建立全球物理治疗师专业的利弊：系统评价和混合方法研究。
The benefits and limitations of establishing the PA profession globally: A systematic review and mixed-methods study.
机构信息
Arden R. Turkewitz practices in family medicine at Hawai'i Island Community Health Center in Hilo and Kea'au, Hawai'i. Jane P. Sallen practices in orthopedic surgery at Dignity Health Medical Foundation in Redwood City, Calif. Rachel M. Smith practices in dermatology at Knoxville (Tenn.) Dermatology Group. Kandi Pitchford is an associate professor and director of capstone, outcomes, and assessment in the PA program at South College in Knoxville, Tenn. Kimberly Lay is an associate professor and associate program director of the PA program at South College. Scott Smalley is president of the International Academy of Physician Associate Educators and an honorary lecturer in the Division of Clinical Associates, Department of Family Medicine and Primary Care, Faculty of Health Sciences, at the University of the Witwatersrand Johannesburg (South Africa). The authors have disclosed no potential conflicts of interest, financial or otherwise.
出版信息
JAAPA. 2024 Nov 1;37(11):1-51. doi: 10.1097/01.JAA.0000000000000146. Epub 2024 Oct 29.
OBJECTIVE
Physician associates/assistants (PAs) and their equivalents offer a solution to the supply and demand crisis to alleviate global healthcare needs. This study investigated how PA and PA equivalents address global healthcare needs across different healthcare systems, revealing recommendations for their use. The study also sought to catalog the global healthcare needs that PAs and equivalents are successfully alleviating, the roles in which they function, and the barriers facing implementation.
METHODS
A systematic review was conducted from October 2021 to April 2022 and rerun in June 2023 following PRISMA 2020 guidelines; additionally, supporting interviews were conducted with PAs and global health experts. Primary outcomes were geographic region, economy, healthcare needs, and healthcare systems. Secondary outcomes were PA use, license recognition, and successes or barriers when implementing PAs.
RESULTS
The literature and interviews focused on the global use of PAs and PA equivalents in six geographic regions, 63 countries, and five US territories where PAs or PA equivalents are employed, have been employed, are volunteering, or are being considered to support global healthcare needs. Most countries have a developing economy and an out-of-pocket healthcare system. PAs and PA equivalents hold 35 different practice titles, and most work in primary care. PAs alleviate healthcare shortages and economic disparities, specifically related to inequitable healthcare access. Globally, the profession is limited by a lack of legislation, regulation, and support.
CONCLUSIONS
PAs and PA equivalents worldwide belong to an adaptable profession that has well-documented success in alleviating the global healthcare shortage and addressing healthcare needs. Countries desiring PAs or PA equivalents should identify their specific needs, train their existing workforce, employ pilot programs, and focus on seeking early legislation and regulation. Broad support for existing PA and PA equivalent international organizations is recommended for global collaboration. This study serves as a guide for those advocating for the continued or future implementation of PAs and PA equivalents in their own country and provides a comprehensive resource to aid in the globalization of this profession. We offer recommendations to address the dire healthcare needs and workforce shortage faced across the globe.
目的
医师助理（PA）及其同等人员为缓解全球医疗保健需求提供了一种解决方案，以应对供需危机。本研究调查了 PA 和同等人员如何在不同的医疗保健系统中满足全球医疗保健需求，揭示了使用他们的建议。该研究还试图编制 PA 和同等人员成功缓解的全球医疗保健需求目录、他们发挥作用的角色以及实施所面临的障碍。
方法
根据 PRISMA 2020 指南，从 2021 年 10 月至 2022 年 4 月进行了系统评价，并于 2023 年 6 月重新运行；此外，还对 PA 和全球卫生专家进行了支持性访谈。主要结果是地理区域、经济、医疗保健需求和医疗保健系统。次要结果是 PA 的使用、许可证认可以及实施 PA 时的成功或障碍。
结果
文献和访谈重点关注全球六个地理区域、63 个国家和五个美国领土的 PA 和 PA 同等人员的使用情况，这些国家和地区都有 PA 或 PA 同等人员在工作、曾经工作、正在志愿工作或正在考虑支持全球医疗保健需求。大多数国家的经济处于发展中，并且采用自费医疗保健系统。PA 和 PA 同等人员拥有 35 种不同的执业头衔，并且大多数从事初级保健工作。PA 缓解了医疗保健短缺和经济差距，特别是与不平等的医疗保健获取有关的差距。在全球范围内，该专业受到缺乏立法、监管和支持的限制。
结论
全球范围内的 PA 和 PA 同等人员属于一个适应性强的职业，他们在缓解全球医疗保健短缺和满足医疗保健需求方面有着良好的记录。希望引进 PA 或 PA 同等人员的国家应确定其具体需求，培训现有的劳动力，采用试点项目，并专注于寻求早期立法和监管。建议广泛支持现有的 PA 和 PA 同等人员国际组织，以促进全球合作。本研究为那些在自己的国家倡导继续或未来实施 PA 和 PA 同等人员的人提供了指导，并为这一职业的全球化提供了全面的资源。我们提出了一些建议，以应对全球范围内的严峻医疗保健需求和劳动力短缺问题。
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