Jaapa-Journal of the American Academy of Physician Assistants最新文献

Objective: With the growth of physician associates/assistants (PAs) and NPs providing primary care services, we sought to understand the public's perception of the different types of healthcare providers (HCPs) they might encounter in a clinical setting, such as primary care.

Objectives: This study aimed to evaluate public perceptions about various types of primary care providers (PCPs), identify public preferences for PCPs in relation to experience and training, and examine public preferences for PCP credentials.

Methods: We conducted semistructured interviews with adults, and used inductive and deductive coding and reflexive thematic analysis to analyze the data.

Results: We reached thematic saturation after 12 completed interviews. Participants reported confusion about the types of HCPs they might encounter in a primary care setting (for example, physician, PA, NP). Participants who reported a preference for a physician valued more years in training and their role in the hierarchy of medicine; those who reported a preference for a PA or NP indicated that compassion, patience, and longer clinic visit times were most important to them.

Conclusions: Previous reports suggested that the public might be confused by the different types of HCPs they might encounter during a primary care visit. Participants identified specific characteristics that are important when they are choosing their PCP. A direct, coordinated marketing campaign may be needed to educate the public and reduce confusion about different types of PCPs, how they contribute to safe and high-quality care, and ensure preference-concordant care.

Abstract: Staphylococcus aureus is a common cause of bacterial infections of the skin, soft tissues, bones, bloodstream, and respiratory system. When the infection spreads to the joints, it is known as septic arthritis. The shoulder is the third most common location for septic arthritis in adults. Treatment is arthroscopic or open irrigation and debridement, but even after eradicating the bacteria, cartilage and bone destruction can occur. This article describes a patient who developed bilateral septic arthritis of the shoulders shortly after a urinary tract infection, and was treated with a relatively rare reverse shoulder hemiarthroplasty procedure.

Abstract: West Nile virus is a mosquito-borne illness that usually presents as asymptomatic or with a viral syndrome, and normally is treated with supportive care or immunotherapy. However, some patients can develop neurologic symptoms of viral meningoencephalitis. This article describes a patient who developed opsomyoclonus, a rare complication of West Nile virus meningoencephalitis. She was treated with immunotherapy with no resolution of her symptoms. Symptom improvement occurred with subsequent treatment with clonazepam and dexamethasone.

Abstract: This article describes minimally invasive treatments for managing chronic low back pain (LBP) related to lumbar spinal stenosis, facetogenic LBP, vertebrogenic LBP, or discogenic LBP. We also propose a clinical decision-making tool to guide clinicians in appropriate patient selection for various treatments.

Abstract: More than 1.6 million US adults identify as transgender (that is, a gender different than the one traditionally associated with the biologic sex assigned to them at birth). These patients suffer from healthcare inequity and lack of access to healthcare, causing a public health crisis. This article seeks to raise awareness of this issue and encourage clinicians and healthcare systems to make meaningful changes to reduce healthcare stigma for transgender patients.

Objective: The Hospital Readmissions Reduction Program (HRRP), started under the Patient Protection and Affordable Care Act and administered by the Centers for Medicare and Medicaid Services, was created with the intention to improve healthcare quality and costs. However, research on disparities in healthcare demonstrates the HRRP's protocolized risk-adjustment calculations neglect social factors, which consequently harms disadvantaged patient populations and unfairly contributes to clinician and hospital penalties.

Methods: A PRISMA literature review was conducted using PubMed and Cochrane Library to explore the inclusion of social factors such as socioeconomic status on risk-adjustment calculations, and their relation to healthcare disparities, penalties, and outcomes. Fifteen articles published in the past 10 years were reviewed.

Results: Eleven (73%) of the 15 articles in this systematic review indicated that the HRRP potentiated healthcare disparities based on risk-adjustment calculation.

Conclusions: This review strongly suggests modifying the HRRP risk-adjustment calculations to include social risk factors has the potential to equalize reimbursement for hospitals that serve the most vulnerable patients and reduce negative unintended consequences of the HRRP. Future studies are needed to produce more conclusive, consistent evidence on the effect of social risk factors in risk-adjustment calculations and associated outcomes and to determine how HRRP's risk-adjustment calculations can be modified to reduce disparities in healthcare.