Halter Mary, Wheeler Carly, Pelone Ferruccio, Gage Heather, de Lusignan Simon, Parle Jim, Grant Robert, Gabe Jonathan, Nice Laura, Drennan Vari M
Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK.
National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK.
BMJ Open. 2018 Jun 19;8(6):e019573. doi: 10.1136/bmjopen-2017-019573.
To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health.
Systematic review.
Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles.
Peer-reviewed articles of any study design, published in English, 1995-2017.
Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken.
Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs.
5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent.
PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting.
CRD42016032895.
评估并综合有关医师助理（PA）在二级医疗保健中，特别是在急性内科、老年护理、急诊医学、创伤与骨科以及心理健康方面影响的研究。
系统评价。
电子数据库（Medline、Embase、ASSIA、CINAHL、SCOPUS、PsycINFO、社会政策与实践、EconLit和Cochrane）、参考文献列表及相关文章。
1995 - 2017年以英文发表的任何研究设计的同行评审文章。
采用盲法平行流程筛选摘要和全文，依据已发表指南进行数据提取和质量评估。进行叙述性综合分析。
对以下方面的影响：患者体验和结局、服务组织、工作实践、其他专业群体及成本。
共识别出5472篇参考文献，161篇全文阅读；纳入16篇——急诊医学（7篇）、创伤与骨科（6篇）、急性内科（2篇）、心理健康（1篇）和老年护理（0篇）。所有研究均为观察性研究，方法学质量参差不齐。在急诊医学以及创伤与骨科领域，当团队中加入医师助理时，报告显示等待时间和流程时间缩短、费用降低、再入院率相当，且工作人员和患者的接受度良好。镇痛处方、手术并发症及死亡率结果各不相同。在内科，医师助理和医生提供的护理结局相当。
已部署医师助理以提高团队能力，从而在等待时间、诊疗效率、连续性和医疗覆盖方面取得成效。将医师助理与医务人员进行比较时，令人安心的是，对健康结局或成本几乎没有负面影响。强调了在团队协作的复杂系统中归因因果关系的困难。需要进一步进行严格评估，以解决医师助理角色的复杂性问题，报告多个场景下的情况，并纳入医师助理与其所替代角色之间的比较。
PROSPERO注册号：CRD42016032895。
