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. 2018 Jun 19;8(6):e019573.
doi: 10.1136/bmjopen-2017-019573.

Contribution of physician assistants/associates to secondary care: a systematic review

Mary Halter  1 , Carly Wheeler  1 , Ferruccio Pelone  2 , Heather Gage  3 , Simon de Lusignan  4 , Jim Parle  5 , Robert Grant  1 , Jonathan Gabe  6 , Laura Nice  5 , Vari M Drennan  1
Affiliations

Contribution of physician assistants/associates to secondary care: a systematic review

Mary Halter et al. BMJ Open. .

Abstract

Objective: To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health.

Design: Systematic review.

Setting: Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles.

Included articles: Peer-reviewed articles of any study design, published in English, 1995-2017.

Interventions: Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken.

Outcome measures: Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs.

Results: 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent.

Conclusions: PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting.

Prospero registration number: CRD42016032895.

Keywords: general medicine (see internal medicine); physician assistant; quality in health care.

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Conflict of interest statement

Competing interests: SL: University of Surrey runs a Physician Associate course. JP: chairs the UK and Ireland Board for Physician Associate Education and is the director of the Physician Associate programme at the University of Birmingham.

Figures

Figure 1
Figure 1
‘Risk of bias’ graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.
Figure 2
Figure 2
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart. PA, physician assistant/associate.
See this image and copyright information in PMC

References

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    1. Mittman DE, Cawley JF, Fenn WH. Physician assistants in the United States. BMJ 2002;325:485–7. 10.1136/bmj.325.7362.485 - DOI - PMC - PubMed
    1. NCCPA. 2016 Statistical profile of certified physician assistants an annual report of the national commission on certification of physician assistants: NCCPA, 2017. https://prodcmsstoragesa.blob.core.windows.net/uploads/files/2016Statist... (accessed 25 Jun 2018).
    1. AAPA. What is a PA? https://www.aapa.org/what-is-a-pa/ (accessed 22 Mar 2017).

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