PDF(Pubmed)
Abstract：
BACKGROUND: Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams.
METHODS: We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level).
RESULTS: We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations\' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs\' backgrounds and characteristics, clinical team members\' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained.
CONCLUSIONS: We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.
METHODS: We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level).
RESULTS: We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations\' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs\' backgrounds and characteristics, clinical team members\' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained.
CONCLUSIONS: We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.
摘要：
背景：高级实践提供商（APP），包括医师助理/助理(PA)，执业护士(NPs)和其他非医师角色，主要是为了满足不断变化的医疗保健需求和不断增加的劳动力短缺。首先在美国的初级保健中引入，APP在世界各地不同国家的不同专业领域的二级保健中普遍存在。在这次范围审查中，我们旨在总结影响发展的因素，招募,一体化,医院医疗团队APP角色的保留和职业发展。
方法：我们进行了范围审查并搜索了OvidMEDLINE，OvidEmbase,Ovid全球健康,OvidPsycINFO和EBSCOhostCINAHL获得2000年1月至2023年4月之间发表的相关文章，重点是二级保健APP角色的劳动力管理。文章由两名审稿人独立筛选。对收录文章的数据进行了图表化和迭代编码，以总结影响APP开发的因素，招募,一体化,不同卫生系统结构水平的保留和职业发展(宏观，中观和微观层面)。
结果：我们确定并分析了273篇主要来自高收入国家的文章，例如，美国(n=115)和英国(n=52)，主要集中在NP（n=183）和PA（n=41）。在宏观层面，更广泛的劳动力供应，国家/地区劳动力政策，如医生的工作时间限制，APP执业规定范围，以及外部合作者的观点，利益相关者和APP的公众代表影响了组织关于开发和管理APP角色的决策。在中观层面,组织和部门特征，组织规划,战略和政策，资源的可用性，当地的经验和证据以及当地组织领导人的观点和看法，冠军等部门影响了APP角色管理的各个阶段。最后在微观层面，个人APP的背景和特征，临床团队成员的看法，与APP角色的理解和关系，患者的感知和偏好也影响了APP的开发方式，整合和保留。
结论：我们总结了影响二级护理团队APP角色开发和管理的多种因素。我们强调了组织通过长期投资开发特定环境的劳动力解决方案和战略的重要性，大量的资源投入和透明的流程，以应对不断变化的医疗保健挑战。
方法：我们进行了范围审查并搜索了OvidMEDLINE，OvidEmbase,Ovid全球健康,OvidPsycINFO和EBSCOhostCINAHL获得2000年1月至2023年4月之间发表的相关文章，重点是二级保健APP角色的劳动力管理。文章由两名审稿人独立筛选。对收录文章的数据进行了图表化和迭代编码，以总结影响APP开发的因素，招募,一体化,不同卫生系统结构水平的保留和职业发展(宏观，中观和微观层面)。
结果：我们确定并分析了273篇主要来自高收入国家的文章，例如，美国(n=115)和英国(n=52)，主要集中在NP（n=183）和PA（n=41）。在宏观层面，更广泛的劳动力供应，国家/地区劳动力政策，如医生的工作时间限制，APP执业规定范围，以及外部合作者的观点，利益相关者和APP的公众代表影响了组织关于开发和管理APP角色的决策。在中观层面,组织和部门特征，组织规划,战略和政策，资源的可用性，当地的经验和证据以及当地组织领导人的观点和看法，冠军等部门影响了APP角色管理的各个阶段。最后在微观层面，个人APP的背景和特征，临床团队成员的看法，与APP角色的理解和关系，患者的感知和偏好也影响了APP的开发方式，整合和保留。
结论：我们总结了影响二级护理团队APP角色开发和管理的多种因素。我们强调了组织通过长期投资开发特定环境的劳动力解决方案和战略的重要性，大量的资源投入和透明的流程，以应对不断变化的医疗保健挑战。
