting with an offsite physician via telephone. Our objective was to ascertain the attitudes, feelings and experiences of paramedics working within the CEC construct. Methods: We conducted a qualitative study, guided by the principles of grounded theory. Semi-structured telephone interviews were carried out by the principal investigator with paramedics with experience working in a CEC in the province of Nova Scotia. Interviews were recorded, transcribed and analyzed. Analysis involved an inductive and deductive grounded approach using constant comparative analysis. Data collection and analysis continued until thematic saturation was reached. Results: Fourteen paramedics participated in the study. The majority were male (n=10, 71%), with a mean age of 44 years (STD=8.8) and mean experience as a paramedic of 14 years (STD=9.7). Four major themes were identified from the data: 1) leadership support, encompassing support from Emergency Health Services and Government prior to and after implementation of the model, 2) team work and collaboration, including interprofessional relationships among members of the healthcare team, 3) value to patients and the communities, and 4) professional and personal benefits of working in CECs. Conclusion: Paramedics have found working in CECs to be both professionally and personally rewarding. They perceive the CEC model to be of great value to the patients and communities it serves. Key lessons that might help future expansion of the model in Nova Scotia and other jurisdictions across the country include the importance of building and strengthening relationships between paramedics and nurses, and the need for greater feedback and support from leadership.

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