PDF(Pubmed)
Abstract：
BACKGROUND: The Emergency Department (ED) has seen increased patient attendance and difficulty meeting demands. New healthcare professions such as Physician Associates (PAs) are being utilised to complement the existing medical workforce. Despite the growth of their professions in the United Kingdom, little evidence is available about the perceptions of their roles.
OBJECTIVE: This study aims to provide evidence of doctors\', PAs\' and patients\' perceptions of the PA role in the UK ED.
METHODS: A mixed methods approach consisted of the following: 1. An online exploratory survey of ED doctors at one English ED over 1 month (February-March 2022). 2. Post consultation semi-structured patient questionnaires over 2 weeks (April 2022). 3. Semi-structured virtual interviews with ED consultants across the four regions of the United Kingdom (3 months in 2022). 4. Semi-structured virtual interviews with ED PAs across the four regions of the United Kingdom (3 months in 2022). The analysis methods that were used included frequency counts and percentages from closed questions, and hybrid thematic analysis of free text and interview transcripts.
RESULTS: Four ED consultants and four ED PAs across the United Kingdom were interviewed. Twenty-eight ED doctors participated in the online survey. Fifty-seven patients completed the post consultation questionnaire. Four main themes (PAs being fit for purpose; patient recognition of PAs, PAs providing continuity of care, and future PAs and regulation) were deduced as per the General Medical Council, Good Medical Practice domains (knowledge, skills and development; patients, partnership and communication; colleagues, culture and safety; and trust and professionalism). Other subthemes were induced via hybrid thematic analysis. In this study, doctors and patients had mixed comments about the role of PAs. Most of them were positive as doctor participants perceived PAs to be knowledgeable, highly skilled, with mostly good communication skills, team players, providing continuity of care and overall being fit for purpose. However, some doctor participants commented negatively about PAs for providing little quality healthcare and being inexperienced. There was a desire for career progression among the PA participants and a need to work to their full potential. Although the clinicians of this study displayed a clear understanding of the PA role in the ED, a high frequency of surveyed patients mistook PAs for doctors. It was suggested that future PAs could complete a postqualification programme in emergency medicine, combine roles, be paid on an alternative scale and be formally regulated.
CONCLUSIONS: In this study, mixed views were expressed by ED consultants, ED junior doctors and patients regarding the role of the PA in the ED. Stakeholders can use the information presented to develop a better understanding of the perceptions of the PA role within the UK ED.
UNASSIGNED: The Patient and Public Involvement and Engagement (PPIE) group, led by Healthwatch, made significant contributions to the study\'s design by providing valuable feedback on the information sheets and consent forms utilised. The patients\' responses helped guide the study\'s direction and shape its future work. As part of the dissemination activities, the study findings was shared with both the PPIE team and Healthwatch media production team.
OBJECTIVE: This study aims to provide evidence of doctors\', PAs\' and patients\' perceptions of the PA role in the UK ED.
METHODS: A mixed methods approach consisted of the following: 1. An online exploratory survey of ED doctors at one English ED over 1 month (February-March 2022). 2. Post consultation semi-structured patient questionnaires over 2 weeks (April 2022). 3. Semi-structured virtual interviews with ED consultants across the four regions of the United Kingdom (3 months in 2022). 4. Semi-structured virtual interviews with ED PAs across the four regions of the United Kingdom (3 months in 2022). The analysis methods that were used included frequency counts and percentages from closed questions, and hybrid thematic analysis of free text and interview transcripts.
RESULTS: Four ED consultants and four ED PAs across the United Kingdom were interviewed. Twenty-eight ED doctors participated in the online survey. Fifty-seven patients completed the post consultation questionnaire. Four main themes (PAs being fit for purpose; patient recognition of PAs, PAs providing continuity of care, and future PAs and regulation) were deduced as per the General Medical Council, Good Medical Practice domains (knowledge, skills and development; patients, partnership and communication; colleagues, culture and safety; and trust and professionalism). Other subthemes were induced via hybrid thematic analysis. In this study, doctors and patients had mixed comments about the role of PAs. Most of them were positive as doctor participants perceived PAs to be knowledgeable, highly skilled, with mostly good communication skills, team players, providing continuity of care and overall being fit for purpose. However, some doctor participants commented negatively about PAs for providing little quality healthcare and being inexperienced. There was a desire for career progression among the PA participants and a need to work to their full potential. Although the clinicians of this study displayed a clear understanding of the PA role in the ED, a high frequency of surveyed patients mistook PAs for doctors. It was suggested that future PAs could complete a postqualification programme in emergency medicine, combine roles, be paid on an alternative scale and be formally regulated.
CONCLUSIONS: In this study, mixed views were expressed by ED consultants, ED junior doctors and patients regarding the role of the PA in the ED. Stakeholders can use the information presented to develop a better understanding of the perceptions of the PA role within the UK ED.
