Physician Assistants Research Articles

Talking About Incarceration History: Engaging Patients and Healthcare Providers in Communication.

Incarcerated individuals in carceral facilities demonstrate an elevated prevalence of chronic disease conditions which are likely to persist post-release. Healthcare providers may not be trained on how exposure to incarceration may influence patient health outcomes and patient-provider communication. To examine the self-perceived preparedness of healthcare providers to interview patients regarding history of incarceration and the potential related health consequences. This cross-sectional study consisted of a web-based self-administered questionnaire distributed via email to a random sample of healthcare providers in the Department of Medicine at Brigham and Women's Hospital. In total, 400 healthcare providers were invited to participate; 114 respondents completed the survey, of which 26% were medical doctors (n=30), 41% were physician assistants (n=47), and 32% were nurse practitioners (n=37). Understanding healthcare provider training in caring for formerly incarcerated patients, current treatment practices and confidence caring for patients who have experienced incarceration, and implications for clinical care. Of 114 respondents, 73% reported that they currently care for formerly incarcerated patients. However, only 8% received specialized training for the care of formerly incarcerated patients. While most respondents did not ask their patients about prior history of incarceration (81%), when asked about comfortability in doing so, 60% reported low levels of comfort. Most providers (77%) reported high agreement that incarceration impacted health, with 54% reporting that it led to significant healthcare access barriers, but 64% reported low confidence levels in addressing the needs of formerly incarcerated patients. Healthcare workers recognized incarceration as a detrimental health exposure. However, providers reported low levels of confidence in understanding and addressing the unique needs of patients who experienced incarceration. Findings support the need for further training regarding how to address the needs of formerly incarcerated patients, which would support efforts towards achieving equitable healthcare.

Measures of Success: Making the Case for Advanced Practice-Sensitive Quality Indicators.

Description Advanced practice registered nurses (APRNs) are key health care providers in a variety of settings. Often APRNs are grouped in a collective category, along with physician assistants, and referred to collectively as advanced practice providers. As APRNs assume an increasing role in patient care management in hospital, outpatient, and community settings, such as clinics and rural practices, measuring the impact of their care on patient outcomes and quality of care becomes a necessary component of performance evaluation. APRN-sensitive outcome indicators are an important way to identify the impact of the role. While a number of studies have been conducted that demonstrate APRN outcomes, identifying specific APRN-sensitive outcome indicators can be challenging. This article reviews the use of APRN-sensitive outcome indicators to identify the impact of the APRN role, highlighting exemplars from several clinical practice sites.

Self-Reported Patient and Provider Satisfaction With Neurology Telemedicine Visits After Rapid Telemedicine Implementation in an Urban Academic Center: Cross-Sectional Survey.

Many clinics and health systems implemented telemedicine appointment services out of necessity due to the COVID-19 pandemic. Our objective was to evaluate patient and general provider satisfaction with neurology telemedicine implementation at an urban academic medical center. Patients who had completed 1 or more teleneurology visits from April 1 to December 31, 2020, were asked to complete a survey regarding their demographic information and satisfaction with teleneurology visits. Providers of all specialties within the same hospital system were given a different survey to gather their experiences of providing telemedicine care. Of the estimated 1500 patients who had completed a teleneurology visit within the given timeframe, 117 (7.8%) consented to complete the survey. Of these 117 respondents, most appointments were regarding epilepsy (n=59, 50.4%), followed by multiple sclerosis (n=33, 28.2%) and neuroimmunology (n=7, 6%). Overall, 74.4% (n=87) of patients rated their experience as 8 out of 10 or higher, with 10 being the highest satisfaction. Furthermore, 75.2% (n=88) of patients reported missing an appointment in the previous year due to transportation issues and thought telemedicine was more convenient instead. A significant relationship between racial or ethnic group and comfort sharing private information was found (P<.001), with 52% (26/50) of Black patients reporting that an office visit is better, compared to 25% (14/52) of non-Black patients. The provider survey gathered 40 responses, with 75% (n=30) of providers agreeing that virtual visits are a valuable tool for patient care and 80% (n=32) reporting few to no technical issues. The majority of provider respondents were physicians on faculty or staff (n=21, 52%), followed by residents or fellows (n=15, 38%) and nurse practitioners or physician assistants (n=4, 10%). Of the specialties represented, 15 (38%) of the providers were in neurology. Our study found adequate satisfaction among patients and providers regarding telemedicine implementation and its utility for patient care in a diverse urban population. Additionally, while access to technology and technology literacy are barriers to telemedical care, a substantial majority of patients who responded to the survey had access to devices (101/117, 86.3%) and were able to connect with few to no technological difficulties (84/117, 71.8%). One area identified by patients in need of improvement was comfortability in communicating via telemedicine with their providers. Furthermore, while providers agreed that telemedicine is a useful tool for patient care, it limits their ability to perform physical exams. More research and quality studies are needed to further appreciate and support the expansion of telemedical care into underserved and rural populations, especially in the area of subspecialty neurological care.

