This article summarizes a systematic review of 51 papers on the role of physician assistants (PAs) in rural health care between 1974-2008. The papers were categorized into 4 areas: scope of practice, physician perceptions, community perceptions, and retention/recruitment of rural PAs. Overall, the literature suggests that PAs provide cost-effective medical services to underserved rural populations, which are valued. Rural PAs also appear to have a broader scope of practice than urban PAs to meet extensive rural health needs. While research has improved over time, longitudinal studies on rural PAs remain limited.
2011 08 Hooker Everett Primary Care Pa Reviewrodhooker
Physician assistants can contribute significantly to primary care systems. Studies show that PAs can provide comprehensive care, maintain accessibility and accountability comparable to physicians. While PAs perform many of the key
TRANS-EXPERIENCEand SEXUAL HEALTH in Underserved CommunitiesCDC NPIN
This document summarizes a project by the Transgender Family Program at Community Healthcare Network to improve healthcare for transgender communities in the Bronx and Queens. It describes the high rates of HIV/AIDS in these communities, especially among transgender women of color. The project aims to address this issue through a comprehensive program providing primary care, mental health services, health education, and referrals. Key elements include adopting a patient-centered medical home model, implementing health literacy initiatives like support groups and workshops, and the T-Teach Back intervention to improve patient understanding. The goal is to enhance quality of life and stop the spread of HIV/AIDS through culturally competent care, community involvement, and raising health awareness.
This document summarizes a study that analyzed predictors of traditional medicine utilization in Ashanti Region, Ghana. The study involved a survey of 324 participants across both rural and urban districts. Overall, 86.1% of participants reported using traditional medicine in the previous 12 months. The study found that traditional medicine use was predicted by having low income, being a trader, perceiving traditional medicine as effective and safe, having a good relationship with a traditional medical practitioner, and having a chronic illness. Demographic factors were not strong predictors of traditional medicine use. The study provides insight into why traditional medicine utilization is high in the region.
This chapter provides an orientation to the study by outlining the formulation of the research problem, significance of the study, research methodology, and limitations. The study aims to investigate the factors that contribute to patients' aggressive and violent behavior in mental health facilities in Cape Town, from the patients' perspectives. International research has found that environmental and situational factors play a role in violence in mental health facilities. However, there is a lack of research on this issue from a nursing perspective in South Africa. This study seeks to address that gap by exploring patients' perceptions of contributing factors to aggression and violence in local mental health facilities.
This literature review examines the lack of research on palliative care for people with pre-existing mental health problems. It finds that while the relationship between mental health problems and poor physical health is well documented, there is relatively little literature on challenges in treating people with co-morbidities. The review also finds an overwhelming lack of literature on palliative care needs for those with mental health problems and little on palliative care for anorexia nervosa. It reveals gaps in palliative care provision for those with pre-existing mental illnesses and discusses implications for future research, practice, and policy.
The prevalence, patterns of usage and people's attitude towards complementary...home
The prevalence of CAM in Chatsworth is similar to findings in other parts of the
world. Although CAM was used to treat many different ailments, this practice could not be
attributed to any particular demographic profile. The majority of CAM users were satisfied with
the effects of CAM. Findings support a need for greater integration of allopathic medicine and
CAM, as well as improved communication between patients and caregivers regarding CAM usage.
Stigma and Family reaction among Caregivers of Persons Living with Cancerinventionjournals
Cancer stigma refers to a negative or undesirable perception of a person affected by cancer. Stigma can be internal—it can affect self-perception of survivors, causing guilt, blame or shame. It can also be enacted, causing discrimination, loss of employment or income, or social isolation. It can come from misinformation, lack of awareness and deeply-engrained myth.The present study consisted of 300 caregivers of persons with cancer was selected based on simple random sampling, and with inclusion and exclusion criteria. Those patients satisfying the inclusion and exclusion criteria and attending both outpatient and inpatient services of cancer specialty hospital in KIDWAI Bangalore, Karnataka were selected randomly. The data was collected from the patients & caregivers of persons living with cancer who fulfill the inclusion/exclusion criteria were taken up for the study after their consent. Semi structured interview schedule were used to understand the stigma and family reaction. The interviews and the instruments were administered by research experts.
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
Objective: The study has two objectives: (1) To determine the prevailing characteristics of a given set of patients with “disorganized disease” and (2) to determinate the prevailing outcomes for these patients in family medicine to assess their implications for decision-making. Participants and Methods: A qualitative, longitudinal, and retrospective cases series study based on a single cohort was carried out. Analyses based on a retrospective study of case records from June to October 2017, in a family medicine office in the Health Center Santa Maria de Benquerencia, Toledo, Spain. A convenience sample was selected consisting of patients who consulted during that period and who met the criteria for entering the study. These cases were considered in the epidemiological term as index cases, which means that beyond these the study should be expanded. Hence, in addition, using a technique of snowball “mental” or “astute clinical observation” others patients attended previously were included until the saturation of the data. The cases were described in short case reports. An analysis of the content of these reports was carried out, defining categories of qualitative data. The results were interpreted, and a generalization was drawn from these cases.
2011 08 Hooker Everett Primary Care Pa Reviewrodhooker
Physician assistants can contribute significantly to primary care systems. Studies show that PAs can provide comprehensive care, maintain accessibility and accountability comparable to physicians. While PAs perform many of the key
TRANS-EXPERIENCEand SEXUAL HEALTH in Underserved CommunitiesCDC NPIN
This document summarizes a project by the Transgender Family Program at Community Healthcare Network to improve healthcare for transgender communities in the Bronx and Queens. It describes the high rates of HIV/AIDS in these communities, especially among transgender women of color. The project aims to address this issue through a comprehensive program providing primary care, mental health services, health education, and referrals. Key elements include adopting a patient-centered medical home model, implementing health literacy initiatives like support groups and workshops, and the T-Teach Back intervention to improve patient understanding. The goal is to enhance quality of life and stop the spread of HIV/AIDS through culturally competent care, community involvement, and raising health awareness.
This document summarizes a study that analyzed predictors of traditional medicine utilization in Ashanti Region, Ghana. The study involved a survey of 324 participants across both rural and urban districts. Overall, 86.1% of participants reported using traditional medicine in the previous 12 months. The study found that traditional medicine use was predicted by having low income, being a trader, perceiving traditional medicine as effective and safe, having a good relationship with a traditional medical practitioner, and having a chronic illness. Demographic factors were not strong predictors of traditional medicine use. The study provides insight into why traditional medicine utilization is high in the region.
This chapter provides an orientation to the study by outlining the formulation of the research problem, significance of the study, research methodology, and limitations. The study aims to investigate the factors that contribute to patients' aggressive and violent behavior in mental health facilities in Cape Town, from the patients' perspectives. International research has found that environmental and situational factors play a role in violence in mental health facilities. However, there is a lack of research on this issue from a nursing perspective in South Africa. This study seeks to address that gap by exploring patients' perceptions of contributing factors to aggression and violence in local mental health facilities.
This literature review examines the lack of research on palliative care for people with pre-existing mental health problems. It finds that while the relationship between mental health problems and poor physical health is well documented, there is relatively little literature on challenges in treating people with co-morbidities. The review also finds an overwhelming lack of literature on palliative care needs for those with mental health problems and little on palliative care for anorexia nervosa. It reveals gaps in palliative care provision for those with pre-existing mental illnesses and discusses implications for future research, practice, and policy.
The prevalence, patterns of usage and people's attitude towards complementary...home
The prevalence of CAM in Chatsworth is similar to findings in other parts of the
world. Although CAM was used to treat many different ailments, this practice could not be
attributed to any particular demographic profile. The majority of CAM users were satisfied with
the effects of CAM. Findings support a need for greater integration of allopathic medicine and
CAM, as well as improved communication between patients and caregivers regarding CAM usage.
Stigma and Family reaction among Caregivers of Persons Living with Cancerinventionjournals
Cancer stigma refers to a negative or undesirable perception of a person affected by cancer. Stigma can be internal—it can affect self-perception of survivors, causing guilt, blame or shame. It can also be enacted, causing discrimination, loss of employment or income, or social isolation. It can come from misinformation, lack of awareness and deeply-engrained myth.The present study consisted of 300 caregivers of persons with cancer was selected based on simple random sampling, and with inclusion and exclusion criteria. Those patients satisfying the inclusion and exclusion criteria and attending both outpatient and inpatient services of cancer specialty hospital in KIDWAI Bangalore, Karnataka were selected randomly. The data was collected from the patients & caregivers of persons living with cancer who fulfill the inclusion/exclusion criteria were taken up for the study after their consent. Semi structured interview schedule were used to understand the stigma and family reaction. The interviews and the instruments were administered by research experts.
Disorganized Diseases: Are they a Simple Explosion of Random Energy and there...asclepiuspdfs
Objective: The study has two objectives: (1) To determine the prevailing characteristics of a given set of patients with “disorganized disease” and (2) to determinate the prevailing outcomes for these patients in family medicine to assess their implications for decision-making. Participants and Methods: A qualitative, longitudinal, and retrospective cases series study based on a single cohort was carried out. Analyses based on a retrospective study of case records from June to October 2017, in a family medicine office in the Health Center Santa Maria de Benquerencia, Toledo, Spain. A convenience sample was selected consisting of patients who consulted during that period and who met the criteria for entering the study. These cases were considered in the epidemiological term as index cases, which means that beyond these the study should be expanded. Hence, in addition, using a technique of snowball “mental” or “astute clinical observation” others patients attended previously were included until the saturation of the data. The cases were described in short case reports. An analysis of the content of these reports was carried out, defining categories of qualitative data. The results were interpreted, and a generalization was drawn from these cases.
The study evaluated the success of an intervention in Eastern Visayas, Philippines to strengthen mental health services following Typhoon Haiyan. [1] Between 2014-2015, 1038 community workers were trained in psychosocial support and 290 healthcare providers received mental health training and supervision. [2] By March 2015, 97.5% of primary care units and 87.5% of district hospitals had trained providers, benefiting 50-200 patients each. [3] Regional hospitals added psychiatric beds and provincial hospitals established acute care capacity, improving availability across all levels of care.
