Knowledge, attitudes and practices of UK paramedics regarding pharmacology and the legal, management and administration aspects of medicines : a cross-sectional online quantitative survey

Introduction: Changes in the paramedic profession have seen an increased range of medicines available within UK ambulances services. However, poor practice in medicines management has been identified by the Care Quality Commission. Literature in this area is sparse. This study aimed to determine the perceived knowledge, attitudes and practices of paramedics regarding pharmacology and the legal and regulatory issues of medicines management and administration.Methods: The study utilised a cross-sectional survey design, administering an anonymous online survey to all (approximately 1000) paramedics within one UK NHS ambulance trust. The survey focused on paramedic knowledge on pharmacology, legal supply and administration; self-assessment of knowledge and confidence related to medicine management and administration; and personal characteristics. The primary outcome was percentage of (pre-determined) correct answers.Results: 251 responses were received. The mean percentage of correct answers was 79.0% (SD 10.0), with variation by question observed, from 34.7 to 97.2% correct responses. A higher correct knowledge was associated with: higher self-rated confidence, lower self-reported knowledge, being less likely to report errors and higher education-based initial route into the paramedic profession.Conclusion: This single-site UK-based survey highlighted variation in medicines knowledge among self-selecting paramedic respondents. The results indicate a need for medicines-specific further education for all paramedics, particularly those who have not experienced longer formal education entry routes, integrating a focus on confidence and self-perceived knowledge, and enhancing and embedding integrated improvement strategies. Further research is required with larger, multi-site samples, and to evaluate the impact of education packages developed

Patient-level data linkage across ambulance services and acute trusts: assessing the potential for improving patient care

ABSTRACT Objectives The potential of linked healthcare data to support improvements to the care quality, efficiency and service planning is recognised by the Department of Health and NHS England. UK ambulance services however, have little information regarding the outcome of patients as there is no routine data sharing. An urban ambulance service has previously piloted linked data with one acute trust. The Pre-Hospital Emergency Department Data Linking Project (PHED Data) aims to assess the potential opportunities for and challenges to routinely linking data for several sites. It aims to define what indicator sets can be developed from these linked data, with a view to informing commissioning and improvement of healthcare delivery. Approach The project is a two-year mixed-methods observational study, funded by the Health Foundation, working with six acute trusts of various size and CQC-derived performance, to carry out six work packages. Work package one uses liaison activities with trust senior staff to negotiate information sharing agreements, and a learning log to enable an economic assessment of the set-up costs. Work packages two to five analyse ambulance response time, referrals from healthcare professionals, ED mortality, and frequent ED diagnoses, respectively, exploring relationships with ED outcomes, quantitatively. Qualitative analysis will explore, with staff groups, how the findings might influence commissioning and pre-hospital care. Work package six will examine commissioning decisions and patient care, through interviews with commissioners and performance managers. Results In work package one, we have successfully negotiated overall research ethics and governance approval, involving in-depth discussion about definitions of identifiable patient data, and protecting against potential re-identification. We have recruited six acute trusts, comprising 13 hospital sites, for whom equivalent data is available. We have been working for six months in liaison with these Trusts to deliver information sharing agreements (three are currently approved) and data transfer, working with research governance, information governance and clinical staff. The processes have varied, with intra-Trust co-dependencies introducing delays and non-linear processes being common. For work packages two to five, some data analysis will be available for presentation at the conference. Conclusion This project has the potential to shed light on the practicalities of data linkage for health service providers who face similar challenges with patient data held in multiple organisations. The study also anticipates being able to recommend quality improvement to support the development of new pathways in pre-hospital care

The development of advanced clinical practitioners in NHS organisations providing acute, community and emergency services in London : an evaluative interview study