Clinical Staff Perceptions of Pay-for-Performance Financial Incentives for HPV Vaccine Promotion.

The purpose was to investigate clinical staff perceptions of pay-for-performance human papillomavirus (HPV) vaccination financial incentives. In 2022, the authors conducted a national survey of clinical staff (N = 2527; response rate = 57%). Respondents were (1) certified to practice in the United States; (2) practiced as a physician, physician assistant, nurse practitioner, advanced practice nurse, registered nurse, licensed practical/vocational nurse, medical assistant, or certified nursing assistant; (3) worked in pediatrics, family medicine, or general medicine specialties; and (4) had a role in HPV vaccination for children ages 9 through 12 years. The team used ordered regressions to model whether respondents agreed with (ie, "Strongly agreed" or "Agreed" on a 5-point Likert scale) each of the 9 statements. The statements were mapped to domains based on the theory of planned behavior: attitudes (5 statements), perceived behavioral control (2), and norms (2). Favorable responses to 9 statements ranged from 32% to 85%; 5/9 items had more than 50% favorable responses. The following example odds ratios (ORs) are for "agree" versus "neutral" or "disagree" to change their behavior to obtain the incentive. Clinical staff with prior experience with incentives were more likely to agree with 8/9 positive statements about incentives (eg, OR = 1.32 [95% confidence interval {CI}: 1.12-1.57]). Family medicine clinics were more likely than pediatric clinics to agree with 5/9 statements (eg, OR = 1.42 [95% CI: 1.18-1.70]). Clinical staff with more years of experience were less likely to agree with 6/9 statements (eg, OR = 0.97 [95% CI: 0.97-0.98]). Clinical staff's perceptions of pay-for-performance HPV vaccination financial incentives were generally favorable.

Resident physician burnout and association with working conditions, psychiatric determinants, and medical errors: A cross-sectional study.

Burnout has become a significant occupational concern for resident physicians, primarily attributed to chronic workplace stressors, inadequate work-life balance, high expectation from attending staffs, steep learning curve, and limited patient care experience. The study aimed to investigate the prevalence and associated factors of burnout in medical residents. This cross-sectional study was conducted online questionnaire of all specialists in a university hospital from September to October 2022. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey for Medical Personnel. The data collection encompassed information on socio-demographics, working conditions, psychiatric issues, and medical errors as potential predictive variables. To analyze the association between these factors and burnout, a confounder summary score model was employed in four separate models utilizing multivariable logistic regression. A total of 238 participants, the average age of participants was 28.1 years (SD 2.7), and 56.2% of them were female. Weekly working hours averaged 75 (SD 21.8). Burnout prevalence was 46.3%. This prevalence was characterized by high levels of emotional exhaustion (57.1%) and depersonalization (36.1%), along with low levels of personal accomplishment (52.4%). Summary of association in each domain with burnout were as follow: demographic determinants, (adjusted odds ratio (aOR) 2.80, 95% CI 1.68-4.64), working conditions (aOR 2.97, 95% CI 1.54-5.71), psychiatric determinants (aOR 2.47, 95% CI 1.77-3.45) medical errors (aOR 2.14, 95% CI 1.05-4.34). Medical residency training programs should provide a supportive system that actively monitors and addresses depressive symptoms. Implementing preventive measures, such as increasing pay rates, can play a role in mitigating burnout.

