Abstract:
OBJECTIVE:Effective use of staff is a major aim in all health-care systems both to maximize their impact and to minimize costs. In England, a few general practitioners (GPs) have been recruiting physician assistants (PAs) to work in their practices, independent of any pilot schemes. Our objective was to study the motivation of GPs and practice managers who employed PAs and to understand the factors that sustained their employment. METHODS:A qualitative study using semi-structured interviews, analysed thematically, was carried out with 13 GPs and three practice managers from 15 general practices employing PAs in five areas of England. RESULTS:All practices were employing USA-trained PAs. Motivating factors for their employment included increasing the general practice capacity to manage patient demand within government targets for access, broaden the skill-mix in the practice team and financial considerations. The issues that needed to be taken into account in employing PAs included: the requirement for medical supervision; the PAs current lack of a regulatory framework and prescribing authority; and some patients' lack of familiarity with the concept of the PA. CONCLUSIONS:General practice employers view PAs as a positive addition to a mixed skill team for meeting patient demand within a practice's finances. There is a need to develop stronger governance and regulatory frameworks for this emerging profession.
journal_name
J Health Serv Res Policyjournal_title
Journal of health services research & policyauthors
Drennan V,Levenson R,Halter M,Tye Cdoi
10.1258/jhsrp.2010.010061subject
Has Abstractpub_date
2011-04-01 00:00:00pages
75-80issue
2eissn
1355-8196issn
1758-1060pii
jhsrp.2010.010061journal_volume
16pub_type
杂志文章abstract:OBJECTIVES:The National Health Insurance (NHI) system in Taiwan launched a trial capitation provider payment programme in 2011, with the capitation formula based on patients' average NHI expenditure in the previous year. This study seeks to examine the concentration and persistence of health care expenditure among the ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819615577711
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVE:Cost-utility analysis is gaining importance as a tool for setting priorities in health care. The approach requires quality-of-life weights on a scale from 0.00 (corresponding to death) to 1.00 (corresponding to perfect health). Different methods and perspectives of the evaluators tend to give different result...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/135581904322716111
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVES:To evaluate the effect of a risk factor checklist and training video for general practitioners in reducing inter-practice variation and improving the appropriateness of referrals (assessed by their positive predictive value or PPV) of patients with suspected otitis media with effusion (OME or 'glue ear') to ...
journal_title:Journal of health services research & policy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1258/1355819011927387
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVE:The effects of demographic, locational and socio-economic disadvantage, and the influence of private health care on five-year mortality rates in patients with lung cancer or after breast cancer surgery in Western Australia were examined. METHODS:The Western Australian Record Linkage Project was used to extra...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/1355819042248116
更新日期:2004-10-01 00:00:00
abstract::Discussion of unanticipated problems in care with patients and their families ('open disclosure') is now widely advocated. Despite international efforts and the introduction of a range of policies and guidance to promote such discussions, the expectations of policy makers and patients are often not matched in practice...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819614558100
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:To explore some of the impacts of star performance ratings in acute hospital trusts in England. METHODS:A multiple case study design was used which incorporated purposeful sampling of 'low' and 'high' performing trusts using the star rating system. In each case study site, data collection comprised semi-stru...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581960501000106
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVES:Successful partnership working has theoretically been linked to improvements in service delivery and is dependent on the strength of the partnership, trust, communication, professional roles and resource sharing. Empirical evidence to confirm the relationships between these factors and improved service provi...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819612473584
更新日期:2013-07-01 00:00:00
abstract::This paper deals with three concerns about the evaluative framework that is currently dominant within health economics. These concerns are: that the evaluative framework is concerned entirely with health; that the evaluative framework has an individualistic focus on patients alone; and that the methods used to estimat...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2008.008024
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVES:To determine the extent to which reports of Cochrane reviews recommend the need for further research and, if so, the extent to which they make suggestions regarding that research. METHODS:We examined all 2535 reviews in Issue 4, 2005 of The Cochrane Library. Each review was categorized on the basis of wheth...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581907780279648
更新日期:2007-04-01 00:00:00
abstract::Almost everything you know about heroin addiction is wrong. Not only is it wrong, but it is obviously wrong. Heroin is not highly addictive; withdrawal from it is not medically serious; addicts do not become criminals to feed their habit; addicts do not need any medical assistance to stop taking heroin; and contrary t...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2008.008022
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVES:To explore patients' and carers' views on what constitutes high-quality communication and information provision during diagnostic assessment in memory clinic services in three areas of England. METHODS:Interviews with 27 people with cognitive impairment (13 with confirmed dementia) and 26 carers (20 matched...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819613479945
更新日期:2013-07-01 00:00:00
abstract::Continuity of care is concerned with the quality of care over time. There are two important perspectives on this. Traditionally, continuity of care is idealized in the patient's experience of a 'continuous caring relationship' with an identified health care professional. For providers in vertically integrated systems ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581906778476490
更新日期:2006-10-01 00:00:00
abstract:OBJECTIVES:To conduct an economic evaluation comparing a traditional antenatal visiting schedule (traditional care) with a reduced schedule of visits (new style care) for women at low risk of complications. METHODS:Economic evaluation using the results of a randomised controlled trial, the Antenatal Care Project. This...
