The contribution of Physician Assistants in primary care: A systematic review

BMC Health Services Research

Volumn 13, Issue 1, 2013, Pages

  Halter, Mary ^a   Drennan, Vari ^a   Chattopadhyay, Kaushik ^b   Carneiro, Wilfred ^a   Yiallouros, Jennifer ^a   De Lusignan, Simon ^c   Gage, Heather ^c   Gabe, Jonathan ^d   Grant, Robert ^a  

^a ST GEORGE'S UNIVERSITY OF LONDON   (United Kingdom)

^b KING'S COLLEGE LONDON   (United Kingdom)

^c UNIVERSITY OF SURREY   (United Kingdom)

^d UNIVERSITY OF LONDON   (United Kingdom)

Author keywords

Family; Family practice; General practice; Physician assistants; Physicians; Primary health care; Review

Indexed keywords

AUSTRALIA; ECONOMICS; FEMALE; HUMAN; MALE; MANPOWER; NETHERLANDS; ORGANIZATION AND MANAGEMENT; PHYSICIAN ASSISTANT; PRIMARY HEALTH CARE; REVIEW; UNITED KINGDOM; UNITED STATES; WORK SCHEDULE;

AUSTRALIA; FEMALE; GREAT BRITAIN; HUMANS; MALE; NETHERLANDS; PHYSICIAN ASSISTANTS; PRIMARY HEALTH CARE; UNITED STATES; WORK SCHEDULE TOLERANCE;

EID: 84879055927     PISSN: None     EISSN: 14726963     Source Type: Journal    
DOI: 10.1186/1472-6963-13-223     Document Type: Review

References (85)