This document describes a study that examined how unmet basic needs cluster in low-income populations and how the effectiveness of health interventions may vary based on levels of unmet basic needs. The study analyzed data from a randomized controlled trial where low-income callers to a 211 helpline received cancer screening referrals along with one of three interventions: verbal referral only, verbal referral plus a printed reminder, or verbal referral plus navigation from a health coach. Latent class analysis identified three classes of unmet basic needs among participants. Logistic regression found that for those with relatively more or money-specific unmet needs, the navigator intervention was more effective at linking them to health referrals, while the printed reminder worked as well as the navigator for those
This document discusses sleep deprivation among night shift nurses. It begins by defining key concepts like community and community health. It then examines the problem of sleep deprivation among nurses, citing studies that have found high rates of insufficient sleep among nurses prior to shifts. The document explores how lack of sleep can negatively impact nurse performance and patient safety. It discusses potential partnerships and strategies to address this issue, including guidelines from the American Nurses Association. Data on the effects of fatigue on cognitive function is also presented. Finally, a nursing diagnosis related to sleep deprivation among night shift nurses is proposed to guide planning interventions.
This document summarizes 10 research studies on the topic of rural health, nurse practitioners, primary care, and research. Most of the studies found that nurse practitioners can help address rural healthcare shortages and improve access and outcomes. Specifically, studies found nurse practitioners improved cost-effectiveness, provided mental healthcare solutions, enhanced care through collaboration with pharmacists, improved patient perceptions of care quality similar to physicians, and positively impacted rural communities. However, some studies also found nurse practitioners had no effect on changing health behaviors or providing culturally competent care to minority patients in rural settings. Overall, the literature suggests nurse practitioners can help address rural healthcare needs but more research is still needed.
At baseline, two of 986 sex workers were HIV positive in Madagascar. 77.5% of sex workers in Antananarivo and 73.5% in Tamatave had at least one curable sexually transmitted infection (STI). Two months after treatment and counseling, 64.9% of sex workers in Antananarivo and 57.4% in Tamatave had at least one STI. The researchers developed evidence-based STI treatment guidelines for sex workers in Madagascar in collaboration with sex workers and health professionals. The guidelines included speculum exams, syphilis screening and treatment, and presumptive treatment for other STIs during initial and follow-up visits.
This document discusses palliative care in Virginia. It defines palliative care in Virginia law and federal regulations. It describes how palliative care differs from hospice care in focusing on symptom relief rather than being limited to terminal patients. The document discusses the growing need for palliative care due to an aging population living longer with chronic conditions. It provides examples of how palliative care can help patients with cancer and cardiovascular disease.
This document provides an overview of epidemiology, including its basic concepts, principles, scope, and measurement tools. Some key points:
- Epidemiology is the study of disease distribution and determinants in populations, and is used to prevent and control health problems. It describes disease patterns and identifies risk factors.
- Epidemiological principles are applied in various areas like clinical research, disease prevention, and health services evaluation. Measurement tools include rates, ratios, and proportions to quantify disease frequency and burden.
- The scope of epidemiology includes measuring mortality, morbidity, disability, births, risk factors, and assessing health needs in populations. Different study designs are used to investigate disease etiology and evaluate interventions.
Methods of Epidemiology - Descriptive epidemiologyKrupa Mathew
This document provides an overview of descriptive epidemiology. Descriptive epidemiology involves observing the distribution of disease in a population in terms of time, place, and person. The key steps are: defining the population and disease, describing occurrences and distributions, measuring disease prevalence and incidence, comparing data to known indices, and formulating hypotheses about disease etiology. The goal is to identify characteristics associated with disease and ask questions that can provide clues about causation. Descriptive studies lay the groundwork for further analytical epidemiological research.
This document discusses integrative medicine and its principles. It defines integrative medicine as patient-centered care that uses both conventional and alternative therapies. The document outlines the history of complementary and alternative medicine in the US healthcare system. It was largely pushed out after the Flexner Report in 1910 but continued growing. The document discusses the principles of integrative medicine, which include treating the whole person, using natural therapies when possible, and emphasizing prevention and health promotion. It provides a case study of how integrative medicine helped an 18-year-old with persistent headaches by addressing physical and lifestyle factors. The document advocates for a healthcare system grounded in these integrative principles.
This document summarizes key concepts in epidemiological studies. It discusses how epidemiological studies aim to determine the differences between those who get a disease and those who are spared. This is done by investigating the nature and extent of the disease, causative agents, sources of infection, modes of transmission and susceptibility of the population. The document also outlines the two main approaches in epidemiological investigations - asking questions and making comparisons. It provides examples of the types of questions asked and comparisons that can be made, such as between rural and urban populations. Finally, it defines epidemiological terms like case counts, rates, ratios and proportions that are used to measure and compare health outcomes.
Racial and Socioeconomic Disparities in Substance Abuse TreatmentAlexandraPerkins5
This document provides an overview of racial and socioeconomic disparities in substance abuse treatment in the United States. It discusses how factors like insurance coverage, treatment availability, and social determinants can influence disparities in treatment completion and outcomes. Specifically, it notes that Black and Hispanic youth are less likely to complete substance abuse treatment than white youth. While Medicaid expands coverage for treatment, not all providers accept it, creating availability issues. The document also explores historical models of addiction and how they impacted disparities, and examines various treatment approaches including medication-assisted treatment, peer-based support, and harm reduction strategies.
Hospice aims to treat the whole person rather than the disease and focus on quality of life over length of life. It provides comfort and dignity for patients dealing with terminal illness through physical, spiritual, and emotional support for patients and their families. There are several ethical issues around patient autonomy, access to care, and overcoming barriers for underserved groups. A lack of communication and cultural understanding can negatively impact minority groups' access and experience with hospice care. Additionally, over-reliance on technology risks losing personal interactions that are important for end-of-life care.
The document discusses the epidemiology course which covers applying epidemiological procedures to understand occurrences and control of various health conditions. The course objectives are to provide mastery in various epidemiological assessment tools and research designs. It details the grading system, schedule, attendance policy and introduces concepts of epidemiology like descriptive epidemiology and epidemiology of infectious diseases.
Program design and management6 social service programsPOLY33
The National Head Start Association (NHSA) is a non-profit organization that provides early childhood education and support services to low-income families through Head Start programs. NHSA serves over 1 million children through 1,600 local programs. Its mission is to support the Head Start model and advocate for policies that help vulnerable children and families succeed. Head Start programs provide education, health care, parent involvement, and social services to young children and their families. NHSA aims to expand access to Head Start and adapt its services to changing community needs.
This document discusses various types of health indicators that can be used to measure and monitor the health status of a population. It describes indicators such as mortality rates, morbidity rates, disability rates, nutritional status indicators, and utilization rates. Mortality indicators measure deaths, such as infant mortality rate and life expectancy. Morbidity indicators reflect disease burden through incidence and prevalence. Disability rates assess healthy life years lost. Nutritional status is indicated by metrics like stunting. Utilization rates reflect access to healthcare services. The document provides examples for many common health indicators.
Epidemiology has several common practical applications. It is used to investigate infectious diseases through routine surveillance by health departments. Epidemiologists in hospitals explore causes of hospital-acquired infections. It also evaluates the impact of public health policies on trends like smoking rates and obesity. Overall, epidemiology provides data to understand community health issues and disease risks, identify disease syndromes, uncover disease causes, and evaluate treatments and interventions.
Association of an Educational Program in Mindful Communication With Burnout, ...DAVID MALAM
This document summarizes a study that evaluated the effectiveness of an educational program in mindful communication for primary care physicians. The program included mindfulness meditation, narrative exercises, and appreciative inquiry techniques. It was associated with short-term and sustained improvements in physician well-being, burnout, empathy, mood, and personality factors related to patient-centered care. However, the before-and-after study design limits conclusions about the causal effects of the intervention. Randomized trials with larger and more diverse groups of physicians are needed to validate these preliminary findings.
Epidemiological methods are used to study the distribution and determinants of health-related events in populations. There are two main approaches: observational studies and experimental studies. Observational studies include descriptive and analytical methods. Descriptive methods involve measuring disease occurrence without interference to understand time, place, and person distributions. Analytical methods include case-control and cohort studies to test hypotheses about associations between suspected causes and diseases.
Natural History of Disease & Levels of preventionsourav goswami
I have tried to explain the National History of Disease taking the example of a disease condition. Similarly, the different prevention levels are also explained in a similar manner. The presentation also includes few newer concepts of screening like lead time and length time bias.
N.B: Please download to see all the animations.
Physicians provided care at 69% of community health center visits from 2006-2008, while nurse practitioners saw 21% of visits, physician assistants saw 9% of visits, and certified nurse midwives saw 1% of visits. The majority of visits were by Medicaid/SCHIP-insured or uninsured patients and by patients under age 45. Nurse practitioners and certified nurse midwives saw a higher percentage of female patients aged 18-44 compared to other providers. Physicians were more likely than other providers to see patients aged 45 and over. A higher percentage of nurse practitioner and physician assistant visits included health education and counseling compared to physician visits.
This document provides a summary of the education and professional experience of Roderick S. Hooker. It details that he received a PhD in Health Policy from Portland State University in 1999, and has since held various academic positions, including as an Adjunct Professor at multiple universities. His professional experience includes serving as the Director of Rheumatology Research at the Dallas VA Medical Center and Senior Director at The Lewin Group. He has extensive experience conducting national studies and research in areas of health policy, rheumatology, and the physician assistant profession.
2010 05 Morgan Hooker PA Speciatly Health Affairsrodhooker
1) The number of PAs working in primary care specialties like family medicine has declined from 54% in 1996 to 41% in 2005, while the proportion working in medical and surgical subspecialties has increased more rapidly than the overall growth of the PA workforce.
2) The ratios of physicians to PAs vary widely between specialties, from 1:3 in cardiovascular surgery to 1:33 in general pediatrics. Specialties with the highest PA to physician ratios tend to be high-paying subspecialties.
3) Salary appears to correlate with specialty choice for PAs, especially in the highest-paying subspecialties. However, other non-financial factors also likely influence PA specialty
The study evaluated the success of an intervention in Eastern Visayas, Philippines to strengthen mental health services following Typhoon Haiyan. [1] Between 2014-2015, 1038 community workers were trained in psychosocial support and 290 healthcare providers received mental health training and supervision. [2] By March 2015, 97.5% of primary care units and 87.5% of district hospitals had trained providers, benefiting 50-200 patients each. [3] Regional hospitals added psychiatric beds and provincial hospitals established acute care capacity, improving availability across all levels of care.
