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Biomedical subjects

R S Hooker

Publications and source records attributed to R S Hooker.

At least 19 recordsLinked to original sources
PubMed2004

Physician assistants in occupational medicine: how do they compare to occupational physicians?

BACKGROUND: Physician assistants (PAs) have been present in occupational and environmental medicine (OEM) in the USA since 1971, yet remarkably little is known about their activity. METHODS: An administrative study of PA activities was undertaken and compared with the activities of physicians in the same occupational medicine setting. Patients were not triaged to either provider and all resources of care were recorded for the visit. An episode of care approach was used for the analysis. RESULTS: The characteristics of patients seen by each provider were similar in age, gender ratio and severity of injury. Physicians saw a mean of 2.9 patients/h and PAs 2.5, but PAs worked more hours and saw more patients per year than physicians. The average charge per patient visit and total charge for an episode of care were similar. Differences between PAs and physicians were seen in the areas of 'limited duty' duration given to patients and on average PAs prescribed 15 days and physicians 17 days. PAs referred a patient 19.7% of the time, while physicians referred 17.4%. Most of the referrals were to physical therapy. The salary of a physician, based on an hourly rate, was approximately twice as much as a PA. CONCLUSION: The use of PAs in OEM may represent a cost-effective advantage from an administrative standpoint. Clearly, more research is necessary in determining the role and utilization of PAs in OEM and how they may improve the delivery of physician services.

Costs and Cost Analysis↗
PubMed2001

Use of physician assistants and nurse practitioners in primary care, 1995-1999.

Federal policies and state legislation in the United States encourage the use of physician assistants (PAs) and nurse practitioners (NPs) in primary care, although the nature of their work has not been fully analyzed. This article analyzes primary care physician office-encounter data from the 1995-1999 National Ambulatory Medical Care Surveys. About one-quarter of primary care office-based physicians used PAs and/or NPs for an average of 11% of visits. The mean age of patients seen by physicians was greater than that for PAs or NPs. NPs provided counselling/education during a higher proportion of visits than did PAs or physicians. Overall, this study suggests that PAs and NPs are providing primary care in a way that is similar to physician care.

Adult↗
PubMed2001

Physician assistants in Texas.

Understanding the health requirements of a state begins with identifying the population at need and the workforce available to meet those needs. A descriptive study was undertaken to examine the physician assistant (PA) workforce in Texas as part of an ongoing effort to meet the health needs of Texas residents. In September 2000, Texas had 2237 licensed PAs practicing in 186 counties. Education for PAs in Texas began in 1970 and currently includes one private, one military, and six public programs. Most practicing PAs in Texas graduate from in-state programs and tend to locate within the state. Preparations are under way to shift the public undergraduate programs to graduate degree programs. Although barriers to health care access in Texas remain a substantial public health issue, PAs have helped reduce these barriers, especially in many rural communities. The supply of and demand for Texas PAs appear to be in equilibrium. Policy implications are discussed.

Delivery of Health Care↗
PubMed2000

"Elder" physician assistants and their practices.

UNLABELLED: Physician assistants (PAs) in American medicine are aging. After 30 years of having PAs enter the US health care system, it seems an appropriate time to examine where they are in their careers. This study describes the phenomenon of a rising number of elder PAs in the ranks of the nation's health providers and their patterns of practice. METHOD: A subpopulation cohort of practicing PAs 60 years and older was compared to all PAs. Age range, gender, practice setting, specialty, and other demographic variables were analyzed using established methods. Differences between elder PAs and all other PAs and services provided by the two groups were examined. RESULTS: Elder PAs constituted about 1.6% of full-time PAs in practice in 1998. Average age of elder PAs is 64 years (range, 60 years to 74 years) compared to 41 years (range, 21 years to 60 years) for all full-time practicing PAs. Analysis of several variables--gender, ethnicity, geographic distribution, number of patients seen in a week, and hours worked in a week--revealed few differences between the cohorts. On average, older PAs were in practice longer than all PAs (18.3 years and 9.2 years, respectively), had been with their current employer for 7.7 years, and worked one job. Elder PAs had an associate degree at twice the rate of all PAs, but three times as many of them had a doctorate. Elder PAs are more likely to be taking care of older patients, working in a rural area, and remaining in a rural area longer than PAs overall. INTERPRETATION: America's corps of PAs continues to work into and beyond the usual retirement age for most workers, and is caring for a greater percentage of older persons than all PAs are. Most elder PAs practice in family or general medicine and prefer to practice in a rural area. These practice preferences mirror results of previous studies of the practices of elder physicians in the United States and Canada. The aging of PAs has important implications for clinical practice and health workforce planning. If PAs were encouraged to take early retirement, more elderly patients would be shifted to younger providers--with the potential to affect delivery of primary care services in rural communities.