UNASSIGNED: The Patient and Public Involvement and Engagement (PPIE) group, led by Healthwatch, made significant contributions to the study\'s design by providing valuable feedback on the information sheets and consent forms utilised. The patients\' responses helped guide the study\'s direction and shape its future work. As part of the dissemination activities, the study findings was shared with both the PPIE team and Healthwatch media production team.
摘要：
背景：急诊科（ED）的患者出勤率和满足需求的难度增加。新的医疗保健专业，如医师协会（PA）正在被用来补充现有的医疗劳动力。尽管他们在英国的职业有所增长，关于他们角色的看法几乎没有证据。
目的：本研究旨在为医生提供证据，PA和患者对PA在英国ED中的作用的看法。
方法：混合方法方法由以下组成：1.在1个月内（2022年2月至3月）对一名英语ED的ED医生进行的在线探索性调查。2.咨询后，为期2周的半结构化患者问卷（2022年4月）。3.对英国四个地区的ED顾问进行半结构化虚拟访谈（2022年为3个月）。4.对英国四个地区的EDPA进行半结构化虚拟访谈（2022年为3个月）。使用的分析方法包括频率计数和封闭问题的百分比，以及自由文本和访谈成绩单的混合主题分析。
结果：采访了英国的四位ED顾问和四位EDPA。28名ED医生参加了在线调查。57名患者完成了咨询后问卷。四个主要主题(PA适合目的；患者对PA的认可，提供连续性护理的PA，以及未来的PA和法规)是根据总医学委员会推导出的，良好医疗实践领域(知识，技能和发展；患者，伙伴关系和沟通；同事，文化和安全；以及信任和专业精神)。其他子主题是通过混合主题分析得出的。在这项研究中,医生和患者对PA的作用有不同的评价.他们中的大多数是积极的，因为医生参与者认为PA知识渊博，高技能,具有良好的沟通能力，团队球员,提供护理的连续性和整体适合目的。然而,一些医生参与者对PA没有提供高质量的医疗保健和缺乏经验给予负面评价.PA参与者渴望职业发展，并需要充分发挥其潜力。尽管这项研究的临床医生对PA在ED中的作用有清晰的认识，接受调查的患者经常误认为医生。有人建议，未来的PA可以完成急诊医学的资格后计划，结合角色，以替代规模支付，并受到正式监管。
结论：在这项研究中，ED顾问表达了不同的观点，ED初级医生和患者关于PA在ED中的作用。利益相关者可以使用提供的信息来更好地理解英国ED内对PA角色的看法。
■患者和公众参与和参与(PPIE)小组，由Healthwatch领导,通过对所使用的信息表和同意书提供有价值的反馈，对研究的设计做出了重大贡献。患者的反应有助于指导研究方向并塑造其未来的工作。作为传播活动的一部分，这项研究结果与PPIE团队和Healthwatch媒体制作团队分享.
目的：本研究旨在为医生提供证据，PA和患者对PA在英国ED中的作用的看法。
方法：混合方法方法由以下组成：1.在1个月内（2022年2月至3月）对一名英语ED的ED医生进行的在线探索性调查。2.咨询后，为期2周的半结构化患者问卷（2022年4月）。3.对英国四个地区的ED顾问进行半结构化虚拟访谈（2022年为3个月）。4.对英国四个地区的EDPA进行半结构化虚拟访谈（2022年为3个月）。使用的分析方法包括频率计数和封闭问题的百分比，以及自由文本和访谈成绩单的混合主题分析。
结果：采访了英国的四位ED顾问和四位EDPA。28名ED医生参加了在线调查。57名患者完成了咨询后问卷。四个主要主题(PA适合目的；患者对PA的认可，提供连续性护理的PA，以及未来的PA和法规)是根据总医学委员会推导出的，良好医疗实践领域(知识，技能和发展；患者，伙伴关系和沟通；同事，文化和安全；以及信任和专业精神)。其他子主题是通过混合主题分析得出的。在这项研究中,医生和患者对PA的作用有不同的评价.他们中的大多数是积极的，因为医生参与者认为PA知识渊博，高技能,具有良好的沟通能力，团队球员,提供护理的连续性和整体适合目的。然而,一些医生参与者对PA没有提供高质量的医疗保健和缺乏经验给予负面评价.PA参与者渴望职业发展，并需要充分发挥其潜力。尽管这项研究的临床医生对PA在ED中的作用有清晰的认识，接受调查的患者经常误认为医生。有人建议，未来的PA可以完成急诊医学的资格后计划，结合角色，以替代规模支付，并受到正式监管。
结论：在这项研究中，ED顾问表达了不同的观点，ED初级医生和患者关于PA在ED中的作用。利益相关者可以使用提供的信息来更好地理解英国ED内对PA角色的看法。
■患者和公众参与和参与(PPIE)小组，由Healthwatch领导,通过对所使用的信息表和同意书提供有价值的反馈，对研究的设计做出了重大贡献。患者的反应有助于指导研究方向并塑造其未来的工作。作为传播活动的一部分，这项研究结果与PPIE团队和Healthwatch媒体制作团队分享.
