Aaron Eliana Marcus, Andrews Caryn Scheinberg
Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel.
Henrietta Szold School of Nursing, Hadassah Medical Organization, Hebrew University, POB 12000, Ein Kerem, Jerusalem Israel.
Isr J Health Policy Res. 2016 Feb 22;5:7. doi: 10.1186/s13584-016-0065-8. eCollection 2016.
Many countries around the world have integrated various types of Advanced Practice Providers (APPs) into their healthcare systems. The main motivating factors for recognizing and developing APPs worldwide include physician shortages and the need for improved access or delivery (US, France, Belgium, Scotland, Switzerland), reduced residency hours (US, UK), shortages in underserved regions (US, Canada, Finland, Australia), and cost containment (Germany, Netherlands, UK, US). Israel is experiencing a shortage of physicians in peripheral geographic regions and in critical medical specialties. Recent by-laws approved by the Knesset (Parliament), combined with Israel Ministry of Health (MOH) policies, have thus far been unable to fully address the shortages. To understand the potential contribution of APPs in Israel, we evaluated the international historical foundations and development of APP roles. We assessed how APPs have impacted healthcare in other countries by analyzing public data and published international research about APP education, safety, quality of care, motivators, barriers, and impact. We found that APPs are recognized in dozens of countries, and have similar scopes of practice, graduate level education requirements (in developed countries), and clinical training. At the same time, there is wide variability among countries in the actual function and independence of the advanced practice nurse (APN), particularly the nurse practitioner (NP). APPs have been established as cost effective, safe healthcare providers who improve healthcare access. Israel has begun to introduce APPs, specifically NPs, in a variety of fields, including geriatrics, palliative care and diabetic care. We recommend a rapid expansion of existing and new APP roles into the Israeli healthcare system based on evidence and the recommendations of international evaluations by non-government organizations. By shifting the education to a university setting, mirroring successful, evidence-based, and established APP models found internationally, Israel could lessen the projected Israeli physician shortage, improve healthcare access in specific areas, and bolster existing resources towards a larger and richer pool of healthcare providers in Israel.
世界上许多国家已将各类高级执业医疗服务提供者（APPs）纳入其医疗体系。在全球范围内，认可并发展APPs的主要推动因素包括医生短缺以及改善医疗服务可及性或提供方式的需求（美国、法国、比利时、苏格兰、瑞士）、缩短住院医师工作时长（美国、英国）、服务欠缺地区的短缺问题（美国、加拿大、芬兰、澳大利亚）以及成本控制（德国、荷兰、英国、美国）。以色列在偏远地区和关键医学专科领域正面临医生短缺的问题。以色列议会（国会）近期批准的法规，结合以色列卫生部（MOH）的政策，迄今为止仍无法完全解决这些短缺问题。为了解APPs在以色列的潜在贡献，我们评估了APP角色的国际历史基础和发展情况。我们通过分析公开数据以及已发表的关于APP教育、安全性、医疗质量、推动因素、障碍和影响的国际研究，评估了APPs如何对其他国家的医疗保健产生影响。我们发现，APPs在数十个国家得到认可，并且具有相似的执业范围、研究生层次的教育要求（在发达国家）以及临床培训。与此同时，各国在高级执业护士（APN），尤其是执业护士（NP）的实际职能和独立性方面存在很大差异。APPs已被确立为具有成本效益、安全的医疗服务提供者，可改善医疗服务的可及性。以色列已开始在包括老年医学、姑息治疗和糖尿病护理等多个领域引入APPs，特别是NP。我们建议基于非政府组织的国际评估证据和建议，迅速在以色列医疗体系中扩大现有和新的APP角色。通过将教育转移到大学环境中，效仿国际上成功的、基于证据且已确立的APP模式，以色列可以缓解预计的医生短缺问题，改善特定领域的医疗服务可及性，并加强现有资源，以建立一个更大、更丰富的以色列医疗服务提供者群体。