1. World Health Organisation, Primary Care: Now More than ever World Health Report 2008. [ http://www.who.int/whr/2008/en/index.html ]
2. Contribution of primary care to health systems and health. Starfield B, Shi L, Macinko J, Milbank Q 2005 83 457 502 10.1111/j.1468-0009.2005.00409.x 16202000 (Pubitemid 41551756)
3. Starfield B, Primary Health Care: Balancing Health Needs, Services and Technology New York: Oxford University Press Inc 1998
4. World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians, What's in a Name? [ http://www.globalfamilydoctor.com/AboutWonca/brief.aspx ]
5. World Health Organisation, Working Together for HealthWorld Health Report 2006 [ http://www.who.int/whr/2006/en/index.html ]
6. Physician assistants and nurse practitioners as a usual source of care. Everett CM, Schumacher JR, Wright A, Smith MA, J Rural Health 2009 25 407 414 10.1111/j.1748-0361.2009.00252.x 19780923
7. Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Dovlo D, Hum Resour Health 2004 2 7 10.1186/1478-4491-2-7 15207010 (Pubitemid 39112745)
8. Physician assistants in the United States. Mittman DE, Cawley JF, Fenn WH, BMJ 2002 31 485 487 (Pubitemid 34983425)
9. National Centre for Health Statistics, Health, United States 2010 [ http://www.cdc.gov/nchs/data/hus/hus10.pdf ]
10. Survey approach to estimating demand for physician assistants. Scheffler RM, Gillings DB, Soc Sci Med 1982 16 1039 1047 10.1016/0277-9536(82)90176-9 6126009 (Pubitemid 12015632)
11. American Academy of Physician Assistants, Physician Assistant Census Report 2010 [ http://www.aapa.org/uploadedFiles/content/Research/ 2010%20Census%20Report%20National%20-Final.pdf ]
12. Introducing physician assistants into new roles: international experiences. Frossard LA, Liebich G, Hooker RS, Brooks PM, Robinson L, Med J Aust 2008 188 199 201 18279123
13. Physician assistants in Canada: update on health policy initiatives. Jones IW, Hooker RS, Can Fam Physician 2011 57 83 e88 21402955
14. Nederlandse Associate Physician Assistants: Profile [ http://napa.artsennet.nl/English.htm ]
15. Extending rural and remote medicine with a new type of health worker: Physician assistants. O'Connor TM, Hooker RS, Aust J Rural Health 2007 15 346 351 10.1111/j.1440-1584.2007.00926.x 17970896 (Pubitemid 350018245)
16. Physician assistants in English general practice: a qualitative study of the employers' viewpoint. Drennan V, Halter M, Levenson R, Tye C, J Health Serv Res Policy 2011 16 75 80 10.1258/jhsrp.2010.010061 21389060
17. Physician assistants in English primary care teams: a survey. Drennan VM, Chattopadhyay K, Halter M, Brearley S, de Lusignan S, Gabe J, Gage H, J Interprof Care 2012 26 416 8 10.3109/13561820.2012.686538 22574762
18. The impact of nonphysician clinicians: do they improve the quality and cost-effectiveness of health care services? Laurant M, Harmsen M, Wollersheim H, Grol R, Faber M, Sibbald B, Med Care Res Rev 2009 66 36S 89S 10.1177/1077558709346277 19880672
19. A systematic review: The role and impact of the physician assistant in the emergency department. Doan Q, Sabhaney V, Kissoon N, Sheps S, Singer J, Emerg Med Australas 2011 23 7 15 10.1111/j.1742-6723.2010.01368.x 21284809
20. Nurse practitioners and physician assistants in the intensive care unit: an evidence-based review. Kleinpell RM, Ely EW, Grabenkort R, Crit Care Med 2008 36 2888 2897 10.1097/CCM.0b013e318186ba8c 18766097
21. The role of physician assistants in rural health care: a systematic review of the literature. Henry LR, Hooker RS, Yates KL, J Rural Health 2011 27 220 229 10.1111/j.1748-0361.2010.00325.x 21457316
22. Watson P, Hendey N, Dingwall R, Spencer E, Wilson P, The mid-level practitioner: a review of the literature on nurse practitioner and physician assistant programmes Sheffield UK: Sheffield University Trent Institute Discussion Paper. 1996
23. Non-physician practitioners in radiation oncology: advanced practice nurses and physician assistants. Kelvin JF, Moore-Higgs GJ, Maher KE, Dubey AK, Austin-Seymour MM, Daly NR, Mendenhall NP, Kuehn EF, Int J Radiat Oncol Biol Phys 1999 45 255 263 10487543 (Pubitemid 29408536)
24. The emerging role of physician assistants in the delivery of dermatologic health care. Clark AR, Monroe JR, Feldman SR, Fleischer ABJR, Hauser DA, Hinds MA, Dermatol Clin 2000 18 297 302 10.1016/S0733-8635(05)70175-3 10791156 (Pubitemid 30220645)
25. The contributions of physician assistants in primary care systems. Hooker RS, Everett CM, Health Soc Care Community 2012 20 20 31 10.1111/j.1365-2524. 2011.01021.x 21851446
26. Centre for Reviews and Dissemination, Systematic Reviews: CRDs Guidance for Undertaking Reviews in Healthcare York: Centre for Reviews and Dissemination, University of York 2009