Internationally health care systems are developing advanced clinical practitioners (ACPs), such as nurse practitioners, to address growing health care needs, shortages of doctors and financial constraints. At present in the United Kingdom there is no state regulation for such roles in nursing, midwifery, allied health professionals or health scientists, either for the level of education or clinical competency. In England, Health Education England (HEE) which is responsible for workforce planning and training is supporting the development of ACP roles in all types of professional groups (nurses, midwives, allied health professionals and health scientists). The London HEE team commissioned an evaluative study concerned with factors influencing the development of ACPs. The evaluation questions addressed were: 1. What has influenced the development of ACP roles? 2. To what extent are NHS acute, community and emergency services employing and deploying ACPs? 3. What are the factors influencing the success or otherwise in introducing and sustaining ACPs in the workforce? 4. Is there documentary or published evidence of the value, or otherwise, of ACP roles and of patient perceptions of ACP roles. This monograph reports on a qualitative exploration in 2019 of the views of senior NHS managers and clinicians in a range of health care organisations in London

Adult nurse turnover and retention : South London project report

This project was commissioned by Health Education South London (HESL) in response to the workforce planning process for 2014/15 indicating an unprecedented increase in demand for adult nurses in NHS Trusts. The focus of the project was to identify issues and interventions to improve retention of adult nurses and reduce the rate of leaving jobs (turnover). During 2015 the work of the project has included: a systematic literature review to examine evidence of determinants, costs and interventions of adult nurse turnover; analysis of adult nurse workforce data to identify trends and rates in sub-groups of nurses and by characteristics of their employment context; interviews with senior nurse and human resource managers across South London for views and examples of initiatives to reduce turnover; interviews with adult nurses and nurse managers managers as to their views on the issues and initiatives that might help retain nurses. The evidence from each element is presented and then synthesised

Perceived impact on efficiency and safety of experienced American physician assistants / associates in acute hospital care in England : findings from a multi-site case organisational study

Summary Objectives To investigate the contribution, efficiency and safety of experienced physician associates included in the staffing of medical/surgical teams in acute hospitals in England, including facilitating and hindering factors. Design Mixed methods longitudinal, multi-site evaluation of a two-year programme employing 27 American physician associates: interviews and documentary analysis. Setting Eight acute hospitals, England. Participants 36 medical directors, consultants, junior doctors, nurses and manager, 198 documents. Results Over time, the experienced physician associates became viewed as a positive asset to medical and surgical teams, even in services where high levels of scepticism were initially expressed. Their positive contribution was described as bringing continuity to the medical/surgical team which benefited patients, consultants, doctors-in-training, nurses and the overall efficiency of the service. This is the first report of the positive impact that, including physician associates in medical/surgical teams, had on achieving safe working hours for doctors in training. Many reported the lack of physician associates regulation with attendant legislated authority to prescribe medicines and order ionising radiation was a hindrance in their deployment and employment. However, by the end of the programme, seven hospitals had published plans to increase the numbers of physician associates employed and host clinical placements for student physician associates. Conclusions The programme demonstrated the types of contributions the experienced physician associates made to patient experience, junior doctor experience and acute care services with medical workforce shortages. The General Medical Council will regulate the profession in the future. Robust quantitative research is now required

The contribution of physician assistants/associates to secondary care : a systematic review

