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

Drennan, VM; Halter, M; Wheeler, C; Nice, L; Brearley, S; Ennis, J; Gabe, J; Gage, H; Levenson, R; de Lusignan, S; et al. Drennan, VM; Halter, M; Wheeler, C; Nice, L; Brearley, S; Ennis, J; Gabe, J; Gage, H; Levenson, R; de Lusignan, S; Begg, P; Parle, J (2019) What is the contribution of physician associates in hospital care in England? A mixed methods, multiple case study. BMJ Open, 9 (1). e027012. ISSN 2044-6055 https://doi.org/10.1136/bmjopen-2018-027012
SGUL Authors: Drennan, Vari MacDougal

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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
Additional Information: © 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/.
Keywords: hospitals, mixed methods, organisation of health services, physician assistants, physician associates, workforce
Journal or Publication Title: BMJ Open
ISSN: 2044-6055
Language: eng
Dates:
DateEvent
30 January 2019Published
6 December 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
14/19/26National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
PubMed ID: 30700491
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/110656
Publisher's version: https://doi.org/10.1136/bmjopen-2018-027012

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