Drennan Vari M, Halter Mary, Joly Louise, Gage Heather, Grant Robert L, Gabe Jonathan, Brearley Sally, Carneiro Wilfred, de Lusignan Simon
Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London.
Social Care Workforce Research Unit, King's College London.
Br J Gen Pract. 2015 May;65(634):e344-50. doi: 10.3399/bjgp15X684877.
Physician associates [PAs] (also known as physician assistants) are new to the NHS and there is little evidence concerning their contribution in general practice.
This study aimed to compare outcomes and costs of same-day requested consultations by PAs with those of GPs.
An observational study of 2086 patient records presenting at same-day appointments in 12 general practices in England.
PA consultations were compared with those of GPs. Primary outcome was re-consultation within 14 days for the same or linked problem. Secondary outcomes were processes of care.
There were no significant differences in the rates of re-consultation (rate ratio 1.24, 95% confidence interval [CI] = 0.86 to 1.79, P = 0.25). There were no differences in rates of diagnostic tests ordered (1.08, 95% CI = 0.89 to 1.30, P = 0.44), referrals (0.95, 95% CI = 0.63 to 1.43, P = 0.80), prescriptions issued (1.16, 95% CI = 0.87 to 1.53, P = 0.31), or patient satisfaction (1.00, 95% CI = 0.42 to 2.36, P = 0.99). Records of initial consultations of 79.2% (n = 145) of PAs and 48.3% (n = 99) of GPs were judged appropriate by independent GPs (P<0.001). The adjusted average PA consultation was 5.8 minutes longer than the GP consultation (95% CI = 2.46 to 7.1; P<0.001); cost per consultation was GBP £6.22, (US$ 10.15) lower (95% CI = -7.61 to -2.46, P<0.001).
The processes and outcomes of PA and GP consultations for same-day appointment patients are similar at a lower consultation cost. PAs offer a potentially acceptable and efficient addition to the general practice workforce.
医师助理（PA）（也称为医师助手）在英国国家医疗服务体系（NHS）中是新生事物，关于他们在全科医疗中的贡献的证据很少。
本研究旨在比较医师助理与全科医生（GP）当日预约会诊的结果和成本。
对英格兰12家全科诊所当日预约就诊的2086份患者记录进行观察性研究。
将医师助理的会诊与全科医生的会诊进行比较。主要结局是在14天内因相同或相关问题再次会诊。次要结局是医疗过程。
再次会诊率无显著差异（率比1.24，95%置信区间[CI]=0.86至1.79，P=0.25）。所开具诊断检查的比率（1.08，95%CI=0.89至1.30，P=0.44）、转诊率（0.95，95%CI=0.63至1.43，P=0.80）、所开具处方率（1.16，95%CI=0.87至1.53，P=0.31）或患者满意度（1.00，95%CI=0.42至2.36，P=0.99）均无差异。独立的全科医生认为，79.2%（n=145）的医师助理和48.3%（n=99）的全科医生的初次会诊记录是合适的（P<0.001）。调整后的医师助理平均会诊时间比全科医生会诊时间长5.8分钟（95%CI=2.46至7.1；P<0.001）；每次会诊成本低6.22英镑（10.15美元）（95%CI=-7.61至-2.46，P<0.001）。
对于当日预约患者，医师助理和全科医生会诊的过程和结果相似，但会诊成本更低。医师助理为全科医疗队伍提供了一种潜在可接受且高效的补充力量。