Intra-articular knee injections in patients with primary osteoarthritis in a tertiary clinical setting: a best practice implementation project.

This project aimed to improve physicians' adherence to evidence-based practices regarding the selection and administration of intra-articular knee injections for patients with osteoarthritis. The project also aimed to empower patients by increasing their awareness of these evidence-based practices. In the management of knee osteoarthritis, intra-articular injections are commonly used when initial treatments prove inadequate. However, issues such as patients' demand for rapid relief and variability in physicians' familiarity with optimal practices often lead to suboptimal treatment decisions and potential adverse outcomes. This project followed the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit process. Initially, physicians were surveyed on the topic under consideration, and hospital records were reviewed. Subsequently, targeted interventions were implemented, including briefings and the distribution of informative flyers. The baseline audit indicated low adherence with all audit criteria. Various parameters, such as adherence to best clinical practices, informed decision-making by patients, and the recommendation of alternative treatment modalities, were significantly lacking. Following the interventions, substantial improvements were observed, including higher rates of adherence to best clinical practices by physicians for multiple criteria, such as stepwise referral to conservative therapy options and the content of intra-articular injections. Adherence to best clinical practices can be improved through educational briefings for physicians on the most current evidence-based treatment practices for injectable substances in knee osteoarthritis. The active engagement of patients, facilitated by informative flyers and physician assistance, contributed to better involvement in their treatment choices. However, the participation of health care institutions and providers as well as lifelong education practices may be necessary for more comprehensive and sustainable changes. http://links.lww.com/IJEBH/A277.

Styles, strategies, and challenges of PA leaders nationally: An exploratory qualitative study.

To identify the leadership styles, strengths, strategies, and key factors of PA leaders in healthcare executive, clinical, and academic settings. An exploratory, qualitative study was completed through the American Academy of Physician Associates 2023 Practice Survey to answer seven qualitative questions. Of the 1,423 PAs who responded to the survey invitation, 348 PA leaders in formal and informal roles chose to answer, for a 24.4% response rate. For PA leaders' styles and strengths, collaborative and emotional intelligence emerged as themes. For key factors of PA leadership, balancing expectations and giving and receiving critical feedback emerged as themes. For skills or qualities PA leaders wish they had before starting to lead, project management skills and increased confidence emerged as themes. Leadership development training needs to be in the didactic and clinical curriculum of PA programs for the future of PA leadership. Leadership pathways for PA leaders in healthcare executive, clinical, and academic settings need to be created and established more widely.

