scholarly journals A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours? (Preprint)

2019 ◽  
Author(s):  
Frederick North ◽  
Kristine E Luhman ◽  
Eric A Mallmann ◽  
Toby J Mallmann ◽  
Sidna M Tulledge-Scheitel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Care Physician ◽  
Work Hours ◽  
Patient Portal ◽  
Secure Messaging ◽  
After Hours ◽  
Over Time

BACKGROUND Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours. OBJECTIVE This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours. METHODS We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours). RESULTS Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent. CONCLUSIONS Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume.

scholarly journals A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours?

10.2196/16521 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e16521 ◽  
Author(s):  
Frederick North ◽  
Kristine E Luhman ◽  
Eric A Mallmann ◽  
Toby J Mallmann ◽  
Sidna M Tulledge-Scheitel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Care Physician ◽  
Work Hours ◽  
Patient Portal ◽  
Secure Messaging ◽  
After Hours ◽  
Over Time

Background Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours. Objective This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours. Methods We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours). Results Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent. Conclusions Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume.

Health care costs associated with primary care physicians versus nurse practitioners and physician assistants

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Suja S. Rajan ◽  
Julia M. Akeroyd ◽  
Sarah T. Ahmed ◽  
David J. Ramsey ◽  
Christie M. Ballantyne ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Costs ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
Care Costs

Primary Care Teams and Pharmacist Staffing Ratios: Is There a Magic Number?

2017 ◽  
Vol 52 (3) ◽  
pp. 290-294 ◽  
Author(s):  
Marie A. Smith
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Nurse Practitioners ◽  
Magic Number ◽  
Physician Assistants ◽  
Care Physician ◽  
Panel Size ◽  
Staffing Ratios ◽  
Primary Care Teams ◽  
Medication Optimization

Primary care physician (PCP) shortages are predicted for 2025, and many workforce models have recommended the expanded integration of nurse practitioners and physician assistants. However, there has been little consideration of incorporating clinical pharmacists on primary care teams to address the growing number of patient visits that involve medication optimization and management. This article summarizes various estimates of pharmacist staffing ratios based on number of PCPs, patient panel size, or annual patient encounters. Finally, some steps are offered to address the practice- and policy-based implications of expanding primary care pharmacist activities at the local and state levels.

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

scholarly journals Career Regret Among Physician Assistants: A Comparative Survey of Primary and Specialty Care Careers

2019 ◽  
Author(s):  
Talia Sierra ◽  
Jennifer Forbes ◽  
Michael Nelson
Keyword(s):  
Primary Care ◽  
Statistical Significance ◽  
Career Path ◽  
Physician Assistants ◽  
Student Loan ◽  
Care Physician ◽  
Specialty Care ◽  
Care Group ◽  
Care Groups ◽  
Comparative Survey

Purpose: This study investigated if career regret varies among physician assistants (PAs) practicing in primary and specialty care fields. This information may assist practicing and aspiring physician assistants when selecting or changing their career path. Methods: A survey was emailed to 5,000 primary and specialty care physician assistants. Items indicating career regret were compared between primary and specialty care groups. Results: Eight hundred and thrity-four (16.7%) completed surveys were received back. Career regret is similar between primary and specialty care physician assistants, with low reports from both groups. No statistical significance was found between primary care and specialty care groups with regards to career regret or student loan debt. The primary care group noted a less sustainable work/ life balance and higher perceived burnout. Specialty care physician assistants reported higher annual gross income. Regret and disappointment correlated highly with burnout. Conclusions: Physician assistants and prospective physician assistants should carefully consider their career path as regret and disappointment correlated highly with burnout.

PHYSICIAN'S ASSISTANTS

PEDIATRICS ◽  
1975 ◽  
Vol 55 (2) ◽  
pp. 256-256
Author(s):  
W. J. Bicknell
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Financial Incentives ◽  
Health Care Services ◽  
Educational Systems ◽  
American Health Care System ◽  
Physician Visits ◽  
Traditional Patterns ◽  
The U.S

The U.S. primary-care assistant seems lost in a vicious circle: problems in the American health-care system (high cost and hospital orientation, lack of satisfaction for patient and provider with primary-health-care services, and the related maldistribution of physicians)—problems which might be mitigated by utilising physicians' assistants and nurse practitioners—themselves militate against effective use of such assistants. Financial incentives, educational systems, and traditional patterns of behavior and expectation all work in the opposite direction; all favour decisions which virtually preclude good primary care—maximum hospital usage, short physician visits, minimal delegation to non-physicians. There will have to be a substantial change in the U.S. system before physicians' assistants and nurse practitioners can begin to function well, and can hope to contribute to the quality, accessibility, and cost-effectiveness of primary care.

Primary Care Population Management for COVID-19 Patients

2020 ◽  
Author(s):  
MD Deborah Blazey-Martin ◽  
FNP Elizabeth Barnhart ◽  
Joseph Gillis ◽  
Gabriela Andujar Vazquez
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Medical Center ◽  
Academic Medical Center ◽  
Physician Assistants ◽  
Population Management ◽  
Severe Illness ◽  
Management Approach ◽  
Primary Care Population ◽  
At Home

Abstract BACKGROUND: Most patients infected with SARS-CoV-2 have mild to moderate symptoms manageable at home; however up to 20% develop severe illness requiring additional support. Primary care practices performing population management can use these tools to remotely assess and manage COVID-19 patients and identify those needing additional medical support before becoming critically ill.AIM: We developed an innovative population management approach for managing COVID-19 patients remotely.SETTING: Development, implementation, and evaluation took place in April 2020 within a large urban academic medical center primary care practice.PARTICIPANTS: Our panel consists of 40,000 patients. By April 27, 2020, 305 had tested positive for SARS-CoV-2 by RT-qPCR. Outreach was performed by teams of doctors, nurse practitioners, physician assistants, and nurses.PROGRAM DESCRIPTION: Our innovation includes an algorithm, an EMR component, and a twice daily population report for managing COVID-19 patients remotely.PROGRAM EVALUATION: Of the 305 patients with COVID-19 in our practice at time of submission, 196 had returned to baseline; 54 were admitted to hospitals, six of these died, and 40 were discharged.DISCUSSION: Our population management strategy helped us optimize at-home care for our COVID-19 patients and enabled us to identify those who require inpatient medical care in a timely fashion.

Coordinated Primary Care (“Medical Home” Model)

2009 ◽  
Vol 2 (2) ◽  
pp. 60-64 ◽  
Author(s):  
Mary Petermann Garnica
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Medical Home ◽  
Primary Care Physicians ◽  
Team Leaders ◽  
Care Nurse ◽  
Medical Home Model ◽  
Primary Care Practices ◽  
Primary Care Medical Home

Health care is inaccessible and too expensive for a large segment of the U.S. population. In addition, the past decade has produced many reports of significant problems related to safety, quality, and effectiveness in U.S. health care. The future of primary care is in question because of a current and projected worsening shortage of primary care physicians. A physician-led coordinated primary care model has been endorsed by major physicians groups as having the potential to address many of these problems. The model, also known as the “medical home,” has gained momentum and appears likely to play a central role as the nation moves forward to reform health care. Nurse practitioners have traditionally practiced “coordinated primary care” and are ideally suited to lead practices adopting this model of care. This article provides rationale for nurse practitioners to be fully recognized as team leaders of coordinated primary care practices.

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