The P. A. journal最新文献

Although American medicine has vastly improved the delivery of medical care during the last half-century, there are still many problems confronting our health care delivery system. The physician assistant concept is but one attempt of many to alleviate the problem of access to health care of an acceptable quality. Another concept is national health insurance as a measure to bridge the economic gaps in medical care not met by Medicare, Medicaid, and private health insurance; and to make better use of all health resources. Physician assistants can have a beneficial impact on health care under national health insurance by: improving access to care; keeping practice costs down; and improving the quality of care provided. A program of national health insurance will undoubtedly create increased public demand to provide more health services than currently offered by federal programs. National health insurance can succeed only if an appropriate financing mechanism is developed and valid attempts are made to utilize available manpower such as physician assistants. These issues are discussed.

Evidence on the cost-effectiveness of physician assistants has accumulated in diverse sources in recent years. In this analysis the findings of major studies which bear on the issue are assembled and evaluated. Numerous studies indicate that the utilization of physician assistants has a positive correlation with productivity measures; other studies reveal significant cost savings as well. This conclusion has several important qualifications and implications: (1) the generality of physician assistants cost-effectiveness has not yet been demonstrated; (2) patients and third parties may not benefit so that physician assistants may serve only in increase physician incomes, which may reduce patient acceptance and affect overall utilization rates of physician assistants; and (3) reimbursement policies are inadequate and may curtail cost-effective utilization of physician assistants in many circumstances.

An investigation of the differences in the perceptions of the role of physician assistant between physicians and physician assistants in the same primary care practice was conducted. A sample of six practices (one physician and one physician assistant from each practice), obtained from six Appalachian counties in New York State, was examined. Data was collected through the administration of a questionnaire, personal interviews, and on-site activity observations. Comparisons were made for two items: Number of errors between physicians' or physician assistants' perceptions and actual observations for a specified group of 23 activities, and the number of discrepancies between physicians' and physician assistants' perceptions for the same 23 activities. Study results produced significant numbers of errors and discrepancies suggesting that certain barriers to communication exist between the physicians and physician assistants and that a substantial amount of physician-physician assistant activity interaction is necessary to ensure positive conformance of standard duties and functions to practice goals and objectives.

In order for the physician assistant (PA) to function as an effective member of a health care team, he must develop certain skills and abilities. These include personal and professional awareness of himself and others, interpersonal and interprofessional communications skills, and appropriate interfacing techniques which enable him to establish harmonious working relationships with his team members. The PA profession, by its very nature, lends itself naturally to the team delivery of health care.