Underrepresentation of Black Men in Physician Assistant and Associate Training

The underrepresentation of Black men in the health care workforce, particularly among physician assistants and associates (PAs), represents a missed opportunity to alleviate shortages of health care professionals and enhance workforce diversity. Increasing the number of Black men in the training pipeline could significantly benefit education, patient care, and overall health outcomes. To analyze patterns from 2013 to 2021 among Black men applying to and matriculating into PA programs and compare these figures with the age-specific US population of Black men. This cohort study assessed deidentified application and matriculation data from the Central Application Service for Physician Assistants (CASPA) for PA training programs in the US, alongside US Census data. CASPA applicants reporting race and gender identities as Black male were included. Data were obtained March 10, 2023, from the 2012-2013 to the 2020-2021 application cycles; data were analyzed from June 2023 to May 2024. Black male applicants and matriculation. Patterns and proportion of Black male applicants and matriculants to PA programs relative to total rates and expected numbers. From 2013 to 2021, PA programs grew 64.3%, with an increase in applicants from 19 761 to 30 196 and matriculants from 6192 to 11 115. Despite this growth, the representation of Black men among applicants (from 435 to 732) and matriculants (from 73 to 156) remained stagnant, averaging 2.2% and 1.2%, respectively, significantly lower than their 8.7% (3 920 231 individuals aged 20-29 years) representation in the US Census. In 2021, the matriculation rate for Black men (156 of 732 [21.3%]) was notably lower than the matriculation rate for all applicants (11 115 of 30 196 [36.8%]). Based on the expected proportion of Black men in the PA applicant age range, there should have been 2641 applicants (actual: 732) and 972 matriculants (actual: 156) across 308 PA programs in 2021; these numbers indicate that, per program, approximately 9 applicants would have to have been evaluated and 3 matriculated to achieve parity, in contrast to the mean of 2 applicants and 1 matriculant per 2 programs. In this cohort study of PA applicants and matriculants, Black men remained substantially underrepresented despite overall growth of PA training programs. The low representation among matriculants was due in part to the low numbers of applicants but also to substantially lower matriculation success. This persistent underrepresentation highlights systemic barriers and underscores the need for targeted interventions to achieve a more representative health care workforce. To achieve equitable admissions, each PA program should aim to evaluate 9 Black male applicants and matriculate 3 Black men annually.

Burnout and Turnover Among Veterans Health Administration Primary Care Providers From Fiscal Years 2017-2021.

We examined how individual-level turnover among Veterans Health Administration primary care providers (PCPs) from fiscal years 2017 to 2021 was associated with health care system-level burnout and turnover intent. Burnout among PCPs has been well documented in recent studies, but less is known about the potential relationship between burnout and turnover. We identified a national cohort of 6444 PCPs (physicians, nurse practitioners, and physician assistants) in 129 Veterans Health Administration health care systems in the first quarter of fiscal year 2017 and tracked their employment status for 20 quarters. PCP employment data on turnover were linked to annual health care system-level employee survey data on burnout, turnover intent, and other covariates. We performed logistic regression to estimate the impact of health care system-level burnout and turnover intent on individual PCP turnover, controlling for individual and health care system-level covariates and adjusting for clustering at the health care system level. Median health care system-level burnout ranged from 42.5% to 52.0% annually, and turnover among PCPs ranged from 6.3% to 8.4% (mean = 7.0%; SD = 0.9%). Separation from employment was higher among employees at health care systems with the highest burnout (odds ratio =1.14; 95% CI = 1.01-1.29) and turnover intent (OR = 1.18; 95% CI = 1.03-1.35). PCPs in health care systems with high burnout are more likely to separate from employment. Policymakers and administrators seeking to improve retention should consider system-level interventions to address organizational drivers of burnout.

Advanced Practice Registered Nurses Student Cross-Specialty Procedural Training: Effective Collaboration and Student Experience.

Intraprofessional simulation and training in acute care nursing specialties can generate synergies that will promote safe, quality patient care. Implementation of multiple intraprofessional simulations across the life span allowed for sharing of faculty and simulation resources. Simulations encompassed both adult and pediatric patients and consisted of airway skills, point-of-care ultrasound, and a multi-skills day encompassing vascular access experiences, chest tube placement, and lumbar puncture. During 5 years, 235 graduate students across three advanced practice nursing specialties participated in the intraprofessional simulation. Learner feedback showed improved confidence, benefit to future practice, and improved clinical judgment via these intraprofessional simulations. Future development of standardized and validated assessments to evaluate each skill will provide quantitative metrics for each clinical skill set and patient population. Further, additional initiatives will include both continuing and expanding intraprofessional simulation offerings, as well as developing interprofessional simulations with physician assistant and perfusionist colleagues. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Physician Assistant Training, Collaboration, and Practice Act Legislation: Perspectives From Practicing Physician Assistants.

