scholarly journals Factors Associated with Physician Assistant Practice in Rural and Primary Care in Utah

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Jennifer M. Coombs ◽  
Perri Morgan ◽  
Donald M. Pedersen ◽  
Sri Koduri ◽  
Stephen C. Alder
Keyword(s):  
Primary Care ◽  
Rural Communities ◽  
Physician Assistants ◽  
The United States ◽  
Rural Practice ◽  
Professional School ◽  
Care Practice ◽  
Cross Sectional Survey ◽  
Lower Odds ◽  
Practice Location

Physician Assistants (PAs) have become an integral part of the United States (U.S.) health care system since the profession began in the late 1960s. PAs have been suggested as solutions to predicted physician shortages especially in primary care. This study examined the predictors of primary care and rural practice patterns of PAs in Utah. A cross sectional survey design was utilized. The outcome variables were practice specialty and practice location. The predictor variables were age, gender, number of years in practice, location of upbringing, and professional school of graduation. There was a response rate of 67.7%. The Utah Division of Occupational and Professional Licensing (DOPL) provided the list of licensed PAs in the state. Physician assistants who reported being raised in rural communities were 2.29 times more likely to be practicing in rural communities (95% CI 0.89–5.85). Female PAs had lower odds of practicing in a rural area (OR: 0.26; 95% CI: 0.10–0.66). Female PAs had lower odds of practicing in primary care versus their male counterparts (OR: 0.56; 95% CI: 0.33–0.96). Graduation from the Utah PA Program was more likely to result in primary care practice (OR: 2.16; 95% CI: 1.34–3.49).

scholarly journals IMPACT OF GERIATRIC INTERPROFESSIONAL TRAINING ON ADVANCE CARE PLANNING IN GERIATRIC PRIMARY CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Maureen E Barrientos ◽  
Anna Chodos ◽  
Alicia Neumann ◽  
Yvonne Troya ◽  
Pei Chen
Keyword(s):  
Primary Care ◽  
Social Work ◽  
Advance Care Planning ◽  
Health Resources ◽  
The United States ◽  
Care Practice ◽  
Care Planning ◽  
Office Visits ◽  
Advance Care ◽  
Telephone Calls

Abstract Currently, an important measure of Advance Care Planning (ACP), Advance Health Care Directives (AHCD) documentation rate, is at 33% for older adults in the United States. To address this disparity, geriatric faculty in an academic geriatric primary care practice aimed to train geriatrics fellows and other interprofessional (IP) learners to engage patients in ACP. As part of a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, geriatrics faculty and the Medical Legal Partnership for Seniors based at University of California Hastings College of Law provided ACP training to fellows and IP learners, including social work interns. In practice, the fellows and social work interns collaborated to incorporate ACP into patient visits and follow-up telephone calls. To monitor ACP progress, research staff reviewed patients’ electronic health records and performed descriptive analysis of the data. In 21 months, 4 geriatrics fellows built a panel of 59 patients who on average had 3 office visits and 7 telephone calls per person. Prior to clinic enrollment, 12 (20.3%) patients had preexisting AHCD, and 47 lacked AHCD documentation. After ACP intervention, 42 of 47 patients without AHCD documentation engaged in ACP discussion. Of those who engaged in ACP discussion, 24 completed AHCD, raising AHCD completion rate to 61%, or 36 patients in the panel of 59. ACP is a complex process that benefits from skilled communication among interprofessional providers and patients. Findings underscore the potential advantages of IP training and engaging patients in ACP discussion in an academic primary care setting.

Information Technology in Primary Care Practice in the United States

2011 ◽  
pp. 131-163
Author(s):  
James G. Anderson ◽  
E. Andres Balas
Keyword(s):  
Primary Care ◽  
Information Technology ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Medical Specialty ◽  
The United States ◽  
Care Practice ◽  
It Applications ◽  
The Cost ◽  
Privacy And Confidentiality

The objective of this study was to assess the current level of information technology used by primary care physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted by e-mail and asked to complete a Web-based questionnaire. A total of 2,145 physicians responded. Overall between 20% and 25% of primary care physicians reported using electronic medical records, e-prescribing, point-of-care decision support tools and electronic communication with patients. This indicates a slow rate of adoption since 2000-2001. Differences in adoption rates suggest that future surveys need to differentiate primary care and office-based physicians by specialty. An important finding is that one-third of the physicians surveyed expressed no interest in the four IT applications. Overcoming this barrier may require efforts by medical specialty societies to educate their members as to the benefits of IT in practice. The majority of physicians perceived benefits of IT, but they cited costs, vendor inability to deliver acceptable products and concerns about privacy and confidentiality as major barriers to implementation of IT applications. Overcoming the cost barrier may require that payers and the federal government share the costs of implementing these IT applications.