OBJECTIVE: To appraise and synthesise research on the impact of physician assistants/associates (PA) in secondary care, specifically acute internal medicine, care of the elderly, emergency medicine, trauma and orthopaedics, and mental health. DESIGN: Systematic review. SETTING: Electronic databases (Medline, Embase, ASSIA, CINAHL, SCOPUS, PsycINFO, Social Policy and Practice, EconLit and Cochrane), reference lists and related articles. INCLUDED ARTICLES: Peer-reviewed articles of any study design, published in English, 1995-2017. INTERVENTIONS: Blinded parallel processes were used to screen abstracts and full text, data extractions and quality assessments against published guidelines. A narrative synthesis was undertaken. OUTCOME MEASURES: Impact on: patients' experiences and outcomes, service organisation, working practices, other professional groups and costs. RESULTS: 5472 references were identified and 161 read in full; 16 were included-emergency medicine (7), trauma and orthopaedics (6), acute internal medicine (2), mental health (1) and care of the elderly (0). All studies were observational, with variable methodological quality. In emergency medicine and in trauma and orthopaedics, when PAs are added to teams, reduced waiting and process times, lower charges, equivalent readmission rate and good acceptability to staff and patients are reported. Analgesia prescribing, operative complications and mortality outcomes were variable. In internal medicine outcomes of care provided by PAs and doctors were equivalent. CONCLUSIONS: PAs have been deployed to increase the capacity of a team, enabling gains in waiting time, throughput, continuity and medical cover. When PAs were compared with medical staff, reassuringly there was little or no negative effect on health outcomes or cost. The difficulty of attributing cause and effect in complex systems where work is organised in teams is highlighted. Further rigorous evaluation is required to address the complexity of the PA role, reporting on more than one setting, and including comparison between PAs and roles for which they are substituting. PROSPERO REGISTRATION NUMBER: CRD42016032895

Physician associates working in secondary care teams in England: Interprofessional implications from a national survey

Physician associates (PAs) are a new type of healthcare professional to the United Kingdom; however, they are well established in the United States (where they are known as physician assistants). PAs are viewed as one potential solution to the current medical workforce doctor shortage. This study investigated the deployment of PAs within secondary care teams in England, through the use of a cross-sectional electronic, self-report survey. The findings from 14 questions are presented. Sixty-three PAs working in a range of specialties responded. A variety of work settings were reported, most frequently inpatient wards, with work generally taking place during weekdays. Both direct and non-direct patient care activities were reported, with the type of work undertaken varying at times, depending on the presence or absence of other healthcare professionals. PAs reported working within a variety of secondary care team staffing permutations, with the majority of these being interprofessional. Line management was largely provided by consultants; however day-to-day supervision varied, often relating to different work settings. A wide variation in ongoing supervision was also reported. Further research is required to understand the nature of PAs' contribution to collaborative care within secondary care teams in England

Physician associates and GPs in primary care: a comparison.

BACKGROUND: Physician associates [PAs] (also known as physician assistants) are new to the NHS and there is little evidence concerning their contribution in general practice. AIM: This study aimed to compare outcomes and costs of same-day requested consultations by PAs with those of GPs. DESIGN AND SETTING: An observational study of 2086 patient records presenting at same-day appointments in 12 general practices in England. METHOD: PA consultations were compared with those of GPs. Primary outcome was re-consultation within 14 days for the same or linked problem. Secondary outcomes were processes of care. RESULTS: There were no significant differences in the rates of re-consultation (rate ratio 1.24, 95% confidence interval [CI] = 0.86 to 1.79, P = 0.25). There were no differences in rates of diagnostic tests ordered (1.08, 95% CI = 0.89 to 1.30, P = 0.44), referrals (0.95, 95% CI = 0.63 to 1.43, P = 0.80), prescriptions issued (1.16, 95% CI = 0.87 to 1.53, P = 0.31), or patient satisfaction (1.00, 95% CI = 0.42 to 2.36, P = 0.99). Records of initial consultations of 79.2% (n = 145) of PAs and 48.3% (n = 99) of GPs were judged appropriate by independent GPs (P<0.001). The adjusted average PA consultation was 5.8 minutes longer than the GP consultation (95% CI = 2.46 to 7.1; P<0.001); cost per consultation was GBP £6.22, (US$ 10.15) lower (95% CI = -7.61 to -2.46, P<0.001). CONCLUSION: The processes and outcomes of PA and GP consultations for same-day appointment patients are similar at a lower consultation cost. PAs offer a potentially acceptable and efficient addition to the general practice workforce

A patient survey of out-of-hours care provided by Emergency Care Practitioners

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