This document describes a study that examined how unmet basic needs cluster in low-income populations and how the effectiveness of health interventions may vary based on levels of unmet basic needs. The study analyzed data from a randomized controlled trial where low-income callers to a 211 helpline received cancer screening referrals along with one of three interventions: verbal referral only, verbal referral plus a printed reminder, or verbal referral plus navigation from a health coach. Latent class analysis identified three classes of unmet basic needs among participants. Logistic regression found that for those with relatively more or money-specific unmet needs, the navigator intervention was more effective at linking them to health referrals, while the printed reminder worked as well as the navigator for those
This document discusses sleep deprivation among night shift nurses. It begins by defining key concepts like community and community health. It then examines the problem of sleep deprivation among nurses, citing studies that have found high rates of insufficient sleep among nurses prior to shifts. The document explores how lack of sleep can negatively impact nurse performance and patient safety. It discusses potential partnerships and strategies to address this issue, including guidelines from the American Nurses Association. Data on the effects of fatigue on cognitive function is also presented. Finally, a nursing diagnosis related to sleep deprivation among night shift nurses is proposed to guide planning interventions.
This document summarizes 10 research studies on the topic of rural health, nurse practitioners, primary care, and research. Most of the studies found that nurse practitioners can help address rural healthcare shortages and improve access and outcomes. Specifically, studies found nurse practitioners improved cost-effectiveness, provided mental healthcare solutions, enhanced care through collaboration with pharmacists, improved patient perceptions of care quality similar to physicians, and positively impacted rural communities. However, some studies also found nurse practitioners had no effect on changing health behaviors or providing culturally competent care to minority patients in rural settings. Overall, the literature suggests nurse practitioners can help address rural healthcare needs but more research is still needed.
At baseline, two of 986 sex workers were HIV positive in Madagascar. 77.5% of sex workers in Antananarivo and 73.5% in Tamatave had at least one curable sexually transmitted infection (STI). Two months after treatment and counseling, 64.9% of sex workers in Antananarivo and 57.4% in Tamatave had at least one STI. The researchers developed evidence-based STI treatment guidelines for sex workers in Madagascar in collaboration with sex workers and health professionals. The guidelines included speculum exams, syphilis screening and treatment, and presumptive treatment for other STIs during initial and follow-up visits.
This document discusses palliative care in Virginia. It defines palliative care in Virginia law and federal regulations. It describes how palliative care differs from hospice care in focusing on symptom relief rather than being limited to terminal patients. The document discusses the growing need for palliative care due to an aging population living longer with chronic conditions. It provides examples of how palliative care can help patients with cancer and cardiovascular disease.
This document provides an overview of epidemiology, including its basic concepts, principles, scope, and measurement tools. Some key points:
- Epidemiology is the study of disease distribution and determinants in populations, and is used to prevent and control health problems. It describes disease patterns and identifies risk factors.
- Epidemiological principles are applied in various areas like clinical research, disease prevention, and health services evaluation. Measurement tools include rates, ratios, and proportions to quantify disease frequency and burden.
- The scope of epidemiology includes measuring mortality, morbidity, disability, births, risk factors, and assessing health needs in populations. Different study designs are used to investigate disease etiology and evaluate interventions.
Methods of Epidemiology - Descriptive epidemiologyKrupa Mathew
This document provides an overview of descriptive epidemiology. Descriptive epidemiology involves observing the distribution of disease in a population in terms of time, place, and person. The key steps are: defining the population and disease, describing occurrences and distributions, measuring disease prevalence and incidence, comparing data to known indices, and formulating hypotheses about disease etiology. The goal is to identify characteristics associated with disease and ask questions that can provide clues about causation. Descriptive studies lay the groundwork for further analytical epidemiological research.
This document discusses integrative medicine and its principles. It defines integrative medicine as patient-centered care that uses both conventional and alternative therapies. The document outlines the history of complementary and alternative medicine in the US healthcare system. It was largely pushed out after the Flexner Report in 1910 but continued growing. The document discusses the principles of integrative medicine, which include treating the whole person, using natural therapies when possible, and emphasizing prevention and health promotion. It provides a case study of how integrative medicine helped an 18-year-old with persistent headaches by addressing physical and lifestyle factors. The document advocates for a healthcare system grounded in these integrative principles.
This document summarizes key concepts in epidemiological studies. It discusses how epidemiological studies aim to determine the differences between those who get a disease and those who are spared. This is done by investigating the nature and extent of the disease, causative agents, sources of infection, modes of transmission and susceptibility of the population. The document also outlines the two main approaches in epidemiological investigations - asking questions and making comparisons. It provides examples of the types of questions asked and comparisons that can be made, such as between rural and urban populations. Finally, it defines epidemiological terms like case counts, rates, ratios and proportions that are used to measure and compare health outcomes.
Racial and Socioeconomic Disparities in Substance Abuse TreatmentAlexandraPerkins5
This document provides an overview of racial and socioeconomic disparities in substance abuse treatment in the United States. It discusses how factors like insurance coverage, treatment availability, and social determinants can influence disparities in treatment completion and outcomes. Specifically, it notes that Black and Hispanic youth are less likely to complete substance abuse treatment than white youth. While Medicaid expands coverage for treatment, not all providers accept it, creating availability issues. The document also explores historical models of addiction and how they impacted disparities, and examines various treatment approaches including medication-assisted treatment, peer-based support, and harm reduction strategies.
Hospice aims to treat the whole person rather than the disease and focus on quality of life over length of life. It provides comfort and dignity for patients dealing with terminal illness through physical, spiritual, and emotional support for patients and their families. There are several ethical issues around patient autonomy, access to care, and overcoming barriers for underserved groups. A lack of communication and cultural understanding can negatively impact minority groups' access and experience with hospice care. Additionally, over-reliance on technology risks losing personal interactions that are important for end-of-life care.
The document discusses the epidemiology course which covers applying epidemiological procedures to understand occurrences and control of various health conditions. The course objectives are to provide mastery in various epidemiological assessment tools and research designs. It details the grading system, schedule, attendance policy and introduces concepts of epidemiology like descriptive epidemiology and epidemiology of infectious diseases.
Program design and management6 social service programsPOLY33
The National Head Start Association (NHSA) is a non-profit organization that provides early childhood education and support services to low-income families through Head Start programs. NHSA serves over 1 million children through 1,600 local programs. Its mission is to support the Head Start model and advocate for policies that help vulnerable children and families succeed. Head Start programs provide education, health care, parent involvement, and social services to young children and their families. NHSA aims to expand access to Head Start and adapt its services to changing community needs.
This document discusses various types of health indicators that can be used to measure and monitor the health status of a population. It describes indicators such as mortality rates, morbidity rates, disability rates, nutritional status indicators, and utilization rates. Mortality indicators measure deaths, such as infant mortality rate and life expectancy. Morbidity indicators reflect disease burden through incidence and prevalence. Disability rates assess healthy life years lost. Nutritional status is indicated by metrics like stunting. Utilization rates reflect access to healthcare services. The document provides examples for many common health indicators.
Epidemiology has several common practical applications. It is used to investigate infectious diseases through routine surveillance by health departments. Epidemiologists in hospitals explore causes of hospital-acquired infections. It also evaluates the impact of public health policies on trends like smoking rates and obesity. Overall, epidemiology provides data to understand community health issues and disease risks, identify disease syndromes, uncover disease causes, and evaluate treatments and interventions.
Association of an Educational Program in Mindful Communication With Burnout, ...DAVID MALAM
This document summarizes a study that evaluated the effectiveness of an educational program in mindful communication for primary care physicians. The program included mindfulness meditation, narrative exercises, and appreciative inquiry techniques. It was associated with short-term and sustained improvements in physician well-being, burnout, empathy, mood, and personality factors related to patient-centered care. However, the before-and-after study design limits conclusions about the causal effects of the intervention. Randomized trials with larger and more diverse groups of physicians are needed to validate these preliminary findings.
Epidemiological methods are used to study the distribution and determinants of health-related events in populations. There are two main approaches: observational studies and experimental studies. Observational studies include descriptive and analytical methods. Descriptive methods involve measuring disease occurrence without interference to understand time, place, and person distributions. Analytical methods include case-control and cohort studies to test hypotheses about associations between suspected causes and diseases.
Natural History of Disease & Levels of preventionsourav goswami
I have tried to explain the National History of Disease taking the example of a disease condition. Similarly, the different prevention levels are also explained in a similar manner. The presentation also includes few newer concepts of screening like lead time and length time bias.
N.B: Please download to see all the animations.
Physicians provided care at 69% of community health center visits from 2006-2008, while nurse practitioners saw 21% of visits, physician assistants saw 9% of visits, and certified nurse midwives saw 1% of visits. The majority of visits were by Medicaid/SCHIP-insured or uninsured patients and by patients under age 45. Nurse practitioners and certified nurse midwives saw a higher percentage of female patients aged 18-44 compared to other providers. Physicians were more likely than other providers to see patients aged 45 and over. A higher percentage of nurse practitioner and physician assistant visits included health education and counseling compared to physician visits.
This document provides a summary of the education and professional experience of Roderick S. Hooker. It details that he received a PhD in Health Policy from Portland State University in 1999, and has since held various academic positions, including as an Adjunct Professor at multiple universities. His professional experience includes serving as the Director of Rheumatology Research at the Dallas VA Medical Center and Senior Director at The Lewin Group. He has extensive experience conducting national studies and research in areas of health policy, rheumatology, and the physician assistant profession.
2010 05 Morgan Hooker PA Speciatly Health Affairsrodhooker
1) The number of PAs working in primary care specialties like family medicine has declined from 54% in 1996 to 41% in 2005, while the proportion working in medical and surgical subspecialties has increased more rapidly than the overall growth of the PA workforce.
2) The ratios of physicians to PAs vary widely between specialties, from 1:3 in cardiovascular surgery to 1:33 in general pediatrics. Specialties with the highest PA to physician ratios tend to be high-paying subspecialties.
3) Salary appears to correlate with specialty choice for PAs, especially in the highest-paying subspecialties. However, other non-financial factors also likely influence PA specialty
2011 04 Sargen Hooker Cooper Gaps In Physician Supplyrodhooker
If current projections for training programs of advanced practice nurses and physician assistants are realized but physician residency programs are not expanded, the combined supply of advanced clinicians will be 20% less than projected demand in 2025. Increasing the number of first-year residency positions by 500 annually would narrow but not close the gap, which would remain above 15%. Efforts must be made to expand training of physicians, advanced practice nurses, and physician assistants, while also reforming clinical practice models to facilitate task sharing among a broader range of providers.
