Physician Assistants: A Literature Review - Health Professions ...

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No. Description Reference51 Purpose To explore the licensing, certification, governance and education requirements of nurse practitioners (NPs) and physicianassistants (PAs) in the state of Montana. Services provided and privileges retained in employment were also analyzed. Data SourcesThis was a descriptive study using a survey of rural hospital administrators (N=34). Conclusions Hospital administrators reported that92.5% of PAs and their sponsoring physicians met the supervision requirements through site inspection and telephonecommunication, while 7.5% were required to have direct physician supervision. In contrast, 54.2% of NPs, who are autonomous bylegal definition, have a telephone supervision requirement imposed on them by their employers. Implications for Practice Thesefindings have implications for the current and prospective professionals and the businesses for which they work. Nurse practitionersand their professional organizations need to consider the implications these findings have on the professional image andmarketability of all NPs. The authors note that both NPs and PAs are eligible to prescribe schedule II-V drugs. This excludes onlyschedule I drugs which have a high abuse potential and are not generally considered for medical use (e.g. heroin). The PA applies tothe Board of Medical Examiners for prescriptive authority as part of the utilization plan. Physician assistants who are delegatedprescribers of controlled medications are required to register with the federal Drug Enforcement Agency. The rules for the PAsemphasize the supervisory role of the physician. In the most autonomous scenario, the PA operating in a remote site will require thesupervising physician to inspect the remote site and review patient records and office procedures at least once every 30 days oranother interval at the discretion of the Board of Medical Examiners. The Board of Medical Examiners may grant the PA authority tomaintain an office separate from the supervising physician.52 Background. Nonphysician health care providers are in an optimal position to provide cancer prevention and screening services.Methods. We conducted a survey of primary care physicians to determine physician use and amenability to use of nonphysicianhealth care providers to perform skin cancer screening in comparison with other cancer screening examinations. Results. A total of1,363 eligible physicians completed the survey. Of these, 382 (28%) reported having a PA in their practice, and 671 (49.2%) reportedhaving either a NP or a PA in their practice. 631 physicians (46%) reported a nurse practitioner or physician assistant performing atleast one type of cancer screening examination on their patients. Twenty-nine and 22% of all physicians reported nurse practitionersor physician assistants performing skin cancer screening, respectively. Family physicians were more likely to use nurse practitionersand physician assistants to perform these cancer screening examinations than internists (Χ 2 test, P = 0.001 for each examination).Skin examinations were performed less frequently by nurse practitioners and physician assistants than all other cancer screeningexaminations. Overall, PAs performed digital rectal exams in 24.4% of practices, clinical breast exams in 23.8% of practices, andPapanicolaou testing in 23.2% of practices. Within the 382 practices that employed PAs, PAs performed complete body skin examsin 78.3% of practices, digital rectal exams in 86.9% of practices, clinical breast exams in 84.8% of practices, and Papanicolaoutesting in 82.7% of practices. A total of 73–79% of family physicians and 60–70% of internists were amenable to having anonphysician health care provider perform one or more of these examinations. Conclusions. Primary care physicians are currentlyutilizing nonphysician health care providers to perform cancer screening examinations and the majority of those surveyed areamenable to the use of these providers for such examinations. This suggests that one possible strategy for increasing skin cancerscreening is through an expanded role of nonphysician health care providers.Larsson, L. S., & Zulkowski, K.(2002). Utilization and scope ofpractice of nurse practitionersand physician assistants inMontana. Journal of theAmerican Academy of NursePractitioners, 14(4), 185-190.Oliveria, S. A., Altman, J. F.,Christos, P. J., & Halpern, A. C.(2002). Use of nonphysicianhealth care providers for skincancer screening in the primarycare setting. PreventiveMedicine, 34, 374-379.Page 59 of 74
No. Description Reference53 Objective: To compare resource use in physician assistant (PA) services versus teaching services for five medical diagnostic groupsin a large community teaching hospital, while controlling for attending physician. Methods: The sample was drawn from anadministrative database of patients admitted to an internal medicine service in which attending physicians’ cases rotated between thePA and teaching services on a preassigned schedule. Diagnoses included in the study were stroke (diagnosis-related group [DRG]014), pneumonia (DRG 089), acute myocardial infarction (DRG 122), congestive heart failure (DRG 127), and gastrointestinalhemorrhage (DRG 174). Cases discharged between January 1, 1994, and June 30, 1995, were evaluated. Inclusion of cases wasbased on the Integrated Inpatient Management Model (IIMM). Resource use was measured using direct costs expressed as relativevalue units (RVUs) for radiology, laboratory, and total resource use, as well as for length of stay (LOS). Results: After adjustment foradmitting physician effects and other covariates, the mixed model analyses indicated that PAs used fewer total ancillary resources forpatients with pneumonia and fewer laboratory resources for patients with stroke, pneumonia, and congestive heart failure than didresidents, on average. No significant differences were noted in average LOS or use of radiology resources between PA and teachingservices. In no cases did PAs use significantly more resources than residents. However, significantly higher mortality amongpneumonia cases was detected for PAs. Conclusions: In the same practice setting, PAs used resources as effectively as, or moreeffectively than, residents.Van Rhee, J., Ritchie, J. &Eward, A. M. (2002). Resourceuse by physician assistantservices versus teachingservices. Journal of theAmerican Academy ofPhysician Assistants, 15(1), 33-42.Page 60 of 74
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