This study examines training, experience, and collaborative practices of physician assistants (PAs) with employment experience and their perspectives on practice act legislation. Mixed method study with quantitative and qualitative data. One hundred eighty participants completed the survey. During clinical employment, 81.05% of respondents reported physicians participated in training. However, supervising physicians trained only 43.46%; 56.54% reported being trained by nurse practitioners (NPs), PAs, and/or other physicians. Onsite collaboration with physicians was reported by 87.2%. Supervising physician involvement was reported by 67.3%, and of these, 59% collaborated with PAs, NPs, and/or other physicians as well. One-third collaborated only with NPs, PAs, and/or other physicians. Daily/weekly collaboration with a supervising physician was reported by 78.89% in their first position and 54.87% in their current/most recent position; 77.22% collaborated with NPs, PAs, and/or other physicians in their first position and 71.68% in their current/most recent position. Most (64.44%) felt PAs should not be legally required to have physician supervision. Most (76.12%) felt care quality would not decrease if supervision were lifted. Most (74.44%) agreed that PAs are hired less frequently than NPs in states where physician supervision is required for PA but not NPs. Findings suggest that team-based practice is already the current structure of PA clinical training and collaboration with PAs receiving significant support from physicians who are not supervising physicians and other nonphysician practitioners. Establishing oversight at the practice level is supported by this practice structure. Determining effects of practice act legislation on employment training, collaboration, and hiring practices warrants further research.

Mobile Medicine in Ukraine

Global Care Force, an international health nongovernmental organization, sent teams of physicians, physician assistants, nurses, and nurse practitioners every month to Ukraine to provide primary care for war-affected communities. I had the opportunity to partner with GCF in May 2024 during its monthly mission trip to this conflict-ravaged country. I described this medical outreach initiative in a first-person narrative in order to relay to a wider audience the realities of warfare for Ukrainian patients and health care workers. Our team treated chronic diseases in northern as well as southern Ukrainian villages near the front line near Kherson. We set up mobile medical clinics in these regions and delivered medications to patients suffering from blast injuries, hyperglycemia, hypertension, and posttraumatic stress disorder.

Primary Care Clinician Perspectives on Team-Based Welcome Video Visits.

Synchronous virtual visits aid in longitudinal primary care and fulfill unmet needs for patients and clinicians. Virtual visits are widely accepted for specialty consultation and follow-up; however, novel systems-based programs and processes may support earlier engagement. Evaluate primary care clinician attitudes and perspectives on patient information obtained team-based, nurse-led virtual visits ahead of face to face visits. Study occurred in a large, regional, multispecialty group practice in Eastern Pennsylvania. Participants included primary care physicians, nurse practitioners, and physician assistants. Virtual visits are a component of a large, unified network strategy called the Patient Partnership Model which incorporates technology and remote care to achieve improved access and patient satisfaction. Survey of participating primary care clinicians assessing impact of at-hand medical history, social history, and medications on delivering face to face primary care. Weighted mean of satisfied participants was 3.61 on a 5-point Likert scale. Participants reported satisfaction and acceptability of team-based virtual visits, noting high satisfaction with information exchange and actionability of notes. Participants reported ongoing opportunities to enhance medication reconciliation. Virtual visits continue to evolve and may serve varying roles in primary care.

Developing Competencies and Milestones: Putting the Pieces Together for Student Success

Abstract Competency-based medical education has become a means in physician assistant (PA) education to ensure learner readiness for practice; align educational expectations; and assess knowledge, skills, and attitudes. Competency-based education may also serve to meet accreditation requirements. Creating program-defined competencies and associated milestones can help a PA program align with their mission and vision, developmentally guide learners through the curriculum, and ensure program assessments measure the tasks required of practice-ready graduates. This review provides an overview of a single program's process for developing program-defined competencies and associated milestones. Beginning with a literature search, the program was able to develop a working list of competencies that was then further refined into competencies with building block milestones that support the development of competency in various domains. Involving faculty in defining a program's competencies is an Accreditation Review Commission on Education for the Physician Assistant requirement that can be done from the ground up or by using previously published competencies that are refined and tailored for the program. The process of creating the competencies provides significant insight into a program's curriculum, goals and expectations for students, and assessment methods.