2010 05 Hooker Cawley Leinweber PA Career Flexibilityrodhooker
1) Nearly half (49%) of physician assistants change specialties at some point in their careers, with 24% switching specialty classes.
2) Over four decades, physician assistants have demonstrated career flexibility in responding to changing healthcare needs by adapting their specialties.
3) This career flexibility could help address workforce shortages, such as in primary care, by incentivizing physician assistants to work in high-demand specialties.
2011 01 Hooker Klocko Larkin PA Emergency Medicine Rolesrodhooker
This document summarizes a literature review examining the role of physician assistants (PAs) in emergency departments. It finds that:
1) The demand for emergency care is rising substantially but the number of emergency physicians is not, leading to a growing shortage. PAs are being utilized more to help meet this increased demand.
2) Studies show PAs can effectively manage patient treatment and help with emergency service operations. However, evidence of their clinical effectiveness compared to physicians is limited.
3) The use of PAs in emergency departments is increasing and expanding their roles due to staffing needs and cost-effectiveness. Their unique contributions include wound management, patient transfers, and coverage in rural areas with physician shortages.
Este documento presenta una cotización para la compra de equipos de cómputo para diferentes tipos de usuarios, incluyendo usuarios finales, desarrolladores de software, diseñadores gráficos, portátiles de gama alta y baja. Detalla los componentes, marcas, cantidades y precios unitarios de cada elemento necesario para armar los equipos según el perfil del usuario, así como los subtotales y totales a pagar.
1. NPs primarily addressed periodic health examinations and acute respiratory infections, while FPs primarily addressed cardiovascular diseases and musculoskeletal conditions.
2. NPs provided more disease prevention and supportive services per FTE than FPs, while FPs provided more curative and rehabilitative services per FTE than NPs.
3. Referral patterns showed that FPs were more likely to recommend follow-up with another FP, while NPs were more likely to recommend follow-up with another NP, indicating little evidence of shared care between NPs and FPs.
Three key barriers to the diagnosis and treatment of depression in Jordan were identified from focus groups with primary health care providers:
1) Lack of education about depression among providers which hinders proper identification, diagnosis, and treatment.
2) Limited availability of appropriate therapies like counseling services and antidepressant medications at primary care clinics.
3) Social stigma surrounding mental illness that prevents patients from accepting depression diagnoses due to beliefs that it reflects poorly on themselves or their families.
Addressing these barriers through provider education, expanding mental health services, and destigmatizing depression could improve rates of recognizing and treating depression in Jordan's primary care system according to the researchers.
Development and evaluation of an intervention to support family caregivers of...beatriz9911
This study aimed to develop and evaluate an intervention to support family caregivers of cancer patients providing home-based end-of-life care. In Phase 1, interviews with 29 caregivers identified their needs for practical information and support skills. Based on these findings, the researchers created an informational booklet as the preferred format. In Phase 2, 31 caregivers and 14 nurses evaluated the booklet. Caregivers reported feeling more positive, reassured, and competent in their caregiving role after using the booklet. Nurses found the booklet useful and received fewer calls from caregivers who used it. However, caregivers indicated they would have benefited from receiving the booklet earlier in the care trajectory. The researchers concluded the
This project aimed to analyze health data from six Native nations to identify actions to improve community health outside the conventional healthcare system. However, comparable health data across tribes was unavailable. Three new areas of inquiry emerged: 1) Tribes need skills and resources to conduct their own data collection and analysis to support their goals, rather than relying on inaccurate federal data. 2) While tribes have public health authority, they lack infrastructure, capacity and information to operate effective public health systems due to insufficient federal funding and data issues. 3) The social determinants framework for understanding Indigenous health has not been systematically researched and makes assumptions that are not fully applicable, so tribes need community-based efforts to define their own conceptions of health and identify determinants
Pharmacology and Diverse Populations Scoring GuideCRITERIA.docxmattjtoni51554
Pharmacology and Diverse Populations Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Describe the health
concerns and issues
for a population.
Does not describe
the health concerns
and issues for a
population.
Identifies the health
concerns and issues
for a population.
Describes the health
concerns and issues
for a population.
Describes the health
concerns and issues
for a population and
includes information on
rates of occurrence,
severity, and mortality.
Describe current
pharmacological
treatment regimens
for the health
concerns and issues
of a population.
Does not describe
current
pharmacological
treatment regimens
for the health
concerns and issues
of a population.
Lists current
pharmacological
treatment regimens for
the health concerns
and issues of a
population or describes
pharmacological
treatment regimens
that are not current.
Describes current
pharmacological
treatment regimens
for the health
concerns and issues
of a population.
Describes current
pharmacological and
non-pharmacological
treatment regimens for
the health concerns
and issues of a
population.
Explain traditional
beliefs and practices
of a population with
regard to health
concerns and
issues.
Does not explain
traditional beliefs and
practices of a
population with
regard to health
concerns and issues.
Identifies traditional
beliefs and practices of
a population with
regard to health
concerns and issues.
Explains traditional
beliefs and practices
of a population with
regard to health
concerns and
issues.
Explains traditional
beliefs and practices of
a population with
regard to health
concerns and issues
and includes how the
beliefs and practices
are carried out and
their effect on the
health concerns.
Explain how the
cultural values and
traditional practices
of a population
affect the
acceptance and use
of pharmacology.
Does not explain
how the cultural
values and traditional
practices of a
population affect the
acceptance and use
of pharmacology.
Explains how the
cultural values and
traditional practices of
a population affect the
acceptance and use of
pharmacology, but the
explanation is
incomplete or missing
supporting evidence.
Explains how the
cultural values and
traditional practices
of a population affect
the acceptance and
use of
pharmacology.
Explains how the
cultural values and
traditional practices of
a population affect the
acceptance and use of
pharmacology and
discusses how culture
and traditional
practices can impact
the efficacy of
prescribed
medications.
Identify evidence-
based, culturally
sensitive strategies
an organization can
use to educate a
population about the
appropriate use of
pharmacology.
Does not identify
evidence-based,
culturally sensitive
strategies an
organization can use
to educate a
population about the
appropriate use of
pharmacology.
Identifies cultura.
This study examined the psychological well-being and retention of rural general practitioners (GPs) in South Australia. A survey of 187 rural GPs found that those seriously considering leaving rural practice reported higher work-related distress, lower work-related morale, and lower quality of work life than those not considering leaving. GPs considering leaving also reported having fewer colleagues with whom to discuss professional issues. The results indicate that psychological interventions targeting stress reduction and coping mechanisms, such as cognitive behavioral training and increased interaction with colleagues, may help increase retention of rural GPs by improving their psychological well-being.
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docxransayo
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it has been estimated that more than 60% of patient
visits to primary care physicians (PCPs) include mental health concerns (Moon, 1997), and
many of these concerns may not be the presenting complaint (Jackson & Tisher, 1996;
Schurman, Kramer, & Mitchell, 1985). Several MFT ⁄ FP teams have developed models for col-
laboration (Doherty & Baird, 1983; Dym & Berman, 1986; Hepworth & Jackson, 1985; Sea-
burn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). Other researchers and practitioners have
written books that serve as a guide to other mental health practitioners for how to be effective
collaborators with other healthcare practitioners (e.g., Seaburn et al., 1996).
The specialty of family medicine, which arose in the 1960s, embraces a systemic, biopsy-
chosocial perspective to illness that stresses the importance of caring for the whole person
within his or her family, social context, and life cycle stage (Chung, 1996; Fischetti &
McCutchan, 2002). It is not surprising that FPs regularly treat their patients’ mental health
problems. By definition of their specialty, FPs are trained to integrate behavioral science con-
cepts with their biomedical training (AAFP, 2000; Seaburn et al., 1996) as well as to manage
Rebecca E. Clark, MS, Lifespan Family Healthcare, Newcastle, Maine; Deanna Linville, PhD, Couples and
Family Therapy .
Residents and family members perceived nurse practitioners in long-term care homes positively, seeing them as providing both resident- and family-centered care as well as enhancing the overall quality of care. Nurse practitioners were seen as establishing caring relationships, providing informational and emotional support, facilitating participation in decision-making, improving access to timely care, and helping to prevent unnecessary hospitalizations. The perceptions of residents and family members aligned with concepts of person-centered and relationship-centered care.
Family Therapy CourseUsing the brief case description below, pre.docxssuser454af01
Family Therapy Course
Using the brief case description below, prepare a script you could use to call the mock client’s pediatrician for a 10-minute conversation. To prepare, consider the following: What facts do you need to communicate to the doctor? What will the doctor likely want to know from you? What will you want to be sure to tell the doctor about your diagnosis of him having ADHD and treatment plan for family? You diagnose that he should be placed on medication and pediatricians nurse prescribe the diagnosis level
Case description: Your client is an 8-year-old male whose parents are concerned might have ADHD. He is the middle child of three boys. You have met the parents and the child in your initial sessions. At this point, you have had only three sessions with the family. Your client says he has lots of friends, he hates school because it’s boring, and his parents yell at him too much!
Write a mock transcript of an imaginary phone call between you and the client’s physician. In your mock discussion, include information you would provide to the doctor about your assessment, treatment plan, and orientation to treating ADHD; include the doctor’s questions or responses to the information you provide. Also, include questions you would ask the doctor, and the doctor’s responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it ...
#35773 Topic PROBLEM STATEMENT AND LIT REVIEW FOR END OF LIFE CAR.docxAASTHA76
#35773 Topic: PROBLEM STATEMENT AND LIT REVIEW FOR END OF LIFE CARE
Number of Pages: 2 (Double Spaced)
Number of sources: 5
Writing Style: APA
Type of document: Essay
Academic Level:Master
Category: Nursing
Language Style: English (U.S.)
Order Instructions:
PROBLEM STATEMENT AND LIT REVIEW
Evidence-based practice is extremely important in nursing. Throughout your master’s program, you will complete research on various topics. Knowing how to construct a strong problem statement and complete a critical analysis of the available information to write a literature review is essential. Follow the instructions in the bullets below to direct you where to find resources on problem statements and literature reviews.
You will write a problem statement and perform a literature review in preparation for your ethical issues debate presentation.
Share your problem statement in this discussion so that you can review each other’s work and provide peer-to-peer feedback.