27. WONCA Europe, European Definition of General Practice/Family Medicine Short Version [ http://www.woncaeurope.org/sites/default/files/documents/ Definition%203rd%20ed%202011%20with%20revised%20wonca%20tree.pdf ]
28. The quality of care. How can it be assessed? Donabedian A, JAMA 1988 260 1743 1748 10.1001/jama.1988.03410120089033 3045356
29. Critical Appraisal Skills Programme (CASP), Critical Appraisal Checklists [ http://www.casp-uk.net/homepage/ ]
30. Guidance for peer reviewers. British Medical Journal, Br Med J 2011 [ http://www.bmj.com/about-bmj/resources-reviewers/guidance-peer-reviewers ]
31. The PRISMA group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Moher D, Liberati A, Tetzlaff J, Altman DG, PLoS Med 2009 6 1000097 10.1371/journal.pmed.1000097 19621072
32. Distribution of primary care physicians assistants in state of Iowa. Oliver DR, Laube DW, Gerstbrein JJ, Wombacher N, J Iowa Med Soc 1977 67 320 323 19544
33. Rural physician assistants: a survey of graduates of MEDEX Northwest. Larson EH, Hart LG, Hummell J, Public Health Rep 1994 109 266 274 7908746 (Pubitemid 24123590)
34. Use of physician assistants in a managed health care system. Hooker RS, Freeborn DK, Public Health Rep 1991 106 90 94 1671718
35. Physician assistants: an overview of an emerging health profession. Perry HB, Med Care 1977 15 982 990 10.1097/00005650-197712000-00002 22795
36. The physician's assistant profession: results of a 1978 survey of graduates. Perry HB, Fisher DW, J Med Educ 1981 56 839 845 6116807 (Pubitemid 12199876)
37. Implications for recruitment: comparing urban and rural primary care PAs. Muus KJ, Geller JM, Ludtke RL, Pan S, Kassab C, Luloff AE, Hart G, JAAPA 1996 9 49
38. A comparative analysis of primary care nurse practitioners and physician assistants. Pan S, Geller JM, Gullicks JN, Muus KJ, Larson AC, Nurse Pract 1997 22 14 16-17 9078510
39. "Elder" physician assistants and their practices. Duryea WR, Hooker RS, JAAPA 2000 13 67 71-74,80 11503405
40. National estimates of physician assistant productivity. Larson EH, Hart LG, Ballweg R, J Allied Health 2001 30 146 152 11582977 (Pubitemid 33759718)
41. Trends in the supply of physician assistants and nurse practitioners in the United States. Hooker RS, Berlin LE, Health Aff (Millwood) 2002 21 174 181 10.1377/hlthaff.21.5.174
42. Use of nonphysician health care providers for skin cancer screening in the primary care setting. Oliveria SA, Altman JF, Christos PJ, Halpern AC, Prev Med 2002 34 374 379 10.1006/pmed.2001.0995 11902855 (Pubitemid 34969597)
43. Growth and change in the physician assistant workforce in the United States, 1967-2000. Larson EH, Hart L, J Allied Health 2007 36 121 130 17941405
44. Evaluation of physician assistants in rural primary care. Duttera MJ, Harlan WR, Arch Intern Med 1978 138 224 228 10.1001/archinte.1978.03630260036013 24428 (Pubitemid 9003875)
45. Retention of physician assistants in rural health clinics. Henry LR, Hooker RS, J Rural Health 2007 23 207 214 10.1111/j.1748-0361.2007.00092.x 17565520
46. Attitudes of primary care physicians in the state of Alabama toward physician assistants: a preliminary report. Joiner CL, Ala J Med Sci 1974 11 363 365 4156626
47. What Iowa family physicians, residents and medical students think about physician's assistants. Oliver D, Preston D, J Iowa Med Soc 1980 70 466 470 6108345
48. What's happening. Family physician perceptions of nurse practitioners and physician assistants in a family practice setting. Ford VH, Kish CP, J Am Acad Nurse Pract 1998 10 167 171 10.1111/j.1745-7599.1998.tb01285.x 9801550
49. Projections for the viability of the physician assistant occupation based on the intended hiring practices of family medicine physicians. Engel GV, Roy A, Martin LR, Matheny SC, Fam Pract Res J 1984 4 122 124
50. Utilization of physician assistants: incentives and constraints for rural physicians. Isberner FR, Lloyd L, Simon B, Craven JM, Perspective on Physician Assistant Educ 2003 14 69 73
51. Medex: a time motion study. Sells CJ, Herdener RS, Pediatrics 1975 56 255 261 240149
52. Discourse and occupational perspective-a comparison of nurse practitioners and physician assistants. Drass KA, Discourse Process 1988 11 163 181 10.1080/01638538809544697
53. The medical care practitioner: developing a physician assistant equivalent for the United Kingdom. Parle JV, Ross NM, Doe WF, Med JAust 2006 185 13 17 (Pubitemid 44056798)
54. A study of PA perceptions: impediments to the practice of medicine in Iowa. Dehn RW, Asprey DP, JAAPA 1995 8 49
55. Allied health manpower strategies: estimates of the potential gains from efficient task delegation. Golladay FL, Miller M, Smith KR, Med Care 1973 B 457 469
56. A study of physicians' assistants in a rural setting. Miles DL, Rushing WA, Med Care 1976 B 987 995 (Pubitemid 8019295)
57. Physicians, physicians' assistants, and the social characteristics of patients in Southern Appalachia. Rushing WA, Miles DL, Med Care 1977 B 1004 1013 (Pubitemid 8262985)