Age Factors↗
PubMed2000

Physician assistants and the practice of neurology.

This is the first study of how physician assistants (PAs) function in neurology practice. Forty-six PAs who work full-time in a neurology practice were surveyed by telephone and by mail; 100% responded to all telephone survey questions on aspects of practice, and almost all responded to the mailed survey. Of these, 26 worked in a group practice; the average duration of neurology experience was 7 years. Diagnoses seen by these PAs were similar to those seen in most neurology practices. The scope of findings is limited but suggests that, in neurology settings where PAs are employed, they perform a broad range of functions. Furthermore, PAs in most neurology practices likely assist in off-loading patients whose requirements for care are considered "routine" by the PAs' supervising physician(s).

Adult↗
PubMed1999

Implications for practice and education. Clinical activities of Iowa family practice PAs.

A survey of family practice physician assistants (PAs) in Iowa was undertaken to determine the frequency with which they utilized specific clinical skills. A response was received from 55 of 77 (74%) PAs surveyed. Average age of respondents was 42 years (range, 35 to 50). Respondents had, on average, been practicing for 13 years, mostly in family medicine; on average, they saw 25 patients a day. All reported providing patient education, prescribing and dispensing medication, interpreting radiographs, referring patients, and providing a wide range of services similar to their physician counterparts in Iowa. In regard to 62 activities identified, few differences emerged among respondents when population setting was considered--except that PAs who work in communities of fewer than 10,000 residents often perform a wider range of services than those who work in larger communities. Activities that have been ranked as important by Iowa family practice physicians in other surveys were also the clinical skills that PAs in this survey reported performing most often. This study supports mounting evidence that PAs are an important aspect of primary care delivery across society. Their activities in the delivery of care are similar to those that the physicians with whom they are most closely associated consider important.

Adult↗
PubMed1997

Analysis of the costs of NSAID-associated gastropathy. Experience in a US health maintenance organisation.

Clinicians recognise nonsteroidal anti-inflammatory drugs (NSAIDs) as valuable first-line agents in the treatment of rheumatic disorders and as dangerous irritants to the gastrointestinal tract. This has led to questions about the economic impact of NSAID-induced gastropathy in populations. This study estimated the 1992 costs of NSAID-associated gastropathy episodes, and calculated an iatrogenic cost factor for NSAID-associated gastropathy among elderly members of a health maintenance organisation (HMO), the Northwest Region of Kaiser Permanente. Using data retrieved from automated databases and from medical records, NSAID and antiulcer drug costs were calculated, and estimates were made of the incidence rates of inpatient and outpatient NSAID-associated gastropathies, the services provided to treat them, and the cost of those services. Kaiser Permanente Northwest spent $US0.35 for each $US1.00 spent on NSAID therapy for the elderly, an iatrogenic cost factor of 1.35. The estimated average treatment per NSAID-associated gastropathy episode was $US2172. The average outpatient pharmacy cost per elderly NSAID user was $US80 and estimated average NSAID-associated treatment cost per elderly NSAID user was $US43. Although the findings were specific to the HMO because of the databases used, the methodology employed and the drug formulary influence on NSAID selection, they show that a substantial amount of resources were used to treat NSAID-induced gastropathies in the elderly, underscoring the risk of prescribing NSAIDs and reinforcing the need for their prudent use in elderly patients.

Adolescent↗
PubMed1996

Emergency department uses of physician assistants and nurse practitioners: a national survey.