Also, describe what you think are the most important learning takeaways from the literature review resources you reviewed.
THIS IS MY TOPIC FOR DEBATE:
ETHICAL ISSUES ON END OF LIFE CARE
" All human-beings are mortals and hence death is an inevitable occurrence" (Karnik and Kanekar, 2016). With the medical advancement and technology nowadays, there are some ethical issues on end of life care . The limitations of health care workers vs the quality patient care and of course the decision of the patient itself are all conflicting at the same time. Respecting patient's right, patient advocacy and PSDA should be taken into consideration and respected.
PROs - better decision-making - both for health care workers and family, reducing lawsuits, quality patient care
CONS - cost of care, death
Reference: FOR END OF LIFE CARE
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934577/
• EBP and levels of evidence: https://www.nurse.com/evidence-based-practice
• The relationship between EBP and “big ideas” in nursing:http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html
• The limitations of EBP: https://www.cebma.org/faq/limitations-evidence-based-practice/
I WILL ATTACH SOME MATERIALS/REFERENCES
Ethics Perspectives on End-of-life Care
Virginia P. Tilden, RN, DNSc, FAAN
Aggressive medical management of the terminally ill
has given rise to significant issues in the ethics of end-
of-life care. The major ethics principles of autonomy,
beneficence, and justice help frame existing research
findings. A w a v e of national initiatives to improve
end-of-life care is occurring.
T echnologic advancements in aggressive medical manage- ment at the end o f life now have led more Americans to
fear how they die than death itself. The lay popular press 1-4
reflects how widespread is public dissatisfaction about health
care system management o f dying .
Prepared by louise kaplan, ph d, arnp, fnp bc, faanp senior pamit657720
This document provides a framework for critiquing research studies. It outlines 14 key aspects of a research article to evaluate, including the title, abstract, introduction, literature review, methods, analysis, results, discussion, limitations and conclusion. It recommends determining the level and quality of evidence using an appropriate scale. Finally, it asks the reader to decide if the study is applicable to their own practice. The overall purpose is to provide guidance on thoroughly reviewing and assessing the strengths and weaknesses of a research article.
Community members and stakeholders in North Carolina provided perspectives on health equity as part of a statewide healthy environments initiative. Through focus groups and interviews, they discussed three strategies - farmers markets, shared outdoor spaces, and smoke-free housing. Two key themes emerged. First, "access" - how easy it is for communities to use resources. Factors like location, cost, and safety can create barriers. Second, "community fit" - whether a strategy aligns with community values and norms. Suggestions to improve equity focused on transportation, market hours, safety, and involving both smokers and nonsmokers in policy decisions. The views of community members and stakeholders can help shape culturally-relevant strategies to promote health and prevent chronic diseases
(2016) NorthBEAT: A mixed-method approach to examine the needs of youth in No...Dr. Chiachen Cheng
2016 International Early Psychosis Association (IEPA) 10th Biennial Conference: Milan, Italy. October 2016.
Poster Presentation
CHENG C, NADIN S, KATT M, LEM C, DEWA CS, MINORE B
Acknowledgements: The NorthBEAT Project was funded by the Sick Kids Foundation in partnership with CIHR. Attendance at this conference is supported by St. Joseph’s Care Group Thunder Bay.
This document summarizes a study examining the mental health needs of Latino older adults. The study used surveys and focus groups of 121 Latino older adults to understand barriers to mental health services, satisfaction with services, and preferences for treatment. Key findings included high satisfaction with traditional and non-traditional services but significant barriers like language difficulties, lack of provider cultural competence, and lack of transportation or health insurance. The study provides guidance for developing more accessible and culturally-appropriate mental health programs for this population.
State Tested Nursing Aides’Provision of End-of-LifeCare in.docxdessiechisomjj4
State Tested Nursing Aides’
Provision of End-of-Life
Care in Nursing Homes
Implications for Quality Improvement
Emma Nochomovitz, MPH
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN
Mary Dolansky, PhD, RN
Mendel E. Singer, PhD
Peter DeGolia, MD, CMD
Scott H. Frank, MD, MS
v An increasing prevalence in deaths occurring
within nursing homes has led to a growing
concern surrounding quality issues in end-of-life
(EOL) nursing home care. In addition, prior
research has failed to emphasize the importance
of state tested nursing aides (STNAs) in
providing this type of care. The purpose of this
study was to examine quality issues in EOL
nursing home care within the context of STNAs’
comfort in providing this care. A convenience
sample of 108 STNAs from four nursing homes
in the Cleveland, Ohio area used PDAs to
provide answers to an audio questionnaire.
Questions included emergent themes from the
literature pertaining to EOL care in nursing
homes, as well as materials from a national
education initiative to improve palliative care.
Findings demonstrated lack of comfort in
discussing death with nursing home residents
and their families and insufficient knowledge
surrounding EOL decisions and certain types
of EOL care. Overall, the level of comfort
providing EOL care was found to be associated
with STNAs’ perceived importance of EOL
care, understanding of hospice, and spiritual
well-being.
JOURNAL OF HOSPICE AND PALLIATIVE NURSING v Vol. 12, No. 4, July/August 2010 255
Author Affiliations: Emma Nochomovitz, MPH, is
Research Analyst, National Quality Forum,
Washington, DC and Case Western Reserve
University, Cleveland, OH.
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN,
is Assistant Professor, Frances Payne Bolton School of
Nursing, Case Western Reserve University, Cleveland, OH.
Mary Dolansky, PhD, RN, is Assistant Professor,
Frances Payne Bolton School of Nursing, Case
Western Reserve University, Cleveland, OH.
Mendel E. Singer, PhD, is Associate Professor,
Department of Epidemiology and Biostatistics, Case
Western Reserve University, Cleveland, OH.
Peter DeGolia, MD, CMD, is Director, Center for
Geriatric Medicine, University Hospitals Case
Medical Center and Associate Professor, Family
Medicine, Case Western Reserve University School of
Medicine, Cleveland, OH.
Scott H. Frank, MD, MS, is Director, Master of
Public Health Program, Department of Epidemiology
and Biostatistics, Department of Family Medicine,
Case Western Reserve University, Cleveland, OH.
Address correspondence to Emma Nochomovitz,
MPH, National Quality Forum, 601 13th St
NW, Suite 500 North Washington, DC 20005
([email protected]).
K E Y W O R D S
end-of-life care
hospice
nursing aides
nursing home
I
n recent years, the growth of the older segment of
the population and the prevalence of chronic illness
have led to increased institutionalization of the frail
and elderly prior to their deaths. In particular, nursing
homes have been identified as a place in which end-of-
life .
This document summarizes a study on the motivational drivers for non-skilled Kenyan community health volunteers. The study found that the largest proportion of volunteers provide services in maternal and child health and HIV/AIDS and malaria. The main motivations for volunteers include fulfilling religious values, serving humanity, and access to training and support. Most volunteers are female and over 30 years old, with the largest group providing maternal and child health services. Their motivations help address healthcare worker shortages in Kenya.
Assessing the Quality of End of-Life Care for Older Persons with Advanced Dem...mjbinstitute
Dementia is one of the most devastating illnesses affecting older persons. According to a survey from the Myers-JDC-Brookdale Institute, approximately 5% of Israeli elderly living in the community have advanced dementia.
This first study of the care of older people with advanced dementia in Israel reveals a wide range of unmet health and social service needs. It points to the need for a comprehensive policy for developing services to improve the quality of care and reduce the burden on the families.
The findings are contributing to the implementation of the national strategic plan for addressing the challenges of dementia, currently being implemented by the Ministry of Health, and to a new national program for palliative care for people with terminal illnesses, which is in the planning stages as a joint initiative of the Ministry of Health, JDC-ESHEL, and MJB.
The study was funded with the assistance of the Helen Daniels Bader Fund of Bader Philanthropies of Milwaukee, Wisconsin.
SLC CME- Evidence based medicine 07/27/2007cddirks
Saint Luke's Care, a quality improvement organization within Saint Luke's Health System, presents a CME presentation by Dr. Brent Beasley on Evidence Based Medical Care.
The Mental Health of Federal Offenders A SummativeReview of.docxoreo10
The Mental Health of Federal Offenders: A Summative
Review of the Prevalence Literature*
Philip R. Magaletta,1 Pamela M. Diamond,2,5 Erik Dietz,3 and Stephen Jahnke4
To date, only a small number of government and peer-reviewed studies have examined the
mental health of federal offenders. Although these studies provide isolated bits of
information they have yet to be organized into a coherent body of knowledge from which
clinicians, administrators and policy makers can inform their work. As a first step in
constructing this knowledge and understanding the possible mental health needs of this
population (currently America’s largest correctional population), this paper delineates the
available government and peer-reviewed studies on federal offenders, highlights their
convergent findings, and suggests opportunities for growth in research, administration and
policy.
KEY WORDS: offenders; federal prisons; service utilization; diagnoses.
There is an increasing demand for effective,
empirically informed, prison-based mental health
services in America. It is a demand driven by the
needs of the offender population, the clinicians who
serve them, and the public’s expectation of
accountability. It is the product of multiple factors:
courts mandating that mentally ill persons receive
treatment while in custody; national mental health
screening and treatment standards being rigorously
applied; and increasingly porous boundaries be-
tween the mental health and criminal justice systems
(Fisher et al., 2002; Jemelka, Trupin, & Chiles,
1989). Furthermore, growth in the offender popu-
lation has remained mostly constant (Harrison &
Beck, 2005) and little debate remains that the
prevalence of mental illness in prison populations is
higher than that of the general population (Dia-
mond, Wang, Holzer, Thomas, & Cruser, 2001;
Jemelka et al., 1989). Finally, among community
mental health providers there is an increasing rec-
ognition that many patients have histories of crimi-
nality, incarceration, and prison-based mental health
treatment (Jemelka et al., 1989; Manderschied,
Gravesande, & Goldstrom, 2004; Morgan, Beer,
Fitzgerald, & Mandracchia, in press).
Far beyond the application of mental health
principles to those who ‘‘simply’’ happen to be
incarcerated, the provision of mental health services
in corrections remains a complex enterprise. It re-
quires strong clinicians, administrators who have a
keen and sensitive understanding of the multiple
systems comprising the correctional environment,
and policy makers who can draw upon an empirical
understanding of the population’s needs. To inform
the effective deployment of mental health resources
to this growing population it is imperative that this
*The views expressed in this paper are those of the authors (Philip
R. Magaletta and Erik Dietz) only and do not necessarily rep-
resent the policy or opinions of the Federal Bureau of Prisons,
the Department of Justice, or their academic affiliates.