Predictors and Outcomes of Burnout Among Primary Care Providers in the United States: A Systematic Review

2019 ◽  
Vol 77 (5) ◽  
pp. 387-401 ◽  
Author(s):  
Cilgy M. Abraham ◽  
Katherine Zheng ◽  
Lusine Poghosyan
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Organizational Level ◽  
Care Practice ◽  
Practice Environment ◽  
Care Providers ◽  
Cross Sectional ◽  
Study Designs

Primary care providers (PCPs) in the United States work in challenging environments and may be at risk for burnout. This article identifies the predictors and outcomes of burnout among PCPs in the United States. A comprehensive literature search of eight databases was conducted to identify studies investigating predictors or outcomes of PCP burnout. The Joanna Briggs Institute’s critical appraisal checklists for cross-sectional and cohort studies were used for quality appraisal. Overall, 21 studies met inclusion criteria, had sufficient quality, reported personal and/or organizational predictors of burnout, and described burnout outcomes at the patient, provider, or organizational level. Prevalence of PCP burnout ranged from 13.5% to 60%. The primary care practice environment was the most common predictor of PCP burnout. In conclusion, developing interventions to improve the practice environment may help reduce PCP burnout. Future studies using robust study designs and standardized instruments to consistently measure burnout are needed.

scholarly journals The Impact of Primary Care: A Focused Review

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-22 ◽  
Author(s):  
Leiyu Shi
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Negative Impact ◽  
Healthcare Services ◽  
The United States ◽  
Emergency Department Visits ◽  
Care Practice ◽  
Quality Healthcare ◽  
The Usa ◽  
The Impact

Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as “snowballing” based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health.

Primary Care and Physician Extenders in Affluent Countries

1977 ◽  
Vol 7 (4) ◽  
pp. 545-555 ◽  
Author(s):  
Milton I. Roemer
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
The United States ◽  
Industrialized Countries ◽  
Major Response ◽  
Urban And Rural Areas ◽  
Physician Extenders

The worldwide growth of specialization in medicine has led to a perceived shortage of primary care. A major response in the United States has been the training of physician extenders (both physician assistants and nurse practitioners). Other industrialized countries have rejected this approach, in favor of strengthening general medical practice through continuing education, provision of ancillary personnel, use of health centers, and by other methods. Developing countries use doctor-substitutes as a reasonable adjustment to their lack of economic resources. All countries use ancillary personnel for selected procedures, such as midwifery, which involve only limited judgment and decision making. The American strategy on use of doctor-substitutes for primary care, however, follows from unwillingness to train greater numbers of primary care physicians and to require them to serve in places of need. This results in an inequitable concentration of doctor-substitutes on service to the poor in both urban and rural areas.

scholarly journals Procedural Telementoring in Rural, Underdeveloped, and Austere Settings: Origins, Present Challenges, and Future Perspectives

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Juan P. Wachs ◽  
Andrew W. Kirkpatrick ◽  
Samuel A. Tisherman
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
The United States ◽  
Rural Practice ◽  
Annual Review ◽  
Publication Date ◽  
Future Perspectives ◽  
Medical Assistance ◽  
Residency Programs ◽  
Rural Settings

Telemedicine is perhaps the most rapidly growing area in health care. Approximately 15 million Americans receive medical assistance remotely every year. Yet rural communities face significant challenges in securing subspecialist care. In the United States, 25% of the population resides in rural areas, where less than 15% of physicians work. Current surgery residency programs do not adequately prepare surgeons for rural practice. Telementoring, wherein a remote expert guides a less experienced caregiver, has been proposed to address this challenge. Nonetheless, existing mentoring technologies are not widely available to rural communities, due to a lack of infrastructure and mentor availability. For this reason, some clinicians prefer simpler and more reliable technologies. This article presents past and current telementoring systems, with a focus on rural settings, and proposes a set of requirements for such systems. We conclude with a perspective on the future telementoring systems and the integration of artificial intelligence within those systems. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 23 is June 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States

2016 ◽  
Vol 91 (9) ◽  
pp. 1313-1321 ◽  
Author(s):  
Amelia Goodfellow ◽  
Jesus G. Ulloa ◽  
Patrick T. Dowling ◽  
Efrain Talamantes ◽  
Somil Chheda ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Physician ◽  
Rural Areas ◽  
The United States ◽  
Care Physician ◽  
Physician Practice ◽  
Practice Location

Moral Distress and Attitudes About Timing Related to Comfort Care for Hospitalized Patients: A Survey of Inpatient Providers and Nurses

2019 ◽  
Vol 36 (11) ◽  
pp. 967-973 ◽  
Author(s):  
Melissa A. Bender ◽  
C. Holly A. Andrilla ◽  
Rashmi K. Sharma ◽  
Caroline Hurd ◽  
Nicole Solvang ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Moral Distress ◽  
Physician Assistants ◽  
Hospitalized Patients ◽  
Professional School ◽  
Inpatient Setting ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Comfort Care ◽  
Order Set

Context: Providing nonbeneficial care at the end of life and delays in initiating comfort care have been associated with provider and nurse moral distress. Objective: Evaluate provider and nurse moral distress when using a comfort care order set and attitudes about timing of initiating comfort care for hospitalized patients. Methods: Cross-sectional survey of providers (physicians, nurse practitioners, and physician assistants) and nurses at 2 large academic hospitals in 2015. Providers and nurses were surveyed about their experiences providing comfort care in an inpatient setting. Results: Two hundred five nurse and 124 provider surveys were analyzed. A greater proportion of nurses compared to providers reported experiencing moral distress “some, most, or all of the time” when using the comfort care order set (40.5% and 19.4%, respectively, P = .002). Over 60% of nurses and providers reported comfort care was generally started too late in a patient’s course, with physician trainees (81.4%), as well as providers (80.9%) and nurses (84.0%) < 5 years from graduating professional school most likely to report that comfort care is generally started too late. Conclusions: The majority of providers and nurses reported that comfort care was started too late in a patient’s course. Nurses experienced higher levels of moral distress than providers when caring for patients using a comfort care order set. Further research is needed to determine what is driving this moral distress in order to tailor interventions for nurses and providers.

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