A study was undertaken to determine the extent to which physician assistants (PAs) and/or nurse practitioners (NPs) are a source of health care delivery in emergency departments (EDs) in the United States. The National Hospital Ambulatory Medical Survey (NHAMCS) uses a multistage probability sample that examines patient visits within EDs. The sample included 437 hospitals with EDs. Visits were mostly from self-referred patients to EDs within nonfederal, short-stay hospitals, or general hospitals. Analysis of NHAMCS data found that a PA and/or NP was seen for 3.5 million ED visits in 1992. Remarkably little difference in gender, reason for visit, diagnosis, and medication prescribed was found between PA/NP visits and visits to all providers. This was the first study that systematically identified the extent of PA/NP-delivered ED services in the United States and compared it with physician services. Overall, PAs and NPs were found to be significant sources of health care service for hospital EDs. They are involved in care for almost 4% of all ED visits nationally and manage a wider range of conditions than has been previously reported. When types of visits are analyzed, including reasons for ED care, diagnosis, and treatment, it appears that visits associated with care by ED-based PA/NPs are similar to all ED visits, including those attended by emergency medicine physicians. More studies are needed to better understand the role of PAs and/or NPs in various ED settings. Recruitment and use of PAs and NPs may be a cost-effective strategy for improved delivery of emergency services.

Adolescent↗
PubMed1996

Determinants of specialty choice of physician assistants.

PURPOSE: Although physician assistants (PAs) became part of the U.S. health scene in 1967 and have made important contributions to primary care, available information about the factors that may influence the career choices of this rapidly-growing group of health care providers is sparse. The intent of this analysis was to identify the main factors underlying the specialty-choice decisions of PAs in the first practice year after completing PA training and the reasons for their selections. METHOD: Data were collected from a 1994 survey of 4,416 PAs who had graduated in 1991-1993. Usable responses were obtained from 1,472 PAs (33%). Each PA was asked to state the specialty he or she had entered in the first practice year and also to rate each of 33 possible reasons for this decision. Primary care specialties were defined as family medicine, general internal medicine, and general pediatrics. The ratings were subjected to a factor analysis. RESULTS: The 33 original variables were reduced to nine basic factors influencing the specialty-choice decisions of the PAs, accounting for 47.3% of the variance. The two most important factors were intellectual content of the specialty and a technical orientation. Then factor scores were computed for each PA and subjected to further examination, in which the PAs were divided into two groups: 776 who had entered primary care specialties, and 646 who had entered non-primary-care specialties (50 did not specify their specialties). For the PAs in non-primary-care specialties, the most influential factors were technical orientation and income/employment. For the PAs in primary care, the most influential factors were prevention, academic environment, debt/scholarship, intellectual content, and peer influence. CONCLUSION: For this recently graduated group of PAs, factors representing the kinds of activities they would be engaged in as health care providers were among the most influential, but the relative importances of the factors varied according to whether the PAs were in primary care or non-primary-care specialties, with the latter group being more strongly influenced by marker forces such as income and employment opportunities.

Career Choice↗
PubMed1994

PAs and NPs in HMOs.

Recognition of NPP contributions to the delivery of care in HMOs has come slowly. Staffing continues to be a function of physician attitude instead of management rationale. Only a few enlightened HMOs seek management and staffing input from NPPs. Investigation of the role of NPPs in HMOs has seriously lagged behind that of physicians, nurses, pharmacists, and other health professionals. The status, reward systems, and job satisfaction of nonphysician clinicians, as well as efforts and problems in recruiting them, have been inadequately reported. Only a handful of HMOs have contributed to our understanding of NPP productivity and task delegation. If HMOs plan to continue using NPPs, much more information on optimizing their deployment must be shared. Member satisfaction surveys must be reported, prescribing practices must be compared, liability issues explored, and outcomes research pursued. We know little about the outcome of nonacute illness managed by NPPs. Do NPPs negate their cost-effectiveness by using more or different resources? Do differences between PAs and NPs exist with regard to each of these issues? Because so many study variables can be held constant by a large HMO which provides care in a given area under uniform market forces, HMOs can best explore how to maximize NPP effectiveness.

Health Maintenance Organizations↗
PubMed1991

The military physician assistant.

The origin of the physician assistant began with medically trained military personnel. Now, 25 years later, the military has over 1,100 physician assistants working in all aspects of health care delivery. This article examines the historical perspective and discusses current and emerging issues for the utilization of military physician assistants.