1
Psycholo ...
Similar to 2011 06 Henry Hooker Yates Role P As Rural Health (20)
The Mental Health of Federal Offenders A SummativeReview of.docx
2011 06 Henry Hooker Yates Role P As Rural Health
1. ORIGINAL ARTICLE
The Role of Physician Assistants in Rural Health Care:
A Systematic Review of the Literature
Lisa R. Henry, PhD;1 Roderick S. Hooker, PhD, PA;2 & Kathryn L. Yates, BA1
1 Anthropology Department, University of North Texas, Denton, Texas
2 Department of Veterans Affairs, Dallas VA Medical Center, Dallas, Texas
Abstract
Purpose: A literature review was performed to assess the role of physi-
cian assistants (PAs) in rural health care. Four categories were exam-
For further information, contact: Lisa R. Henry, ined: scope of practice, physician perceptions, community perceptions, and
PhD, Anthropology Department, University of retention/recruitment.
North Texas, 1155 Union Circle, Box 310409, Methods: A search of the literature from 1974 to 2008 was undertaken by
Denton, TX 76203; e-mail: lisa.henry@unt.edu.
probing the electronic bibliographic databases of English language literature.
Criterion for inclusion was original data published on rural PAs. Each paper
doi: 10.1111/j.1748-0361.2010.00325.x
was assessed and assigned to the four categories.
Findings: A total of 51 papers were identified; 28 papers had a primary focus
on research and specified PAs in a rural setting. Generally, the literature
suggests that PAs provide cost-efficient and supplemental medical services
to underserved rural populations and that these services are valued. It also
appears that rural PAs possess a larger scope of practice than urban PAs. This
broad range of skills and procedures may be necessary to match the extensive
health care needs of underserved rural populations. Over a 35-year period
of examination, the literature improved in numbers of PAs studied and the
quality of research. However, the lack of longitudinal studies was considered a
shortcoming of rural health PA observational research.
Conclusions: Through this review, some insights about the role of PAs
emerged. Overall, they seem well adapted to rural health. Important issues
regarding the recruitment and retention of PAs to rural populations also
emerged. Improvement in enabling legislation contributes to the utilization
of PAs in America.
Key words Acceptance, physician assistants, primary care, retention, rural
health care.
Physician assistants (PAs) are health care professionals To qualify for practice, PAs must be licensed (creden-
trained within the medical model and licensed to practice tialed) in the state where they work. All PAs must grad-
medicine under the supervision of a licensed doctor.1 uate from an accredited educational program and pass
During the mid-1960s, the PA emerged in the United a certifying examination administered by the National
States in an effort to relieve a nationwide shortage of Commission on Certification of PAs. To work clinically
doctors in primary care, as well as to increase access the PA must obtain authorization to practice from the
to health care for patients in rural and underserved appropriate regulatory board and be supervised by a
populations.2 The number of PAs in America has steadily doctor. Since 2007, all states have enabled legislation that
increased and as of 2009, there were 148 PA programs sanctioned delegated prescribing by PAs and permitted
and over 72,000 clinically active PAs.3 The PA model PAs to prescribe controlled substances.
has also been implemented in Canada, the Netherlands, The development of PAs was intended to improve
Australia, South Africa, England, and Scotland.1 health care delivery. There were no preconditions to
The Journal of Rural Health 00 (2010) 1–10 c 2010 National Rural Health Association 1
2. Role of Physician Assistants in Rural Health Care Henry, Hooker and Yates
this development, but the early creators were strongly “nonphysician provider,” “PA,” and “mid-level provider.”
aware of a social mandate to improve access to These search terms were matched with “rural,” “under-
care in rural and underserved communities. Conse- served,” “practice location,” “rural health,” and “short-
quently, PAs from many of the first education programs age.” To ensure a comprehensive search, we included a
went to rural areas in West Virginia, North Carolina, manual search through journals, Internet resources, and
Colorado, Oregon, and Washington State.1 Almost from bibliographies of retrieved articles. Our criterion for inclu-
the beginning, researchers began documenting PAs in sion was original data published on rural PAs. All authors
terms of personality, geographical location, practice and reviewed each paper and assessed its characteristics. Any
population characteristics, and economics. However, only level of disagreement was resolved by consensus.
a few studies examine the role of the rural PA. Interest Each paper was analyzed, abstracted, and categorized
in this topic is growing because of a shortage of doctors into the following categories:
across North America. Since 2000, far fewer doctors
have been choosing rural care or primary care.4 Other 1. scope of practice;
countries are also looking at PAs from a rural deployment 2. physician perception;
standpoint.5,6 3. community perception;
In 1977, the US Congress enacted the Rural Health 4. retaining and recruiting rural PAs.
Clinics Act (Public Law [PL] 95-210), which among other
actions, encouraged the use of PAs, nurse practitioners
Results
(NPs), and certified nurse midwives in rural areas since
many small communities could no longer support a A total of 51 papers were identified and reviewed.
sufficient number of physicians. PL 95-210 facilitated Twenty-eight papers met the criterion of a primary focus
rural health expansion by entitling various providers to on research and specified PAs in a rural setting. Arti-
receive reimbursement from Medicare and Medicaid on cles that lacked original data, editorials, and nonspecific
a cost basis. However, after four decades, information on articles that were outside the objectives of the review
the PA’s role in rural health remains fragmented from were omitted. Informative literature regarding the PA’s
a national standpoint. What is the accumulative role of history and role in rural health care was omitted from
PAs and NPs in rural health? Our intent is to identify, the summary table (see Table 1), but it was included in
appraise, select, and synthesize the research evidence the discussion and references.
about 1 type of provider. We purposely focus on PAs The span of the literature review was from 1974 to
but include references to NPs where appropriate. The 2008. Two-thirds of the papers were published after
rationale is that the PA is trained in the medical model 1989. An increasing trend in both the number of pub-
and is in a dependent relationship with an employing lished studies and the size of the population studied was
physician. NPs, on the other hand, are sanctioned to work observed over the 35-year study period. Some of the
independently in many states, which distinguishes them research was centered on a state or geographical region,
from PAs, and their role may be different. with other studies being national in scope. Overall, the
methodology employed was broad: 17 surveys, 8 inter-
views/focus groups, and 4 secondary analyses of large
Objective
databases. A few of the papers overlapped in method-
The primary objective was to perform a review of the ology (eg, survey and interview). The manuscripts were
literature in order to evaluate the factors that contribute published in peer-reviewed journals: 10 in The Journal
to the assumed role of PAs in rural practice locations. of Rural Health, 5 in the Journal of the American Academy
The secondary objective was to identify any relationship of Physician Assistants, and the remainder spread over 12
among those factors that influence the retention and other journals.
recruitment of PAs in rural practice.
Scope of Practice
Methods
“Scope of practice” is terminology used by state licensing
A search of the English-speaking literature was under- boards for PAs as well as many other professions. The
taken spanning the years 1966 to 2009. We employed the term generally defines the limit to which the law, an
computer bibliographic databases of MEDLINE, Google organization, or an employer permits the PA to provide
Scholar, and the Cumulative Index of Nursing and Al- care, procedures, actions, and processes. The experience
lied Health Literature (CINAHL). Key search terms in- and competency of the PA helps to define the scope of
cluded “physician(s) assistant,” “physician(s) extender,” practice.1
2 The Journal of Rural Health 00 (2010) 1–10 c 2010 National Rural Health Association
3. Henry, Hooker and Yates Role of Physician Assistants in Rural Health Care
Table 1 Public Papers on Rural Health Physician Assistants
Target Population
First Author Year Reference# Journal Location Year Studied Methods Number Studied Results
13 ∗
Anderson (1999) J Rural Health Nationwide National Hospital PAs and NPs—N/A Describes the
1994 Ambulatory Medical cost-effectiveness of
Care Surveys PAs in rural practice
1994
Asprey (2006)18 J Physician Assist Rural Iowa Mailed survey PAs in rural primary Identifies the PAs most
Educ 2002 care practice—94 frequently
performed skills in
towns with <10,000
people
Baldwin (1998)25 Public Health Nurs Rural Midwest 1996 Five focus groups Rural community Describes the
members per focus community
group—4-9 perceptions of rural
PAs
Bergeron (1997) 23 J Rural Health Rural Minnesota Mailed survey Physicians—277 Reveals the positive
1995 and negative
perceptions of MDs
regarding the role
and practice of rural
PAs
Bergeron (1999) 10 J Rural Health Rural hospitals in the Mailed survey and Rural hospital Discusses the tasks
United States case studies administrator—285 and benefits related
1995–1996 Hospitals observed in to PAs in small rural
a case study—36 hospitals
Burgess (2003)21 J Rural Health South Carolina Mailed survey Rural and urban Reveals the positive
2001 primary care and negative
physicians—681 perceptions of MDs
regarding the role
and practice of rural
PAs
Chumber (2001)9 J Allied Health Wisconsin 1997 Mailed survey PAs, full-time and PAs who practice in
part-time—433 rural communities
have a high degree
of practice
autonomy
Ford (1998)11 J Am Acad Nurs Family practice residency Semi-structured Physicians in a family Reveals the positive
Practitioners program in the interview/ practice residency and negative
Southeast United Qualitative program—10 perceptions of MDs
States 1996 methodology regarding the role
and practice of rural
PAs
Gairola (1982)38 J Commun Health Kentucky 1982 Mailed survey PA graduates from the Discusses PA
University of characteristics that
Kentucky’s Clinical relate to location
Associate Program decisions
Henry (2007)12 J Rural Health Eight rural towns in Texas Direct observation, PAs, town mayors, Describes factors
2005 semi-structured and town contributing to the
interviews, and representatives—8 retention of rural
focus groups PAs
Henry (2008)26 J Physician Assist Eight rural towns in Texas Direct observation, PAs, town mayors, and Describes factors
Educ 2005 semi-structured town contributing to the
interviews, and representatives: 8 retention of rural
focus groups Average focus PAs
