Evidence map›Paper›PMID 29921680›Full record

SynthesisBMJ open2018

Contribution of physician assistants/associates to secondary care: a systematic review.

Mary Halter, Carly Wheeler, Ferruccio Pelone, Heather Gage, Simon de Lusignan, Jim Parle, Robert Grant, Jonathan Gabe, Laura Nice, Vari M Drennan

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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  7. The workforce crisis in public psychiatry can be addressed by asking psychiatrists to focus on psychiatry.Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Mary HalterFaculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK.ORCID 0000-0001-6636-0621
Carly WheelerFaculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK.
Ferruccio PeloneNational Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK.
Heather GageSchool of Economics, University of Surrey, Guildford, Surrey, UK.
Simon de LusignanDepartment of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK.
Jim ParleInstitute of Clinical Sciences, University of Birmingham, Birmingham, UK.
Robert GrantFaculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK.
Jonathan GabeCentre for Criminology and Sociology, School of Law, Royal Holloway, University of London, London, UK.
Laura NiceInstitute of Clinical Sciences, University of Birmingham, Birmingham, UK.
Vari M DrennanFaculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK.ORCID 0000-0002-8915-5185

Funding

Department of Health 14/19/26Department of Health HS&DR/14/19/26
6 · The paper itself

Abstract

objectiveTo 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.

designSystematic review.

settingElectronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. INCLUDED ARTICLES: Peer-reviewed articles of any study design, published in English, 1995-2017.

interventionsBlinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. OUTCOME MEASURES: Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs.

results5472 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.

conclusionsPAs 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. PROSPERO REGISTRATION NUMBER: CRD42016032895.

Indexed as

Health WorkforceHumansPhysician AssistantsSecondary Health CareWork Schedule Tolerancegeneral medicine (see internal medicine)physician assistantquality in health care

Identifiers

PMID29921680
PMCPMC6020983

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.