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Physician Assistants (physician + assistant)
Selected AbstractsPhysician assistants: a UK perspective on clinical need, education and regulationTHE CLINICAL TEACHER, Issue 1 2008Nick Ross First page of article [source] Physician assistants: trialling a new surgical health professional in AustraliaANZ JOURNAL OF SURGERY, Issue 6 2010Phyllis Ho Abstract Background:, The Australia health workforce productivity Commission Research Report in 2005 identified workforce shortages. One of the recommendations is that new models of health care be established. As a result South Australia is trialling United States trained physician assistants in a pilot program. This paper summaries the review of literature of the physician assistant role and safety in the surgical setting. Methods:, A literature search using Medline and Pubmed from 1966 until 2009 with key words: physician assistants, midlevel providers, surgery. The references of the results were also searched for suitable articles. The Google search engine was also used with the above keywords to search for latest developments from nontraditional sources. Results:, There were over 200 suitable articles relating to the quality and safety of physician assistants. The overwhelming majority of the articles originate from the United States and these vary in quality. There were 13 published studies identified that documented physician assistants in the surgical setting. Conclusion:, From the published data physician assistants have been shown to provide safe and provide high quality care in surgical units. It is important that prior to their commencement their role is defined to alleviate conflict and confusion in the team. Continued auditing should be conducted to monitor progress and impact. [source] Extending rural and remote medicine with a new type of health worker: Physician assistantsAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2007Teresa M. O'Connor Abstract The purpose of this paper was to demonstrate that the medical workforce shortage is an international phenomenon and to review one of the strategies developed in the USA in the late 1960s: the physician assistant model of health service provision. The authors consider whether this model could provide one strategy to help address the medical workforce shortage in Australia. A systematic review of the literature about medical workforce shortages, strategies used to address the medical workforce shortage, and the physician assistant role was undertaken. Literature used for the review covered the period 1967,2006. Physician assistants provide safe, high-quality and cost-effective primary care services under the direction of a doctor and respond to workforce shortages in rural and remote areas, family practice medicine and hospital settings. This model of health care provision has been adopted in several other developed countries, including England, Scotland, the Netherlands and Canada. The physician assistant concept might provide Australia with a novel strategy for addressing its medical workforce shortage, particularly in rural and remote settings. [source] Impact of Scribes on Performance Indicators in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 5 2010Rajiv Arya MD Abstract Objectives:, The objective was to quantify the effect of scribes on three measures of emergency physician (EP) productivity in an adult emergency department (ED). Methods:, For this retrospective study, 243 clinical shifts (of either 10 or 12 hours) worked by 13 EPs during an 18-month period were selected for evaluation. Payroll data sheets were examined to determine whether these shifts were covered, uncovered, or partially covered (for less than 4 hours) by a scribe; partially covered shifts were grouped with uncovered shifts for analysis. Covered shifts were compared to uncovered shifts in a clustered design, by physician. Hierarchical linear models were used to study the association between percentage of patients with which a scribe was used during a shift and EP productivity as measured by patients per hour, relative value units (RVUs) per hour, and turnaround time (TAT) to discharge. Results:, RVUs per hour increased by 0.24 units (95% confidence interval [CI] = 0.10 to 0.38, p = 0.0011) for every 10% increment in scribe usage during a shift. The number of patients per hour increased by 0.08 (95% CI = 0.04 to 0.12, p = 0.0024) for every 10% increment of scribe usage during a shift. TAT was not significantly associated with scribe use. These associations did not lose significance after accounting for physician assistant (PA) use. Conclusions:, In this retrospective study, EP use of a scribe was associated with improved overall productivity as measured by patients treated per hour (Pt/hr) and RVU generated per hour by EPs, but not as measured by TAT to discharge. ACADEMIC EMERGENCY MEDICINE 2010; 17:490,494 © 2010 by the Society for Academic Emergency Medicine [source] Attitudes and Intentions of Future Health Care Providers Toward Abortion ProvisionPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 2 2004Solmaz Shotorbani CONTEXT: Induced abortion is one of the most common procedures performed among women in the United States. However, 87% of all counties had no abortion provider in 