group—8
Continued
The Journal of Rural Health 00 (2010) 1–10 c 2010 National Rural Health Association 3
4. Role of Physician Assistants in Rural Health Care Henry, Hooker and Yates
Table 1 Continued
Target Population
First Author Year Reference# Journal Location Year Studied Methods Number Studied Results
20
Hooker (2005) J Rural Health Nationwide Data drawn from Physicians, rural and PAs more likely to
1997-2002 6 years of National urban—2,500 prescribe controlled
Ambulatory Medical substances than
Care Surveys on NPs or physicians;
prescribing trends PAs wrote fewer
prescriptions than
NPs in rural areas
Isberner (2003)16 Perspect Physician Rural Illinois Mailed survey Rural physicians—226 Reveals the positive
Assist Educ 2000 and negative
perceptions of MDs
regarding the role
and practice of PAs
Krein (1997)15 J Rural Health Eight Midwest states Telephone interviews Hospital Identifies
1994 administrators— characteristics of
407 rural PA practice
and employers’
hospitals
Larson (2007)28 J Allied Health Nationwide 1967-2000 Data from the AAPA PAs working in Discusses how trends
supplemented with the United in practice
data from the ARF States—49,641 specialization and
education affect
retention and
recruiting
Larson (1999)29 J Rural Health Nationwide Mailed survey PAs – 1,521 Verifies a health care
1993-1994 shortage in rural
practice locations
and discusses
retention and
recruitment
Legler (2003)30 Perspect Physician Pacific Northwest Results from funded PA students/whole Reveals methods of
Assist Educ 1999–2002 project community—35 rural recruitment
and retention of PAs
Lindsay (2007)34 J Rural Health New York and Semi-structured PAs, NPs, and nurse Reveals the role of
Pennsylvania 2003 interviews anesthetists—55 gender in PA
location decisions
Martin (2000)8 J Am Acad Pennsylvania 1996 Mailed survey PAs—1,002 Describes differences
Physician Assist (Dillman’s total between PAs in rural
design method) and urban practice
1996
Muus (1998)36 J Rural Health Nationwide 1996 Mailed survey Rural PAs—1,263 Describes the
relationship
between job
satisfaction and
rural PA retention
Muus (1996)37 J Am Acad AAPA membership Mailed survey Primary care PAs Discusses the
Physician Assist database 1994 2,500 surveyed; implications for
1,534 responded recruitment by
comparing urban
and rural PAs
Nelson (1974)27 JAMA Eighteen practices in Mailed survey Patients—449 Describes the
upper New England community
1972 perceptions of rural
PAs in upper New
England
Continued
4 The Journal of Rural Health 00 (2010) 1–10 c 2010 National Rural Health Association
5. Henry, Hooker and Yates Role of Physician Assistants in Rural Health Care
Table 1 Continued
Target Population
First Author Year Reference# Journal Location Year Studied Methods Number Studied Results
24
Oliver 1986 Physician Assist Midwestern rural Questionnaire Patients—308 Describes the
communities 1985 distributed PAs—11 community
following visit perceptions of rural
PAs in Midwestern
communities
Pan (1996)35 Hosp Health Serv Nationwide 1993–1994 Mailed survey Members of American Discusses the factors
Adm Academy of that relate to PA
Physician retention and
Assistants—1,560 recruiting in rural
responses practice
Shi (1993)14 J Rural Health Nationwide 1991 Mailed survey and Community and Reveals patterns of
telephone migrant health retention and
interviews center recruitment among
administrators— community and
243 migrant health
centers
Staton (2007)22 J Am Acad Nationwide survey Weighted logistic Retrospective Analysis Discusses the
Physician Assist 1997-2003 regression analysis of National contributions of PAs
Ambulatory Medical to rural health care
Care Survey and the issues that
Data—N/A contribute to their
retention
Travers (1996)39 J Am Acad Communities in Maine Mailed survey, Former rural PAs 25 Reveals reasons for PA
Physician Assist with populations telephone interview departure from rural
<10,000 1988-1990 practice
∗
N/A, not applicable.
Eleven papers discussed PA scope of practice in rural departments, surgeries, and during inpatient rounds, and
areas. Generally, there is consensus within the literature they had admitting/discharge privileges.10,15,16
regarding the autonomy and scope of practice for rural The literature identified many tasks performed by rural
PAs. Larson and associates observed that Medex-trained PAs. The most common duties observed included pre-
PA graduates from rural Washington State spent less time natal/postpartum care, house calls, night calls, nursing
with their supervising physician and had a broader scope home rounds, and athletic team coverage. Other activ-
of practice than their urban cohorts.7 Martin validated ities noted involved follow-up care for patients, rou-
Larson’s work studying Pennsylvania PAs. He found that tine administrative duties, ordering routine laboratory
compared to urban PAs, rural PAs spent more time with tests and radiological studies, recording patient histories,
patients clinically, saw more patients on a daily basis, patient education, counseling, routine physical exams,
and had more patients for whom they were the principal diagnosing common illnesses, and performing minor
provider. The authors thought that the PAs profiled were surgical procedures.7,10,11,15-18 Historically, the illnesses
more likely to work in underserved areas than their and procedures attended to by rural PAs were generally
urban counterparts.8 considered commonplace and not critical.19 In the 1970s,
The most common type of practice for a rural PA is Pacific Northwest patients in need of acute care tended
primary care.7-12 The most represented practice settings to be seen by the supervising physician.17 Researchers
in these studies were a solo physician’s private practice observing PAs in the 1970s noted that written guidelines
or a small group practice clinic.8,10 The federal govern- and/or protocols were used with patients in making
ment also employs rural PAs.7,13 Typical government- clinical decisions.11 Later, protocols gave way to best
sponsored sites included community health centers, mi- practices and evidence-based medicine standards of care.
grant health centers, Indian health centers, and prison One study suggested that the delegated scope of prac-
systems.7,14 Krein’s study of northern states indicated that tice, at times, might have been exceeded by PAs who
more than 50% of rural hospitals utilized PAs.15 Within were under pressure to increase patient volume or make
these hospitals, most PAs provided services in emergency decisions alone when their supervisor was unavailable.
The Journal of Rural Health 00 (2010) 1–10 c 2010 National Rural Health Association 5
6. Role of Physician Assistants in Rural Health Care Henry, Hooker and Yates
Bergeron et al suggested that the PA might be encouraged and constraints associated with employing a PA in rural
to exceed his or her scope of practice for patients who fail practice.
to differentiate between PAs and physicians. The authors
suggested that exceeding a defined scope of practice
Reasons for not hiring
might lead to clinical error, which puts the patient’s
health at risk and increases a physician’s liability for Some physicians expressed that PA employment would
malpractice.10 increase their liability.10,16,21 Another important issue was
Prescriptive authority is mentioned frequently the time and effort (or the perception of it) required
throughout the literature as a critical aspect of the to supervise and delegate.10,21 Theoretical issues raised
scope of practice. The ability to prescribe is especially among respondents to some survey questions included
important for PAs in rural practice due to the limited opposition from patients, increased competition for pa-
availability of supervising physicians. Chumber et al. tients, decreased quality of care, confusion between the
found that the rural PA’s years in practice with their providers and their delegated roles, and loss of continuity
supervising physician were inversely associated with of care.10,14,16,21
greater autonomy in terms of routine prescriptive Incentives for PA employment included positive con-
ability. The researchers believed that their findings tributions to quality of care, patient education, and freed-
implied a significant relationship between the age of up time for physicians, which in turn relieved work-
the supervising physician and amount of prescriptive load. Additionally, PAs enabled the physician to focus
authority that they delegated to their PAs.9 on more complex cases.10,11,16,21 More tangible economic
considerations included cost-effectiveness, increased pa-
“Physicians who first employed PAs, particularly in tient volume, reduced patient wait time, and increased
rural areas, tended to be older physicians, a group patient satisfaction.10,11,13-16,21,22 Burgess suggested that
who typically did not have training or experience physicians highly receptive to PAs often delegated a
in practicing with PAs. Thus, these older physicians broader scope of practice to their PAs when compared to
did not delegate as often or at all. Conceivably, it those who were less receptive.21
is the younger physicians, who perhaps went to The early literature suggests that there were mixed
school with PAs, who are more likely to delegate feelings among physicians about PAs and their role in
responsibilities.”9 rural health care. Some felt that they played a “vital role”
A 1997–2002 national study found that, proportion- and were very useful in the hierarchy of care, whereas
ally, rural PAs write fewer prescriptions than their super- others viewed them as a burden.16 Some unreceptive
vising physicians do. However, they are more likely to physicians also indicated that they were confused by the
prescribe a controlled substance when given the right to ambiguity of the PA’s role and were unsure of their
do so. The researchers hypothesized that this trend may capability as a provider.14,21 Rural Minnesota physicians
have resulted from PAs having more on-call hours where who responded to a mailed survey in the mid-1990s
they were available to patients in need of urgent care. In considered the most important duties of the PA as those
these emergencies, controlled substances may have been that were routine and required fewer diagnostic skills.
frequently required for treatment.20 This same study also identified opposition to laws that
In general, the rural PA’s role includes a scope of permitted PAs to establish their own practice.23 South
practice that enhances health care delivery. Utilizing Carolina physicians responded that the lack of prescrip-
a PA appears to be cost-effective in numerous set- tive authority impeded PAs’ service in rural areas.21 In
tings.10,11,13-16,21,22 PAs also appear to supplement care studies since the late 1990s, attitudes have shifted and
provided by physicians.10,15 The literature indicates that physicians seem to believe that PAs possess the necessary
PAs decreased the time patients spent waiting for an ap- skills and knowledge to provide basic care, to diagnose in-
pointment, spent more time with patients, and increased dependently, and to treat stable health care conditions.21
overall patient volume.10,15,21 Generally, it seems that rural physicians accept PAs and
recognize many benefits associated with their role. This
acceptance seems to have grown with each survey year.