US Primary Care WorkforceGrowth: A Decade of Limited Progress, and Projected Needs Through 2040.

Despite efforts to mitigate a projected primary care physician (PCP) shortage required to meet an aging, growing, and increasingly insured population, shortages remain, compounded by the COVID-19 pandemic, growing inequity, and persistent underinvestment. We examined primary care workforce trends over the past decade and revisited projected primary care clinician workforce needs through the year 2040. Using data from the AMA Masterfile and Medical Expenditure Panel Survey (MEPS), we analyzed trends in the number of primary care physicians (PCPs) and in outpatient PCP visits by age and gender over the past decade. We then used the Medicare PECOS and Physician & Other Practitioners datasets to identify nurse practitioners (NPs) and physician assistants (PAs) in primary care. Using these baseline clinician enumerations and projected population growth estimates from the US Census Bureau for the years 2020-2040, we calculated estimated primary care workforce needs by 2040. The effects of aging and population growth and baseline shortages in the primary care workforce call for significant increases in the primary care workforce to accommodate rising demands. Office visits to primary care clinicians are projected to increase from 773,606 in 2020 to 893,098 in 2040. We project a need for an additional 57,559primary care clinicians by 2040. Workforce shortages in primary care continue to expand due to populationaging, growth, and heightened rates of clinicianburnout& egress.

Clinician Staffing and Quality of Care in US Health Centers

Health centers are vital primary care safety nets for underserved populations, but optimal clinician staffing associated with quality care is unclear. Understanding the association of clinician staffing patterns with quality of care may inform care delivery, scope-of-practice policy, and resource allocation. To describe the association of clinician staffing models and ratios with quality-of-care metrics in health centers. This cross-sectional study of US health centers used data from the 2022 Health Resources and Services Administration Uniform Data System (UDS). Clinician staffing ratios, expressed as the fraction of full-time equivalents (FTEs) per 1000 visits of physicians, advanced practice registered nurses (APRNs), and physician associates (PAs) to total clinician FTEs at each health center. Percentage of eligible patients receiving the corresponding service or outcome for 14 individual clinical quality metrics collected by the UDS, including infant immunizations; screening for cancer, depression, tobacco use, hypertension, HIV, and glycated hemoglobin levels; weight and body mass index (BMI) assessment; and appropriate statin, aspirin, and/or antiplatelet therapy. This analysis of 791 health centers serving 16 114 842 patients (56.6% female) identified 5 clinician staffing models: balanced (similar FTEs of physicians, APRNs, and PAs; 152 [19.2%] of health centers), higher FTEs of APRNs than physicians (174 [22.0%]), higher FTEs of physicians than APRNs (160 [20.2%]), approximately equal FTEs of physicians and APRNs (263 [33.2%]), and large scale (42 [5.3%]). Adjusted linear models showed positive associations between physician FTEs per 1000 visits and cervical (β, 14.9; 95% CI, 3.1-26.7), breast (β, 15.7; 95% CI, 3.2-28.1), and colorectal (β, 18.3; 95% CI, 6.0-30.6) cancer screening. Generalized additive models showed nonlinear positive associations beginning at a physician FTE ratio of 0.45 (95% CI, 0.02-6.22) for infant vaccinations, 0.39 (95% CI, 0.05-2.21) for cervical cancer screening, 0.39 (95% CI, 0.02-1.67) for breast cancer screening, 0.47 (95% CI, 0.00-5.76) for HIV testing, and 0.70 (95% CI, 0.18-19.96) for depression in remission; APRN FTE ratio of 0.45 (95% CI, 0.17-7.46) for adult BMI assessment; and PA FTE ratio of 0.16 (95% CI, 0.11-3.88) for infant vaccinations. Staffing models were not associated with 7 of the 14 metrics analyzed. In this cross-sectional study of health centers, physician FTE ratio was associated with higher performance in cancer screening, infant vaccinations, and HIV testing; APRN FTE ratio was associated with higher performance in preventative health assessments; and PA FTE ratio was associated with higher performance in infant vaccination. These findings suggest that targeted staffing strategies may be associated with quality of care in certain domains and that tailored approaches to health center staffing based on community-specific needs are warranted.