2000, and little is known about the attitudes and intentions of future health care providers, including advanced clinical practitioners, regarding abortion provision. METHODS: During March 2002, first- and second-year students in health sciences programs (i.e., medicine, physician assistant and nursing) at the University of Washington were anonymously surveyed. Univariate, bivariate and multi-variate analyses were used to determine students' attitudes and intentions regarding provision of abortion services. RESULTS: Of the 312 students who completed the survey, 70% supported the availability of legal abortion under any circumstances. Thirty-one percent intended to provide medical abortion in their practice, and 18% planned to offer surgical abortion. Fifty-two percent of all respondents agreed that advanced clinical practitioners should be able to provide medical abortion, and 37% agreed that they should be able to provide surgical abortion services; however, greater proportions of advanced clinical practitioners (45,83%) than of medical students (21,43%) expressed such support. Sixty-four percent of all respondents were willing to attend a program whose curriculum requires abortion training. CONCLUSIONS: Although it may not be possible to require abortion training for every future health care provider, making abortion a standard part of clinical training would provide opportunities for future physicians and advanced clinical practitioners, and would likely ameliorate the abortion provider shortage. [source] Emergency Medicine Practitioner Knowledge and Use of Decision Rules for the Evaluation of Patients with Suspected Pulmonary Embolism: Variations by Practice Setting and Training LevelACADEMIC EMERGENCY MEDICINE, Issue 1 2007Michael S. Runyon MD Abstract Background Several clinical decision rules (CDRs) have been validated for pretest probability assessment of pulmonary embolism (PE), but the authors are unaware of any data quantifying and characterizing their use in emergency departments. Objectives To characterize clinicians' knowledge of and attitudes toward two commonly used CDRs for PE. Methods By using a modified Delphi approach, the authors developed a two-page paper survey including 15 multiple-choice questions. The questions were designed to determine the respondents' familiarity, frequency of use, and comprehension of the Canadian and Charlotte rules. The survey also queried the frequency of use of unstructured (gestalt) pretest probability assessment and reasons why physicians choose not to use decision rules. The surveys were sent to physicians, physician assistants, and medical students at 32 academic and community hospitals in the United States and the United Kingdom. Results Respondents included 555 clinicians; 443 (80%) work in academic practice, and 112 (20%) are community based. Significantly more academic practitioners (73%) than community practitioners (49%) indicated familiarity with at least one of the two decision rules. Among all respondents familiar with a rule, 50% reported using it in more than half of applicable cases. A significant number of these respondents could not correctly identify a key component of the rule (23% for the Charlotte rule and 43% for the Canadian rule). Fifty-seven percent of all respondents indicated use of gestalt rather than a decision rule in more than half of cases. Conclusions Academic clinicians were more likely to report familiarity with either of these two specific decision rules. Only one half of all clinicians reporting familiarity with the rules use them in more than 50% of applicable cases. Spontaneous recall of the specific elements of the rules was low to moderate. Future work should consider clinical gestalt in the evaluation of patients with possible PE. [source] Graduate Medical Education Downsizing: Perceived Effects of Participating in the HCFA Demonstration Project in New York StateACADEMIC EMERGENCY MEDICINE, Issue 2 2001Linda L. Spillance MD Abstract. Objective: Financial support for graduate medical education (GME) is shrinking nationally as Medicare cuts GME funds. Thirty-nine hospitals in New York State (NYS) voluntarily participated in a Health Care Financing Administration demonstration project (HCFADP),the goal of which was to reduce total residency training positions by 4-5%/year over a five-year period, while increasing primary care positions. The objective of this study was to determine the effect of downsizing on emergency department (ED) staffing and emergency medicine (EM) residency training. Methods: Structured interviews and surveys of NYS program directors (PDs) were conducted in October,December 1999. Simple frequencies are reported. Results: One hundred percent of 17 PDs completed the interviews and seven of 12 participants in the HCFADP returned surveys. Twelve of 17 programs participated in HCFADP and two programs downsized outside HCFADP. Seven of 12 participants lost EM positions. Six of 12 programs were forced to exclude outside residents from rotating in their ED, leading to a need for one participating program and one non-participating program to find alternative sites for trauma. Five of 12 institutions provided resident staffing data, reporting a reduction in ED resident coverage in year 1 of the project of 9-40%. Programs