Centre for Rural Health, UHI Millennium Institute, The Centre for Health Science, Perth Road, Inverness IV2 3JH, UK.
Scott Med J. 2011 Aug;56(3):130-4. doi: 10.1258/smj.2011.011109.
Physician assistants (PAs) have medical training and work supervised by a doctor. In 2006-2008 the Scottish Government piloted use of USA-trained PAs. The aim of the paper is to evaluate the impact and contribution made by PAs to delivering effective health care in National Health Service (NHS) Scotland. Mixed methods, longitudinally, including interviews, feedback forms and activity data collection. Data analysis used nVivo, SPSS and Excel. Participants were 15 USA-trained PAs, medical supervisors and team members, 20 patients, four NHS senior managers and three trade union representatives. Settings were four Scottish NHS Boards where PAs worked in primary care, out of hours clinics, emergency medicine, intermediate care and orthopaedics. Two minor patient safety issues arose. Patients were satisfied with PAs. Scope of practice did not replicate US working. Inability to prescribe was a hindrance. PAs tended to have longer consultations, but provided continuity and an educational resource. They were assessed to be mid-level practitioners approximating to nurse practitioner or generalist doctor. Valued features were generalism, medical background, confidence differential diagnosis and communication. Interviewees suggested PAs could fulfil roles currently filled by medical staff, potentially saving resources. In conclusion, there is potential for PAs to fulfil distinctive mid-level roles in the Scottish NHS adding value in continuity, communication and medical approach.
医师助理（PA）接受过医学培训，并在医生的监督下工作。2006 年至 2008 年，苏格兰政府试点使用了美国培训的 PA。本文旨在评估 PA 对苏格兰国民保健制度（NHS）提供有效医疗保健的影响和贡献。混合方法，纵向研究，包括访谈、反馈表和活动数据收集。数据分析使用了 nVivo、SPSS 和 Excel。参与者包括 15 名美国培训的 PA、医疗监督者和团队成员、20 名患者、4 名 NHS 高级管理人员和 3 名工会代表。研究地点是四个苏格兰 NHS 委员会，PA 在那里从事初级保健、非工作时间诊所、急诊医学、中级护理和矫形外科工作。出现了两个轻微的患者安全问题。患者对 PA 感到满意。实践范围没有复制美国的工作模式。不能开处方是一个障碍。PA 往往会进行更长时间的咨询，但提供了连续性和教育资源。他们被评估为中级从业者，类似于护士从业者或全科医生。他们的一般主义、医学背景、诊断差异的信心和沟通能力受到重视。受访者表示，PA 可以在苏格兰 NHS 中承担目前由医务人员承担的角色，从而节省资源。总之，PA 在苏格兰 NHS 中具有履行独特的中级角色的潜力，可以在连续性、沟通和医疗方法方面增加价值。