Compliance With Accreditation Standards on Diversity: Is Institutional Support the Missing Link?

The role of accreditation standards in fostering diversity and inclusion in academic programs remains poorly understood. Accreditation is one approach to increasing diversity through Standard A1.11. This study investigates the impact of the Accreditation Review Commission-Physician Assistant (ARC-PA) standards on diversity and inclusion in physician assistant (PA) programs and explores challenges faced by programs in achieving compliance. This qualitative exploratory study first reviewed diversity standards in accreditation documents among selected health professions; second, data on the frequency of citations from ARC-PA related to diversity were gathered and analyzed; finally, opinions from 23 PA faculty and leaders were solicited through semistructured interviews. Two research team members analyzed the data to identify themes. Most institutions sponsoring PA programs had preexisting diversity policies before the inception of standard A1.11 of the ARC-PA. Between June 2020 and March 2023, seven programs received 16 citations related to Standard A1.11. Interviews with faculty revealed 4 major themes: (1) the importance of institutional support, (2) early pipeline development of applicants, (3) prioritizing faculty and/or student diversity as key program goals, and (4) local context, with institutional support and pipeline development being most prominent. The inclusion of Standard A1.11 in the ARC-PA Standards signifies the growing recognition of diversity, equity, and inclusion (DEI) in PA education. Institutions can advance DEI in the PA profession by leveraging accreditation-related activities through leadership, partnerships, and accountability measures consistent with the institution's mission and applicable laws. Institutional support emerged as an important factor in compliance with diversity-related accreditation standards.

Icodec ONWARDS: A review of the first once-weekly diabetes treatment for nurse practitioners and physician assistants.

Diabetes management is challenged by the complexity of treatment regimens and the need for frequent injections, affecting patient adherence and quality of life. Insulin icodec, a once-weekly basal insulin analog, represents a significant innovation, potentially simplifying diabetes care and improving outcomes. This review aims to evaluate the safety, efficacy, and clinical implications of insulin icodec for individuals with type 1 and type 2 diabetes, highlighting its potential to affect current treatment paradigms. A review was conducted comparing once-weekly insulin icodec with daily basal insulin analogs using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to ensure transparent reporting of systematic reviews. A search was performed in the following databases: PubMed, Google Scholar, Embase, and ClinicalTrials.gov, focusing on efficacy and safety outcomes. Insulin icodec has demonstrated effective glycemic management and a safety profile comparable to daily basal insulins. Its extended half-life and steady-state glucose-lowering effect have the potential to reduce the burden of daily injections and improve patient adherence. The introduction of once-weekly insulin icodec represents an advancement in diabetes care. For front-line clinicians, this innovation aligns with the need for more straightforward medication regimens. Coupled with continuous glucose monitoring systems, it enables a more personalized and efficient approach to diabetes management, with the potential to improve patient satisfaction and clinical outcomes. This underscores the impact of integrating such advancements into practice, highlighting the role of nurse practitioners and physician assistants in adopting these innovations to optimize patient care.

Using artificial intelligence and machine learning to reduce patient wait times and increase patient satisfaction.