compensated by increasing the number of shifts worked (4/12), increasing shift length (1/12), decreasing pediatric ED shifts (1/12), decreasing elective or research time (2/12), and decreasing off-service rotations (4/12). Six departments hired physician assistants or nurse practitioners, two hired faculty, and two hired resident moonlighters. Six of 12 programs withdrew from HCFADP and returned to previous resident numbers. Eight of 12 PDs thought that they had decreased time for clinical teaching. Conclusions: A 4-5% reduction in residency positions was associated with a marked reduction in ED resident staffing and EM residency curriculum changes. [source] Ultrasound Training for Emergency Physicians, A Prospective StudyACADEMIC EMERGENCY MEDICINE, Issue 9 2000Diku P. Mandavia MD Abstract. Objectives: Bedside ultrasound examination by emergency physicians (EPs) is being integrated into clinical emergency practice, yet minimum training requirements have not been well defined or evaluated. This study evaluated the accuracy of EP ultrasonography following a 16-hour introductory ultrasound course. Methods: In phase I of the study, a condensed 16-hour emergency ultrasound curriculum based on Society for Academic Emergency Medicine guidelines was administered to emergency medicine houseofficers, attending staff, medical students, and physician assistants over two days. Lectures with syllabus material were used to cover the following ultrasound topics in eight hours: basic physics, pelvis, right upper quadrant, renal, aorta, trauma, and echo-cardiography. In addition, each student received eight hours of hands-on ultrasound instruction over the two-day period. All participants in this curriculum received a standardized pretest and posttest that included 24 emergency ultrasound images for interpretation. These images included positive, negative, and nondiagnostic scans in each of the above clinical categories. In phase II of the study, ultrasound examinations performed by postgraduate-year-2 (PGY2) houseofficers over a ten-month period were examined and the standardized test was readministered. Results: In phase I, a total of 80 health professionals underwent standardized training and testing. The mean ± SD pretest score was 15.6 ± 4.2, 95% CI = 14.7 to 16.5 (65% of a maximum score of 24), and the mean ± SD posttest score was 20.2 ± 1.6, 95% CI = 19.8 to 20.6 (84%) (p < 0.05). In phase II, a total of 1,138 examinations were performed by 18 PGY2 houseofficers. Sensitivity was 92.4% (95% CI = 89% to 95%), specificity was 96.1% (95% CI = 94% to 98%), and overall accuracy was 94.6% (95% CI = 93% to 96%). The follow-up ultrasound written test showed continued good performance (20.7 ± 1.2, 95% CI = 20.0 to 21.4). Conclusions: Emergency physicians can be taught focused ultrasonography with a high degree of accuracy, and a 16-hour course serves as a good introductory foundation. [source] The Care,tech Link: An Examination of Gender, Care and Technical Work in Healthcare LabourGENDER, WORK & ORGANISATION, Issue 4 2008Sally Lindsay Despite the dramatic increase of technology in the healthcare field, little is known of how care work and technical work are related. Examining substitute healthcare providers offers a useful illustration of the care,tech link because nursing (care) and medical (technical) models often merge. Forty-two interviews with men and women (nurse practitioners, nurse anaesthetists and physician assistants) were conducted in the USA. The results showed that the gendered nature of care,tech boundaries has shifted in small but important ways and that the gendering of work influenced the shape of these boundaries. Men often encountered barriers when moving too far into the care realm and attempted to overcome this by ,caring cautiously' and emphasizing problem-solving care. Women faced similar barriers from the ,old boys network' when they entered highly technical areas. There is also evidence that men and women challenged existing care,tech boundaries and moved beyond their traditional roles. [source] Nursing Home Practitioner Survey of Diagnostic Criteria for Urinary Tract InfectionsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2005Manisha Juthani-Mehta MD Objectives: To identify clinical and laboratory criteria used by nursing home practitioners for diagnosis and treatment of urinary tract infections (UTIs) in nursing home residents. To determine practitioner knowledge of the most commonly used consensus criteria (i.e., McGeer criteria) for UTIs. Design: Self-administered survey. Setting: Three New Haven,area nursing homes. Participants: Physicians (n=25), physician assistants (PAs, n=3), directors/assistant directors of nursing (n=8), charge nurses (n=37), and infection control practitioners (n=3). Measurements: Open- and closed-ended questions. Results: Nineteen physicians, three PAs, and 41 nurses completed 63 of 76 (83%) surveys. The five most commonly reported triggers for suspecting UTI in noncatheterized residents were change in mental status (57/63, 90%), fever (48/63, 76%), change in voiding pattern (44/63, 70%), dysuria (41/63, 65%), and change in character of urine (37/63, 59%). Asked to identify their first diagnostic step in the evaluation of UTIs, 48% (30/63) said urinary dipstick analysis, and 