Physicians’ Perceptions of Rural Health
Some of the early researchers speculated that doctors
Physician Assistants
might benefit from education about a PA’s capabilities as
A physician’s perception of what PAs can do appears to a provider. Bergeron and associates suggest that educat-
be important in a rural setting. Not only does it affect the ing potential employing doctors about PAs could prevent
PA’s job satisfaction, it influences how physicians utilize role confusion and assist in delegating an appropriate
PAs. Nine papers discussed issues surrounding incentives scope of practice.23
6 The Journal of Rural Health 00 (2010) 1–10 c 2010 National Rural Health Association
7. Henry, Hooker and Yates Role of Physician Assistants in Rural Health Care
Communities’ Perceptions of Physician concerning the personal factors listed above.27 However,
Assistants when questioned about their satisfaction with the com-
munity’s health care in general, rural residents in the
A community’s perceptions concerning PAs in rural prac- Pacific Northwest believed that improvements could be
tice can influence the pattern of PA utilization within made.30 For those communities utilizing autonomous
that area. Eight publications addressed the perceptions PAs, residents expressed a desire for the availability of
of patients. The majority of rural residents felt most health care that was outside of the PA’s scope of prac-
comfortable with the PA providing simple treatments and tice.29,30 In the aggregate, the literature suggests that
minor procedures.12,24 Some residents chose to commute a high level of patient acceptance tends to be associ-
out of their area, in spite of the distance, in order to see a ated with familiarity and exposure resulting from the
doctor with whom they were already established.10,12 The retention of PAs within the community. Satisfaction and
reasons for doing so generally included a critical health acceptance by town residents were lower where the
condition that required a specialist, a long-term relation- PA commuted in and out of the community for work
ship with a specific provider, or a lack of confidence in and spent little time participating in the community
the PA’s ability to provide for their needs.12 life.12,27,29,30
Four articles employing qualitative research methods
indicated that many community members tended to be
unaware of the PA’s capabilities and role within a rural Retaining and Recruiting Rural Physician
practice.10,12,25,26 In some instances, there were patients Assistants
who failed to distinguish between physicians and PAs.23 Trends in education, specialty, health care, and com-
This lack of knowledge or understanding might need the pensation are key reasons for the loss of rural health
attention of the rural medical community.10,25,26 Some providers. Recruiting and retention of valued personnel
patients suggested various means of incorporating PAs is at the heart of organizational efficiency. If the person
into the rural community and educating their fellow recruited fits into the culture of the organization (or
townsfolk about the PA’s potential as a health care community), he or she will be welcomed. If the work
provider. situation is conducive to retention, the person will re-
Rural residents suggested certain conditions that the main. Understanding the issues that affect patterns of PA
PA would have to meet before being accepted into the retention and recruiting among underserved rural popu-
community as a viable health care provider.25,26 These lations becomes challenging as lucrative opportunities in
conditions included both personal and system-related urban areas increase. Fifteen papers addressed aspects of
issues. Personal issues identified within the community retention or recruitment of rural PAs.
included friendliness, competence, a willingness to par- In 2009, 15% of all PAs in the United States reported
ticipate in the community’s lifestyle, trustworthiness as working in a nonmetropolitan area and 8.2% of PAs
a provider, and knowledgeable and easy to understand worked in micropolitan areas of 20,000 or fewer peo-
during clinical consultation. System-related issues in- ple.3 PAs and NPs are proportionally more likely than
cluded the type of services they offered, the ease of primary care doctors to practice in these nonmetropoli-
integrating them into the existing health care system, the tan areas.21,27,30-33 Factors that encourage retention and
length of wait time for an appointment, the geographic recruiting include a high degree of practice autonomy,
proximity to the PA’s clinic, and the time allotted for a a broad scope of practice, and liberal prescriptive au-
single appointment.12,22,24-26 Most of the literature sug- thority.10,12,34-37 Other factors discussed by PAs include
gested that PAs and the rural medical community gener- the desire for a small-town community lifestyle, a good
ally meet the personal and system-related conditions that relationship with the supervising physician, and the
community members set. confidence to practice medicine without the constant
Trends in the literature revealed several socio- presence of a physician.12,35,37
demographic issues that relate to the acceptance of PAs in A number of studies identified certain factors of rural
rural communities. Female residents within a small town, practice that discourage the recruitment and retention
for example, were generally more comfortable visiting of PAs. The most frequently mentioned reason that PAs
a PA than were males. It also seemed that a patient’s leave rural health care was professional isolation.34,35,38
degree of education and amount of previous experience For example, most rural communities do not provide
with PAs positively correlated with their acceptance and opportunities for PAs to further their education or work
comfort level.27-30 in specialty practice.35,39 The remote location may also
Generally, those living in small towns have a high limit career opportunities for the PA’s family. Addition-
level of satisfaction with PAs in rural practice, especially ally, some studies suggested that lower salary and long
The Journal of Rural Health 00 (2010) 1–10 c 2010 National Rural Health Association 7
8. Role of Physician Assistants in Rural Health Care Henry, Hooker and Yates
on-call hours might be factors for PA retention in rural care makes PAs susceptible to demands different from
practice.35-37 metropolitan colleagues. The most commons stressors are
A lack of medical equipment, technological advance- the lack of readily accessible medical education opportu-
ment, and pharmacy availability were items identified nities and isolation from peers. Concern was noted that
as other sources of frustration for rural-practice PAs.12,35 PAs must sometimes step outside of their delegated scope
Dissatisfaction occurs when it is necessary for patients of practice in order to fulfill the needs of patients in a rural
to travel to distant hospitals for X-rays, laboratory tests, setting, which can be taxing to the PA’s sense of role.
and medication. Aside from practice-related issues, social Demand for medical services and familiarity with the
isolation also deters PAs from committing to rural areas.39 PA in America has largely improved acceptance by em-
Gender has become an increasingly important aspect ployer and patient alike. However, we suggest there will
of medical workforce research. A shift in gender has always be a small percentage of doctors and patients who
occurred in medicine, along with many other professions. will not accept a PA.
This is especially true for PAs, with females making up The health care needs of rural Americans are increas-
60% of the national cadre.1 Historically, women have ing, and the shortage of primary care physicians remains
been less likely to choose a rural practice setting or to a concern. It is estimated that over 85% of a family
leave an urban location to practice in a rural area.28,38 medicine doctor’s work could be managed by 1 PA. Such
Literature on medical practice location suggests that task transfer permits the doctor more longitudinal care
PAs are more likely to practice in locations similar to and the opportunity to take on new and more interesting
where they have lived. For example, a PA raised in a tasks.1
rural area is more likely to feel comfortable practicing Rural health care offers a distinctive work environment
there.12,29,30,35 Some of the authors suggest that recruiting for PAs. The clinics where they work tend to be small
PA students from rural populations may increase the and the range of services large.40 They are more likely
overall number of PAs practicing in underserved areas. to be in primary care than their urban counterparts
These suggestions may be important considering that PAs and are proportionally more likely than doctors to be
with high levels of rural practice location stability tend to in rural or underserved areas.31 These observations have
come from rural areas.28 policy implications that may resonate in certain rural
Another important finding suggests that PAs with lim- states where the ratio of doctor to population is dwin-
ited academic history prior to PA training were more dling. Since 2009, federally qualified rural clinics have
likely to move to primary rural care. This may be par- been bolstered by new initiatives designed to improve
ticularly true for Alaskan Natives returning to Alaska to staffing arrangements and delivery of services (http://
work in rural areas.28,36 The same researchers noted that www.hhs.gov/recovery/hrsa/healthcentergrants.html).
a PA’s level of education prior to PA training is inversely Efforts to retain and recruit PAs must take into account
related to their likelihood of choosing rural practice.28,36 the unique role of rural health care, and provide oppor-
tunities for practitioners that complement and enhance
the satisfying aspects of their role. Community outreach
through Area Health Education Centers that fosters the
Discussion
role of rural practice may benefit PA programs. Financial
Reviewing the literature on the role of PAs in rural incentives through the National Health Service Corps,
practice provides a number of important observations. loan forgiveness, education grants, and tax incentives are
Generally, the literature suggests that PAs are a cost- examples of federal and state initiatives designed to retain
efficient supplement to medical service where this is health care workers.
centered on underserved rural populations, and that There are contradictions within the literature regarding
these services are valued. It also appears that the rural patient acceptance of PAs. Some of this lack of acceptance
PA possesses a larger scope of practice than that of his is generational and some of it has faded with 4 decades
or her urban counterpart.40 This broad range of skills of familiarity. However, the medical community may
or procedures may be necessary to match the extensive be able to play an important role in changing negative
health care needs of underserved rural populations. Such patient perceptions through education about the com-
diversity of medical care services may be appealing to petent and high-quality care that PAs are trained to
those in rural health. Furthermore, it appears that PAs provide, followed by careful integration of the PA into the
are generally welcomed in rural communities, and they rural practice site. Community perception is also relevant
tend to do well if they are integrated into the community. to PA job satisfaction and retention. When PAs are
The long on-call hours and highly autonomous clini- accepted and respected by the residents and integrated
cal practice that characterize remote community health into the community’s lifestyle, their job satisfaction and
8 The Journal of Rural Health 00 (2010) 1–10 c 2010 National Rural Health Association
9. Henry, Hooker and Yates Role of Physician Assistants in Rural Health Care
probability for retention are higher. Community mem- with PA job satisfaction and retention. Yet, retaining and
bers may benefit from learning about the PA’s role, how recruiting PAs remains challenging.
that role can supplement their health care needs, and In the aggregate, the literature is sufficient to generalize
how important their perceptions and attitudes are in that PAs appear to be a good fit for rural practice, at
retaining these providers. least in America. They seem to be well-received, fit into
The qualitative methodologies utilized in several stud- the community, and are productive. Physician receptivity
ies are useful in understanding the opinions of commu- to PAs is high as well. In addition, rural communi-
nity members and supervising physicians. It may be that ties desiring medical staff for their clinic may benefit
community members and physicians respond fully and from successful strategies that attract and retain medical
truthfully during intimate interviews/group discussions, providers such as PAs.
but they do not share the same opinions with the med- It is difficult to predict if the distribution of the
ical staff and researchers’ surveys. We recommend that nonmetropolitan PA will grow with changes in health
researchers consider the advantages of multi-community, care reorganization. Under current scenarios, we suggest
longitudinal, qualitative research in rural areas. This type that the PA role will continue to expand to meet the
of research may provide a more precise understanding of demands of an aging rural population, but improved
PAs and aid in their retention. access to health care is less predictable. As new methods
for treatment become available, financing improves, and
technology is more accessible for clinicians, interest in
relocating to a small community may become more
Limitations
attractive. However, efforts to recruit and retain rural PAs
The limitations of this literature are characteristic of many will benefit from research that distinguishes the enablers
systematic reviews: the breadth of the subject is wide and barriers to such human capital resources.
and depth is limited. This rural PA literature review
spans 35 years, and while it shows the evolution of the
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10 The Journal of Rural Health 00 (2010) 1–10 c 2010 National Rural Health Association