Madam, Prolonged patient waiting time has long been a significant source of dissatisfaction among patients. Waiting time has been recognized by WHO as one of the key elements of a responsive healthcare system [1]. A study conducted by Bleustein et al. suggested that longer wait times negatively impacted the patient’s confidence in the care provider and the perceived quality of care.[2] Furthermore, in large hospital settings, patients are expected to queue up multiple times before meeting with their physician, which amplifies their stress. We would like to highlight that the incorporation of artificial intelligence (AI) in healthcare can help reduce patient and physician stress. Strategies such as telemedicine and online registration have been acquired in efforts to resolve this issue but these techniques may burden doctors with extra responsibilities. However, introducing an AI-based physician assistance programme, which was able to model itself on the decision-making requirements of the doctor significantly reduced the wait time and the burden on the hospital [3]. Xiaoqing Li et al developed an AI-based model that helped patients automatically order any investigations. Implementation of the model reduces waiting time while also playing a pivotal role in creating alternative methods to improve patient flow. [4] The results of these studies prove that implementation of an AI-based model in daily medicine has helped improve patient experience and minimize hospital burden. The implementation of AI in place of traditional methods, helps enhance patient satisfaction by not only significantly reducing waiting time but also ensuring that patients receive care appropriate to their condition. Moreover, it helps reduce, the workload on the physician and enables them to focus more on the patient. Being a new concept in healthcare AI may not be free of error. This might lead to inaccuracies in medication prescription, investigations, imaging, scheduling of appointments and diagnosis in atypical cases. Patient confidentiality is also an extremely important aspect of healthcare and in an attempt to protect the privacy of the patients, AI models may not have free reign over the patients’ data which may prevent them from assisting in medical practices. Furthermore, there are no organizations that customize the AI models according to the needs of the individual hospital or clinic. Moreover, human interaction is a critical aspect of healthcare which would be significantly impacted by the use of AI which could result in patients being unable to express themselves or feeling a sense of apathy. Furthermore, developing countries are not well equipped to implement AI in daily practice, hence it would not be a practical solution for them. [5] Further research needs to be conducted with regards to the use of AI models in hospitals to understand how they impact patient wait times and satisfaction, alongside their ability to optimize healthcare.

The Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program implementation strategy for expanding treatment for hospitalized adults with opioid use disorder

IntroductionIn 2017, we launched the “B-Team” (buprenorphine team), the first hospitalist-led opioid use disorder (OUD) treatment program in Texas. Based on initial success, we obtained funding from Texas Health & Human Services to expand the model to other hospitals in Texas through the Support Hospital Opioid Use Disorder Treatment (SHOUT) Texas program. MethodsThis is a mixed methods study of the implementation of the SHOUT program, which is an OUD treatment intervention, in different hospitals in Texas. Our implementation approach combined training, tailoring, and technical assistance following the Replicating Effective Programs (REP) strategy with statewide telementoring delivered via Project ECHO. To evaluate the reach, adoption, and impact of SHOUT Texas, we assessed: 1) participating hospitals (adoption); 2) patients screened for OUD (impact); 3) patients started on medications for OUD (impact); 4) patients discharged with coordinated outpatient care (impact); 5) providers and staff trained via ECHO (reach); and 6) satisfaction with ECHO training (impact). Additionally, semi-structured interviews were conducted with key stakeholders at expansion sites to identify strengths and weaknesses of the implementation strategy and supports and barriers to successful implementation. Rapid qualitative analysis was completed by a team of analysts who transcribed and summarized interviews to identify key domains of interest and emergent themes. ResultsBetween 2020 and 2023, the SHOUT Texas program expanded to three additional Texas hospital sites, resulting in 3065 hospitalized adult patients starting treatment for OUD. More than 2500 interprofessional clinicians (physicians, nurses, physician assistants, social workers) received SHOUT training regarding inpatient initiation of OUD treatment, with 241 attending at least one hour-long Project ECHO session. Eight key stakeholders at expansion sites were interviewed. Successful components of the SHOUT program included training resources, in-person launches, and collaboration with specialized addiction treatment subject matter experts. Challenges included identifying outpatient follow-up, pharmacy and medication constraints, and nursing education barriers. Interviews also identified lessons learned, advice to other hospitals, and next steps to build capacity. ConclusionsImplementation of the SHOUT Texas model across diverse hospital settings using REP and Project ECHO resulted in significant provider engagement and rapid increase in the number of patients initiating OUD treatment during hospitalization. Lessons learned from this novel approach may be applicable in other states, particularly those that have not expanded Medicaid.