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

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

Working with Indigenous, local and scientific knowledge in assessments of nature and nature's linkages with people

Working with indigenous and local knowledge (ILK) is vital for inclusive assessments of nature and nature's linkages with people. Indigenous peoples' concepts about what constitutes sustainability, for example, differ markedly from dominant sustainability discourses. The Intergovernmental Platform on Biodiversity and Ecosystems Services (IPBES) is promoting dialogue across different knowledge systems globally. In 2017, member states of IPBES adopted an ILK Approach including: procedures for assessments of nature and nature's linkages with people; a participatory mechanism; and institutional arrangements for including indigenous peoples and local communities. We present this Approach and analyse how it supports ILK in IPBES assessments through: respecting rights; supporting care and mutuality; strengthening communities and their knowledge systems; and supporting knowledge exchange. Customary institutions that ensure the integrity of ILK, effective empowering dialogues, and shared governance are among critical capacities that enable inclusion of diverse conceptualizations of sustainability in assessments

The contribution of physician assistants in primary care: a systematic review

The research evidence of the contribution of PAs to primary care was mixed and limited. However, the continued growth in employment of PAs in American primary care suggests that this professional group is judged to be of value by increasing numbers of employers. Further specific studies are needed to fill in the gaps in our knowledge about the effectiveness of PAs' contribution to the international primary care workforce

Working with indigenous, local and scientific knowledge in assessments of nature and nature's linkages with people

International audienceWorking with indigenous and local knowledge (ILK) is vital for inclusive assessments ofnature and nature’s linkages. Indigenous peoples’ concepts about what constitutessustainability, for example, differ markedly from dominant sustainability discourses.The Intergovernmental Platform on Biodiversity and Ecosystems Services (IPBES) ispromoting dialogue across different knowledge systems globally. In 2017, memberstates of IPBES adopted an ILK Approach including: procedures for assessments ofnature and nature’s linkages with people; a participatory mechanism; and institutionalarrangements for including indigenous peoples and local communities. We present thisApproach and analyse how it supports ILK in IPBES assessments through: respectingrights; supporting care and mutuality; strengthening communities and their knowledgesystems; and supporting knowledge exchange. Customary institutions that ensure theintegrity of ILK, effective empowering dialogues, and shared governance are amongcritical capacities that enable inclusion of diverse conceptualization of sustainability inassessments

Working with indigenous, local and scientific knowledge in assessments of nature and nature's linkages with people

International audienceWorking with indigenous and local knowledge (ILK) is vital for inclusive assessments ofnature and nature’s linkages. Indigenous peoples’ concepts about what constitutessustainability, for example, differ markedly from dominant sustainability discourses.The Intergovernmental Platform on Biodiversity and Ecosystems Services (IPBES) ispromoting dialogue across different knowledge systems globally. In 2017, memberstates of IPBES adopted an ILK Approach including: procedures for assessments ofnature and nature’s linkages with people; a participatory mechanism; and institutionalarrangements for including indigenous peoples and local communities. We present thisApproach and analyse how it supports ILK in IPBES assessments through: respectingrights; supporting care and mutuality; strengthening communities and their knowledgesystems; and supporting knowledge exchange. Customary institutions that ensure theintegrity of ILK, effective empowering dialogues, and shared governance are amongcritical capacities that enable inclusion of diverse conceptualization of sustainability inassessments