journal_title:Journal of health services research & policy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1177/135581960000500203
更新日期:2000-04-01 00:00:00
abstract:BACKGROUND:The Capital Health (CH) region in Alberta serves the population of the Edmonton area as well as a large referral population in western Canada. CH is responsible for the delivery of the spectrum of patient care, from inpatient to outpatient services. Growth in outpatient care, in particular, has led to the de...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2007.007068
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVES:English primary care organisations (primary care groups and trusts - PCGs, PCTs) were, and are, responsible for the quality of general practice but lack hierarchical structures and, frequently, contractual relationships through which to influence it. The theory of soft governance describes how managers can i...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/1355819041403295
更新日期:2004-07-01 00:00:00
abstract::Objectives To investigate the effects of four factors on perceptions of fairness in access to outpatient services: proportions of walk-in versus scheduled registration, consultation queues, regulations for late patients and particular categories of patients getting better access. Methods A total of 124 young adults we...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819617725546
更新日期:2018-01-01 00:00:00
abstract::It has previously been suggested that the English Department of Health seems, wittingly or not, to have drawn on the experiences of Stalinist Russia in devising policies for the National Health Service. The development of general practitioner fundholding during the 1990s could be compared to the Soviet support for the...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581960000500311
更新日期:2000-07-01 00:00:00
abstract::'Integrated care' is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team case management is frequently the primary focus of integrated care when implemented internationally. We examine the practical app...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819616660581
更新日期:2016-10-01 00:00:00
abstract::In most jurisdictions, public policy regarding assisted death has not advanced beyond simple prohibition. However, this issue is increasingly likely to reach the policy agenda. Policy-makers may be tempted to turn for guidance to the three places in the world with developed policy or legislation: the Netherlands; the ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969900400409
更新日期:1999-10-01 00:00:00
abstract:OBJECTIVES:This paper focuses upon health status, need for care, and use of health care from 1994/95 to 2000/01 in the Canadian foreign-born population. METHODS:Using Statistics Canada's longitudinal National Population Health Survey, descriptive and survival analyses are used to explore immigrant health status and he...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/1355819053559074
更新日期:2005-04-01 00:00:00
abstract::The study, first published in 2003, looks at the root causes of adverse events and near misses in obstetrics at seven hospital maternity units by interviewing 93 members of staff, identifying the areas of mismanagement in each case and thematically analysing them. ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2009.09s106
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:the nature of care delivered in emergency departments has changed due to increased demand. In response, one relatively new change is the introduction of a physiotherapy service. There have been anecdotal reports that this may reduce patient waiting times and lead to more effective use of other health care sta...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1258/jhsrp.2010.009129
更新日期:2011-01-01 00:00:00
abstract::Moral hazard in public insurance for long-term care may be counteracted by strategies influencing supply or demand. Demand-side strategies may target the patient or the insurer. Various demand-side strategies and how they are implemented in four European countries (Germany, Belgium, Switzerland and the Netherlands) ar...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819615575080
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVES:To demonstrate the benefits of applying meta ethnography to the synthesis of qualitative research, by means of a worked example. METHODS:Four papers about lay meanings of medicines were arbitrarily chosen. Noblit and Hare's seven-step process for conducting a meta ethnography was employed: getting started; ...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581902320432732
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVES:To critically evaluate the quality of hospital medical care at the beginning, during and shortly after regionalization of health boards in Newfoundland and Labrador, and aggregation of hospitals in the St John's region. METHODS:Retrospective chart audits for the years 1995/96, 1998/99 and 2000/01 (at the be...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581905774424465
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVES:To identify the barriers to shifting services from secondary to primary care perceived by the involved stakeholders. METHODS:Forty-five semi-structured interviews with stakeholders from primary care, acute and community hospitals, purchasers (health authorities) and other agencies involved in two contrastin...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/135581969900400306
更新日期:1999-07-01 00:00:00
abstract::Hospitals are awash with patient experience data, much of it collected with the ostensible purpose of improving the quality of patient care. However, there has been comparatively little consideration of the nature and capacities of data itself. Using insights from actor-network theory, we propose that paying attention...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1177/1355819616685349
更新日期:2017-04-01 00:00:00
abstract::The National Health Service (NHS) in England is not only a commissioner and provider of health care to the sick, but also offers certainty and peace of mind to all citizens--even those who do not use the health service in any year. However, due to the recent dominance of cost-effectiveness and cost-utility analysis as...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/jhsrp.2009.009024
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice. METHODS:We carried out a systematic review and focus groups to valida...
journal_title:Journal of health services research & policy
pub_type: 杂志文章,评审
doi:10.1177/1355819618786764
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVES:The National Service Framework (NSF) for Coronary Heart Disease--published by the English Department of Health in 2000--sets out how those within the health service should seek to prevent and treat coronary heart disease and care for people with the disease. Its prescriptions are partly based on what is know...
journal_title:Journal of health services research & policy
pub_type: 杂志文章
doi:10.1258/135581906776318956
更新日期:2006-04-01 00:00:00