Cheyuo Cletus, Brandmeir Nicholas, Fisher-Perez Natalie, Dekeseredy Patricia, Sedney Cara
Neurosurgery, West Virginia University, Morgantown, USA.
Neurosurgery, Mon Health Systems, Morgantown, USA.
Cureus. 2020 Jul 12;12(7):e9157. doi: 10.7759/cureus.9157.
Introduction Increasing demands for healthcare manpower has necessitated the utilization of advanced practice providers (APPs). The effect of APPs in primary care has been well-characterized but is less studied in surgical subspecialties. The objective of this study is to assess the patient acceptability of APPs in an outpatient neurosurgery setting. Methods We conducted a prospective, survey-based study among 78 adult patients in the neurosurgical outpatient clinic. The survey consisted of 10 questions assessing the hypothetical acceptability of care provided by neurosurgeons and APPs. These were compared as pre-specified dyads, with patients blinded to dyad composition. The data were analyzed with Chi-square tests. Results Patients preferred to see their neurosurgeon for their first clinic visit even with a longer lag time (29% acceptability difference, p = 0.012). Patients also preferred to see the neurosurgeon for their first postoperative visit (20% difference, p = 0.009). For all visits, patients preferred to see an APP if the clinic visit would be on time, rather than see the surgeon with a significant delay (30% difference, p = 0.0002). If their visit was scheduled with an APP, patients preferred that the neurosurgeon review their treatment plan before they left the clinic (15% difference, p = 0.04). Overall, seeing an APP was acceptable if patients were informed ahead of time (37% difference, p < 0.0001). Conclusions Team-based care utilizing APPs is acceptable to patients. Patients had strong preferences for seeing their surgeon for the first neurosurgical clinic visit and first post-operative visit. Patients were satisfied with seeing an APP if they could be seen more expeditiously. Patients also preferred to know ahead of time if they were going to see an APP.
引言 对医疗人力需求的不断增加使得高级实践提供者（APP）的使用成为必要。APP在初级保健中的作用已得到充分描述，但在外科亚专业中的研究较少。本研究的目的是评估门诊神经外科环境中患者对APP的接受程度。方法 我们在神经外科门诊对78名成年患者进行了一项基于调查的前瞻性研究。该调查包括10个问题，评估患者对神经外科医生和APP提供护理的假设接受程度。这些问题以预先指定的二元组形式进行比较，患者对二元组组成不知情。数据采用卡方检验进行分析。结果 即使等待时间更长，患者仍更倾向于在首次门诊就诊时看神经外科医生（接受程度差异为29%，p = 0.012）。患者在首次术后就诊时也更倾向于看神经外科医生（差异为20%，p = 0.009）。对于所有就诊，如果门诊就诊能按时进行，患者更愿意看APP，而不是等待很长时间去看外科医生（差异为30%，p = 0.0002）。如果他们的就诊安排是由APP进行，患者更希望神经外科医生在他们离开诊所前审查他们的治疗计划（差异为15%，p = 0.04）。总体而言，如果提前告知患者，看APP是可以接受的（差异为37%，p < 0.0001）。结论 患者可接受利用APP的团队式护理。患者强烈倾向于在首次神经外科门诊就诊和首次术后就诊时看外科医生。如果能更快就诊，患者对看APP感到满意。患者也更希望提前知道他们是否会看APP。
