Timmermans Marijke J C, van Vught Anneke J A H, Maassen Irma T H M, Draaijer Lisette, Hoofwijk Anton G M, Spanier Marcel, van Unen Wijnand, Wensing Michel, Laurant Miranda G H
Radboud university medical centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
Faculty of Health and Social Studies, Physician Assistant Program, HAN University of Applied Sciences, Nijmegen, The Netherlands.
BMJ Open. 2016 Nov 18;6(11):e011949. doi: 10.1136/bmjopen-2016-011949.
To identify determinants of the initial employment of physician assistants (PAs) for inpatient care as well as of the sustainability of their employment.
We conducted a qualitative study with semistructured interviews with care providers. Interviews continued until data saturation was achieved. All interviews were transcribed verbatim. A framework approach was used for data analysis. Codes were sorted by the themes, bringing similar concepts together.
This study was conducted between June 2014 and May 2015 within 11 different hospital wards in the Netherlands. The wards varied in medical speciality, as well as in hospital type and the organisational model for inpatient care.
Participant included staff physicians, residents, PAs and nurses.
The following themes emerged to be important for the initial employment of PAs and the sustainability of their employment: the innovation, individual factors, professional interactions, incentives and resources, capacity for organisational change and social, political and legal factors.
10 years after the introduction of PAs, there was little discussion among the adopters about the added value of PAs, but organisational and financial uncertainties played an important role in the decision to employ and continue employment of PAs. Barriers to employ and continue PA employment were mostly a consequence of locally arranged restrictions by hospital management and staff physicians, as barriers regarding national laws, PA education and competencies seemed absent.
确定医师助理（PA）从事住院患者护理初始就业的决定因素以及其就业的可持续性。
我们开展了一项定性研究，对医疗服务提供者进行半结构化访谈。访谈持续进行直至达到数据饱和。所有访谈均逐字转录。采用框架方法进行数据分析。代码按主题分类，将相似概念归在一起。
本研究于2014年6月至2015年5月在荷兰的11个不同医院病房内进行。这些病房在医学专科、医院类型以及住院护理组织模式方面各不相同。
参与者包括主治医师、住院医师、医师助理和护士。
以下主题对于医师助理的初始就业及其就业的可持续性而言显得很重要：创新、个体因素、专业互动、激励措施和资源、组织变革能力以及社会、政治和法律因素。
医师助理引入10年后，采用者之间很少讨论医师助理的附加值，但组织和财务方面的不确定性在决定聘用和继续聘用医师助理方面发挥了重要作用。聘用和继续聘用医师助理的障碍主要是医院管理层和主治医师在当地设置限制的结果，因为似乎不存在有关国家法律、医师助理教育和能力方面的障碍。