40% (25/63) said urinalysis and urine culture. Fourteen of 22 (64%) physicians and PAs versus 40 of 40 (100%) nurses were aware of the McGeer criteria for noncatheterized patients (P<.001); 12 of 22 (55%) physicians and PAs versus 38 of 39 (97%) nurses used them in clinical practice (P<.001). Conclusion: Although surveillance and treatment consensus criteria have been developed, there are no universally accepted diagnostic criteria. This survey demonstrated a distinction between surveillance criteria and criteria practitioners used in clinical practice. Prospective data are needed to develop evidence-based clinical and laboratory criteria of UTIs in nursing home residents that can be used to identify prospectively tested treatment and prevention strategies. [source] A hospitalist postgraduate training program for physician assistants,JOURNAL OF HOSPITAL MEDICINE, Issue 2 2010Kristen K. Will MHPE PA-C Abstract Many hospitalist groups are hiring physician assistants (PAs) to augment their physician services. Finding PAs with hospitalist experience is difficult. Employers often have to recruit PAs from other specialties or hire new graduates who have limited hospital experience. Furthermore, entry-level PA training focuses on primary care, with more clinical rotations centered in the outpatient setting. In light of these challenges, our institution created a 12-month postgraduate training program in Hospital Medicine for 1 PA per year. It is the first reported postgraduate PA hospitalist fellowship to offer a certificate of completion. The program's curriculum is based on the Society of Hospital Medicine (SHM) "Core Competencies," and is comprised of 12 one-month rotations in different aspects of hospital medicine supplemented by formal didactic instruction. In addition, the PA fellow completes "teaching modules" on various topics not directly covered in their rotations. Furthermore, this postgraduate physician assistant training program represents a model that can be utilized at almost any institution, academic or community-based. As the need for hospitalists increases, so will the need for trained physician assistants in hospital medicine. Journal of Hospital Medicine 2010;5:94,98. © 2010 Society of Hospital Medicine. [source] Effects of HIV/AIDS on Maternity Care Providers in KenyaJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2008Janet M. Turan ABSTRACT Objective: To explore the impact of HIV/AIDS on maternity care providers in labor and delivery in a high HIV-prevalence setting in sub-Saharan Africa. Design: Qualitative one-on-one in-depth interviews with maternity care providers. Setting: Four health facilities providing labor and delivery services (2 public hospitals, a public health center, and a small private maternity hospital) in Kisumu, Nyanza Province, Kenya. Participants: Eighteen maternity care providers, including 14 nurse/midwives, 2 physician assistants, and 2 physicians (ob/gyn specialists). Results: The HIV/AIDS epidemic has had numerous adverse effects and a few positive effects on maternity care providers in this setting. Adverse effects include reductions in the number of health care providers, increased workload, burnout, reduced availability of services in small health facilities when workers are absent due to attending HIV/AIDS training programs, difficulties with confidentiality and unwanted disclosure, and maternity care providers' fears of becoming HIV infected and the resulting stigma and discrimination. Positive effects include improved infection control procedures on maternity wards and enhanced maternity care provider knowledge and skills. Conclusion: A multifaceted package including policy, infrastructure, and training interventions is needed to support maternity care providers in these settings and ensure that they are able to perform their critical roles in maternal healthcare and prevention of HIV/AIDS transmission. [source] Veterans' perceptions of care by nurse practitioners, physician assistants, and physicians: A comparison from satisfaction surveysJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2010Dorothy Budzi DrPH (Quality Manager/Performance Improvement Coordinator) Purpose: To examine the differences in patient satisfaction with care provided by nurse practitioners (NPs), physician assistants (PAs), and physicians in the Veterans Health Administration (VHA) system. Data source: Secondary data was obtained from the VHA's Survey of Healthcare Experience of Patients (SHEP), a monthly survey designed to measure patient satisfaction. Descriptive statistics were calculated and categorical variables were summarized with frequency counts. Conclusions: Of the 2,164,559 surveys mailed to the veterans, 1,601,828 (response rate 64%) were returned. The study found that satisfaction scores increased by 5% when the number of NPs was increased compared to 1.8% when the number of physicians was increased and slightly increased or remained the same when the number of PAs was increased. Physician to PA/NP ratio was 7:3. Implications for practice: The VHA is the largest healthcare system and the single largest employer of NPs and PAs in the country. This study shows that a majority of the primary care clinic patients prefer to see NPs as compared with PAs and physicians. Besides clinical care, NPs