History, 20th Century↗
PubMedDate not supplied

Use of physician assistants and nurse practitioners in primary care, 1995-1999.

Federal policies and state legislation encourage the use of physician assistants (PAs) and nurse practitioners (NPs) in primary care, although the nature of their work has not been fully analyzed. In this paper we analyze primary care physician office encounter data from the 1995-1999 National Ambulatory Medical Care Surveys. About one-quarter of primary care office-based physicians used PAs and/or NPs for an average of 11 percent of visits. The mean age of patients seen by physicians was greater than that for PAs or NPs. NPs provided counseling/education during a higher proportion of visits than did PAs or physicians. Overall, this study suggests that PAs and NPs are providing primary care in a way that is similar to physician care.

Adult↗
PubMedDate not supplied

Rheumatology referral patterns.

The authors studied the characteristics of patients referred for rheumatology consultation in a group model HMO. Six hundred twelve patients were evaluated in 1986. The ages ranged from 3 to 85 years, with an average of 52 years. Female patients outnumbered male patients almost 3:1. Only 44% of referrals had a presumptive diagnosis and more than one half of these diagnoses were changed by the consulting rheumatology specialist, suggesting a high value added from the HMO rheumatologic consultation. Internists referred at a slightly higher rate than family practitioners, and pediatricians referred children at one tenth of the adult rate. Comparison with other published data on fee-for-service rheumatology practices indicates that in one group model HMO, which prohibits patient self-referral, rheumatologic specialists see a higher percentage of patients with vague or difficult-to-manage conditions such as the connective tissue diseases and fibromyalgia and a lower percentage of osteoarthritis and gout. This finding suggests that the structure and incentives of HMOs alter medical referral and practice patterns in significant ways.

Adolescent↗
PubMedDate not supplied

Use of physician assistants in a managed health care system.

Kaiser Permanente Northwest Region is a prepaid group practice health maintenance organization. Among the employed are 65 physician assistants (PAs) who work in primary care and in certain subspecialties. Kaiser Permanente was one of the first managed health care systems to use PAs and has contributed to the historical documentation of their effectiveness. An interest in experimenting with new forms of health care delivery as well as enabling State legislation has contributed to an expanded role for nonphysician providers. Together with nurse practitioners, PAs comprise 20 percent of the primary care staff and write 25 percent of the prescriptions for the membership. The use of PAs in managed health care settings will likely increase to meet growing primary care demands. Analysts have found the cost of a PA ranges from 25 percent to 53 percent of the cost of a physician. PAs are capable of providing care for 86 percent of the diagnoses seen in outpatient primary care setting, and patient acceptance is high.

Adult↗
PubMedDate not supplied

Satisfaction of physician assistants and other nonphysician providers in a managed care setting.

Health maintenance organizations have employed physician assistants, nurse practitioners, and other nonphysician providers for decades, yet there is little information on how satisfied these providers are with this form of practice. This paper examines how physician assistants evaluate their experience practicing in a large group model health maintenance organization and compares their attitudes and satisfaction levels with those of other nonphysician providers-nurse practitioners, optometrists, mental health therapists, and chemical dependency counselors. The data source is a 1992 survey of 5,000 nonphysician employees of a health maintenance organization. The survey instrument was a self-administrated questionnaire that included both structured and open-ended questions. The response rate averaged 88 percent for physician assistants and the other non-physician providers. Physician assistants expressed the most satisfaction with the amount of responsibility, support from coworkers, job security, working hours, supervision, and task variety. They were less satisfied with workload, control over the pace of work, and opportunities for advancement. Most physician assistants were also satisfied with pay and fringe benefits. Compared with other nonphysician providers, chemical dependency counselors expressed the highest levels of satisfaction across the various dimensions of work and optometrists the lowest. Nurse practitioners, chemical dependency counselors, and mental health professionals also tended to be satisfied with most aspects of practice in this setting. In a number of instances, they were more satisfied than the physician assistants. The findings are consistent with other studies that found health maintenance organizations to be favorable practice settings for physician assistants. The limits of physician assistant involvement and their role satisfaction and efficient use in HMOs are more likely to relate to physician attitudes and acceptance than to lack of support by coworkers and other attributes of the work environment.

Adult↗