Physician assistant (American Academy of Physician Assistants)最新文献

At last year's Annual Conference, the AAPA House of Delegates formally convened, for the first time, a task force to study the problem of chemical dependency among PAs, and to help constituent chapters develop identification and intervention programs. The Task Force on the Impaired PA makes its first report to the HOD at this year's conference. In addition, a special symposium on impaired practitioners is being offered for CME credit. The task force's chairperson reviews efforts made during the past year to raise the profession's awareness of the problem. She focuses on the first-person accounts of six PAs who are recovering alcoholics and addicts (see "The Chemically Dependent PA: Role models for Recovery" on page 115).

The problem of substance abuse and chemical dependency among physician assistants first became evident in the late 1970s. Since then, the profession has taken significant steps to implement impaired provider programs, at both the constituent chapter level and the national level. Increased awareness of these programs--along with a concerted effort to debunk the myths and stereotypes associated with those who abuse chemicals or become dependent--should encourage more PAs who need assistance to seek treatment. Six recovering PAs share their personal experiences in the hope that they can inspire others in the profession who may need help with an addiction problem.

Changes in America's health care delivery system require patients to participate more actively in decisions that affect their well-being. PAs should not discourage this trend; instead, they should help the health care consumer to become a partner in the health care decision-making process, and use their mid-level practitioner status to become consumer advocates within the system. This position requires a commitment to educate patients about the risks, benefits, and costs of care, as well as the available alternatives. In addition, PAs should strive to become information sources about the cost and distribution of services.

Federal legislation that took effect on January 1 provides for Medicare part B reimbursement for physician assistant services in several clinical settings. Besides recognizing PAs' contribution to health care delivery, the law may greatly increase demand for PAs (especially in geriatric medicine), allow them to branch out to more nontraditional forms of practice, and prompt a need for a larger pool of graduates from PA education programs. This legislative victory does not diminish--but heightens--the profession's responsibility to show that PA services are cost-effective.

Physician assistants need to recognize their ability to influence state legislators, to vigilantly review all legislation affecting the PA profession, and to lobby lawmakers whenever possible. Recent experience in Florida provides a good example of how PAs can effect change. The author retraces legislative and regulatory history of the PA profession in Florida, explaining why change in the Medical Practice Act was needed and how Florida's PAs took advantage of this political opportunity. Legislative response to the recommendations made by the Florida Academy of Physician Assistants is discussed, exploring effectiveness of the FAPA's strategy and providing a model for other states faced with similar legislative battles.

A major task of the American Academy of Physician Assistants has been to safeguard the PA's place in today's health care system. Given continued growth of the profession and the diversity of PA employment in specialty settings, periodic review of PA role delineation has been mandatory. To date, three such studies have been conducted: by the National Board of Medical Examiners in 1971 and by the AAPA in 1976 and 1985. This Special Article highlights data collected on practice specialty and performance of individual tasks from the 1985 study. The results show that regardless of practice specialty, PAs are responsible for a broad range of primary care tasks; most primary care tasks performed are fundamental and common to all PAs; and a significant difference exists among specialties, particularly responsibility level and the frequency of performing a specific task. The data do not address ability or expertise in performing those tasks.

Changes in Medicaid reimbursement will extend prospective payment systems for nursing homes nationwide by 1990. The new federal regulations will create economic incentives to admit more critically ill patients, since these patients will receive the highest reimbursement. Nursing home administrators will also look for ways to contain the costs of treating these patients without compromising care. Based on the New York state model, the author predicts increased presence of PAs in this setting. He calls for additional CME on nursing home medicine and encourages the AAPA both to study costs and functions of PAs in nursing homes and to appoint a committee to help federal and state planners develop appropriate regulations governing the use of PAs in nursing homes.

Treatment of pediatric trauma begins at the moment of injury (with the arrival of the first person who assists the victim), continues through transport of the patient to the hospital and administration of definitive medical care, and concludes with a rehabilitation program that is aimed at returning the child to a pre-accident life-style. Community hospitals can reduce morbidity and mortality associated with pediatric trauma by implementing specific organizational concepts and procedures used at established pediatric trauma centers. These include swift and accurate assessment at the scene of the accident, pre-arrival coordination between rescue team and emergency room personnel, a preestablished contact network for essential hospital staff, emergency equipment in a broad range of sizes, and charts specifying pediatric dosages of necessary medications. Morbidity and mortality could be further reduced with a national system of comprehensive regional treatment centers designed specifically for children. PAs who are familiar with the specific needs of seriously injured children can significantly influence community and professional responses to this growing area of medicine.

The time has come for the PA profession to reach out and communicate with other health care providers--with physicians, nurses, health care administrators, and other allied health professionals. In addition, PAs must encourage these providers to share their vision of tomorrow's health care delivery system and the roles that they will play with PAs. A PA educator outlines a plan for starting the process.

Physician assistants who work in community medicine must be aware of the need for, and limitations of, prehospital emergency care systems. In rural communities, effective emergency cardiac care systems lag behind those of urban areas: establishing and maintaining a rural paramedic-level ambulance service is expensive, and continued competency must be shown in complex skills even when the volume of emergency calls is low. Basic-level ambulance technicians can be trained in 16 hours to recognize and defibrillate patients in ventricular fibrillation, however, and automated external defibrillators that require minimal training to use may simplify effective, advanced cardiac care. Defibrillation programs require strong medical control and well-designed quality assurance mechanisms. Medical control is ultimately the responsibility of the physician-medical director, but in many small communities day-to-day tasks of medical control and quality assurance are assumed by PAs.