focus on health promotion, disease prevention, health education, attentiveness, and counseling. Physicians and PAs should be educated on these characteristics to promote patient satisfaction and expected outcomes. [source] Nurse Practitioner, Nurse Midwife and Physician Assistant Attitudes and Care Practices Related to Persons with HIV/AIDSJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 2 2000Jane E. Martin RN ABSTRACT Although multiple studies of nurses' attitudes toward people living with HIV/AIDS (PLWAs) can be found in the literature, little is known about the attitudes, beliefs and practices of nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs). A survey including a 21-item AIDS Attitude Scale measuring the constructs of Avoidance and Empathy was sent to 1,291 NPs, CNMs and PAs in Louisiana, Arkansas and Mississippi to describe their attitudes and care practices related to PLWAs. Respondents who were more comfortable treating PLWAs had significantly lower avoidance scores and significantly higher empathy scores than respondents with lower comfort levels in providing care. Greater than 80% of respondents indicated that they would provide health care to HIV-infected individuals. Respondents who referred HIV/AIDS patients for all care did so primarily due to lack of experience with HIV and the availability of more experienced providers. Avoidance and empathy scores were not found to be significantly associated with referral for care. This study suggests that this group of providers has relatively low avoidance and high empathy toward PLWAs and is willing to care for HIV-infected individuals. This study was supported by Grant No. 5U69PE00112-06 from the Department of Health & Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, National AIDS Education and Training Center. [source] National Health Service Corps Staffing and the Growth of the Local Rural Non-NHSC Primary Care Physician WorkforceTHE JOURNAL OF RURAL HEALTH, Issue 4 2006Donald E. Pathman MD ABSTRACT:,Context: Beyond providing temporary staffing, National Health Service Corps (NHSC) clinicians are believed by some observers to contribute to the long-term growth of the non-NHSC physician workforce of the communities where they serve; others worry that NHSC clinicians compete with and impede the supply of other local physicians. Purpose: To assess long-term changes in the non-NHSC primary care physician workforce of rural underserved counties that have received NHSC staffing support relative to workforce changes in underserved counties without NHSC support. Methods: Using data from the American Medical Association and NHSC, we compared changes from 1981 to 2001 in non-NHSC primary care physician to population ratios in 2 subsets of rural whole-county health professional shortage areas: (1) 141 counties staffed by NHSC physicians, nurse practitioners, and/or physician assistants during the early 1980s and for many of the years since and (2) all 142 rural health professional shortage area counties that had no NHSC clinicians from 1979 through 2001. Findings: From 1981 to 2001, counties staffed by NHSC clinicians experienced a mean increase of 1.4 non-NHSC primary care physicians per 10,000 population, compared to a smaller, 0.57 mean increase in counties without NHSC clinicians. The finding of greater non-NHSC primary care physician to population mean ratio increase in NHSC-supported counties remained significant after adjusting for baseline county demographics and health care resources (P < .001). The estimated number of "extra" non-NHSC physicians in NHSC-supported counties in 2001 attributable to the NHSC was 294 additional physicians for the 141 supported counties, or 2 extra physicians, on average, for each NHSC-supported county. Over the 20 years, more NHSC-supported counties saw their non-NHSC primary care workforces grow to more than 1 physician per 3,500 persons, but no more NHSC-supported than nonsupported counties lost their health professional shortage area designations.Conclusions: These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s. [source] Physician assistants: trialling a new surgical health professional in AustraliaANZ JOURNAL OF SURGERY, Issue 6 2010Phyllis Ho Abstract Background:, The Australia health workforce productivity Commission Research Report in 2005 identified workforce shortages. One of the recommendations is that new models of health care be established. As a result South Australia is trialling United States trained physician assistants in a pilot program. This paper summaries the review of literature of the physician assistant role and safety in the surgical setting. Methods:, A literature search using Medline and Pubmed from 1966 until 2009 with key words: physician assistants, midlevel providers, surgery. The references of the results were also searched for suitable articles. The Google search engine was also used with the above keywords to search for latest developments from nontraditional sources. Results:, There were over 200 suitable articles relating to the quality and safety of physician assistants. The overwhelming majority of the articles originate from the United States and these vary in quality. There were 13 published studies identified that documented physician assistants in the surgical setting. Conclusion:, From the published data physician assistants have been shown to provide safe and provide high quality care in surgical units. It is important that prior to their commencement their role is defined to alleviate conflict and confusion in the team. Continued auditing should be conducted to monitor progress and impact. [source] A Survey of Workplace Violence Across 65 U.S. Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 12 2008Susan M. Kansagra MD Abstract Objectives:, Workplace violence is a concerning issue. Healthcare workers represent a significant portion of the victims, especially those who work in the emergency department (ED). The objective of this study was to examine ED workplace violence and staff perceptions of physical safety. Methods:, Data were obtained from the National Emergency Department Safety Study (NEDSS), which surveyed staff across 69 U.S. EDs including physicians, residents, nurses, nurse practitioners, and physician assistants. The authors also conducted surveys of key informants (one from each site) including ED chairs, medical directors, nurse managers, and administrators. The main outcome measures included physical attacks against staff, frequency of guns or knives in the ED, and staff perceptions of physical safety. Results:, A total of 5,695 staff surveys were distributed, and 3,518 surveys from 65 sites were included in the final analysis. One-fourth of surveyed ED staff reported feeling safe sometimes, rarely, or never. Key informants at the sampled EDs reported a total of 3,461 physical attacks (median of 11 attacks per ED) over the 5-year period. Key informants at 20% of EDs reported that guns or knives were brought to the ED on a daily or weekly basis. In multivariate analysis, nurses were less likely to feel safe "most of the time" or "always" when compared to other surveyed staff. Conclusions:, This study showed that violence and weapons in the ED are common, and nurses were less likely to feel safe than other ED staff. [source] Trained and supervised physician assistants can safely perform diagnostic cardiac catheterization with coronary angiographyCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2003Richard A. Krasuski MD Abstract Using a prospectively collected database of patients undergoing cardiac catheterization, we sought to compare the outcomes of procedures performed by supervised physician assistants (PAs) with those performed by supervised cardiology fellows-in-training. Outcome measures included procedural length, fluoroscopy use, volume of contrast media, and complications including myocardial infarction, stroke, arrhythmia requiring defibrillation or pacemaker placement, pulmonary edema requiring intubation, and vascular complications. Class 3 and 4 congestive heart failure was more common in patients who underwent procedures by fellows compared with those undergoing procedures by PAs (P = 0.001). PA cases tended to be slightly faster (P = 0.05) with less fluoroscopic time (P < 0.001). The incidence of major complications within 24 hr of the procedure was similar between the two groups (0.54% in PA cases and 0.58% in fellow cases). Under the supervision of experienced attending cardiologists, trained PAs can perform diagnostic cardiac catheterization, including coronary angiography, with complication rates similar to those of cardiology fellows-in-training. Cathet Cardiovasc Intervent 2003;59:157,160. © 2003 Wiley-Liss, Inc. [source] The National Trend in Quality of Emergency Department Pain Management for Long Bone FracturesACADEMIC EMERGENCY MEDICINE, Issue 2 2007PA-C, Tamara S. Ritsema MPH Background Despite national attention, there is little evidence that the quality of emergency department (ED) pain management is improving. Objectives To compare the quality of ED pain management before and after implementation of the Joint Commission on the Accreditation of Healthcare Organizations' standards in 2001. Methods The authors performed a retrospective cohort study by using the National Hospital Ambulatory Medical Care Survey from 1998,2003. Patients who presented to the ED with a long bone fracture (femur, humerus, tibia, fibula, radius, or ulna) were compared. The authors extracted data on patient, visit, and hospital characteristics. The primary outcomes were the proportion of patients who received assessment of pain severity and who received analgesic treatment. Results There were 2,064 patients with a qualifying fracture in the study period, 834 from 1998,2000 and 1,230 from 2001,2003. Compared with the early period, a higher proportion of patients in the late period had their pain assessed (74% vs. 57%), received opiates (56% vs. 50%), and received any analgesic (76% vs. 56%). Patients in the late period had higher odds of receiving any analgesia (adjusted odds ratio [OR], 1.43) and opioid analgesia (adjusted OR, 1.27) compared with the early period. Patients in the middle age group (adjusted OR, 2.28) or those seen by physician assistants (adjusted OR, 2.05) were more likely, whereas those with Medicaid (adjusted OR, 0.58) and those in the Northeast were less likely, to receive opiates. Conclusions Although the quality of ED pain management for acute fractures appears to be improving, there is still room for further improvement. [source] | ||||||||||