58. Impact of medex on physician activities: redistribution of physician time after incorporating a medex into the practice. Nelson EC, Johnson KG, Jacobs AR, J Fam Pract 1977 5 607 612 21222
59. A model for the use of physician's assistants in primary care. Frame PS, Wetterau NW, Parey B, J Fam Pract 1978 7 1195 1201 34667
60. An evaluation of a remote, rural clinic manned by a physician's assistant. Hill RF, Greenwood JG, Wert FS, Public Health Rep 1979 94 60 66 33414 (Pubitemid 9127179)
61. Management practices: task allocation between physicians and physician assistants. Fethke C, Ekwo E, Daniels M, J Ambul Care Manage 1979 2 31 45 10314473 (Pubitemid 10127519)
62. Procedures performed by family physicians, internists, and a Medex in a small group practice. Larsen KM, Kirkwood CR, J Fam Pract 1982 15 285 292 6124579
63. Analysis of a rural family-practice-based evening clinic staffed by a PA. Martin E, Sophocles AM Jr, Physician Assist 1984 8 16 19-20,24-26 10314588
64. 1985 physician assistant role delineation study: ten years later. Willis JB, Cyr B, Schafft G, Steinbrueck SP, Physician Assist 1986 10 33 38 81 10314642
65. Physician extenders: Who is using them? Mainous IAG, Bertolino JG, Harrell PL, Fam Med 1992 24 201 204 1349540
66. Implications for practice and education. Clinical activities of Iowa family practice PAs. Dehn RW, Hooker RS, JAAPA 1999 12 63 64 67 11010083
67. The economic benefit for family/general medicine practices employing physician assistants. Grzybicki DM, Sullivan PJ, Oppy JM, Bethke AM, Raab SS, Am J Manag Care 2002 8 613 620 12125801 (Pubitemid 34918718)
68. The physician assistant in general practice in the Netherlands. Simkens ABM, van Baar ME, van Balen FAM, Verheij RA, van den Hoogen HJM, Schrijvers AJP, J Physician Assist Educ 2009 20 30 38
69. How lengths of office visits vary when primary care practices employ physician assistants. Ekwo EE, Dusdieker LB, Bean JA, Daniels MA, Inquiry 1980 17 145 154 6106633 (Pubitemid 11237585)
70. Use of physician's assistants in Gilchrist County, Florida. Henry RA, Health Serv Rep 1972 87 687 692 10.2307/4594632 4404705
71. Costs and outcomes for different primary care providers. Wright DD, Kane RL, Snell GF, Woolley FR, JAMA 1977 238 46 50 10.1001/jama.1977.03280010046020 17020 (Pubitemid 8156396)
72. Differences in the outcomes of acute episodes of care provided by various types of family practitioners. Kane RL, Gardner J, Wright DD, Woolley FR, Snell GF, Sundwall DN, Castle CH, J Fam Pract 1978 6 133 138 23405
73. Evaluation of physician's assistants in Gilchrist County, Florida. Henry RA, Public Health Rep 1974 89 429 432 4153351
74. Patient satisfaction with physician assistant, nurse practitioner, and physician care: a national survey of medicare beneficiaries. Hooker RS, Cipher DJ, Sekscenski E, J Clin Outcomes Manag 2005 12 88 92 (Pubitemid 40439694)
75. Are older patients satisfied with physician assistants and nurse practitioners? Cipher DJ, Hooker RS, Sekscenski E, JAAPA 2006 19 36 39-40,42-44 10.1097/01720610-200601000-00007 16433221
76. Public perceptions of the physicians' assistant-a survey of the attitudes and opinions of rural Iowa and Minnesota residents. Litman TJ, Am J Public Health 1972 62 343 346 10.2105/AJPH.62.3.343 4400962
77. Patient attitudes toward physicians' assistants. Smith CW Jr, J Fam Pract 1981 13 201 204 6114126
78. Are Australians willing to be treated by a physician assistant? Hooker RS, Harrison K, Pashen D, AMJ 2010 3 407 413
79. Quality of diabetes care in family medicine practices: influence of nurse-practitioners and physician's assistants. Ohman-Strickland PA, Orzano AJ, Hudson SV, Solberg LI, DiCiccio-Bloom B, O'Malley D, Tallia AF, Balasubramanian BA, Crabtree BF, Ann Fam Med 2008 6 14 22 10.1370/afm.758 18195310
80. Darzi A, High Quality of Care for All London: Department of Health 2008
81. Changing the skill-mix of the health care workforce. Sibbald B, Shen J, McBride A, J Health Serv Res Policy 2004 9 28 38 15006237 (Pubitemid 38173622)
82. New role, new country: introducing US physician assistants to Scotland. Buchan J, O'May F, Ball J, Hum Resour Health 2007 4 13
83. Sustaining innovation in the health care workforce: a case study of community nurse consultant posts in England. Drennan VM, Goodman C, BMC Health Serv Res 2011 11 200 10.1186/1472-6963-11-200 21854634
84. Establishing new nursing roles: a case study of the English community matron initiative. Drennan V, Goodman C, Manthorpe J, Davies S, Scott C, Gage H, Iliffe S, J Clin Nurs 2011 20 2948 2957 10.1111/j.1365-2702.2010.03643.x 21521390
85. Grey literature in meta-analyses of randomized trials of health care interventions. Hopewell S, McDonald S, Clarke MJ, Egger M, Cochrane Database Syst Rev 2007 2 1 16