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Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Substitution of regulated health professionals, such as doctors and nurses, with unregulated health care workers, such as physician assistants, gives rise to concerns around patient safety and accountability issues: No

Allan R. Moffitt https://orcid.org/0009-0008-6944-4036 1 *
+ Author Affiliations
- Author Affiliations

1 ProCare Health (PHO) Ltd, Auckland, New Zealand.

* Correspondence to: allanm@procare.co.nz

Journal of Primary Health Care 16(2) 220-223 https://doi.org/10.1071/HC24077
Submitted: 6 June 2024  Accepted: 6 June 2024  Published: 25 June 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

References

Clark TL, Fortmann AL, Philis-Tsimikas A, et al. Process evaluation of a medical assistant health coaching intervention for type 2 diabetes in diverse primary care settings. Transl Behav Med 2022; 12(2): 350-361.
| Crossref | Google Scholar | PubMed |

Bosley S, Dale J. Healthcare assistants in general practice: practical and conceptual issues of skill-mix change. Br J Gen Pract 2008; 58(547): 118-124.
| Crossref | Google Scholar | PubMed |

Reich K, Butterworth SW, Coday M, et al. Integrating Lay Health Coaches into Primary Care: acceptability, credibility, and effectiveness from the provider perspective. Cureus 2022; 14(5): e25457.
| Crossref | Google Scholar | PubMed |

Clarke A. 2021 GP Future Workforce Report. 2021. [cited 4 February 2024]. Available at https://www.rnzcgp.org.nz/documents/6/2021-GP-future-workforce-report-FINAL.pdf]

Everett C, Christy J, Batchelder H, et al. Impact of primary care usual provider type and provider interdependence on outcomes for patients with diabetes: a cohort study. BMJ Open Qual 2023; 12(2): e002229 PMCID: PMC10277144.
| Crossref | Google Scholar | PubMed |

Everett C, Thorpe C, Palta M, et al. Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes. Health Aff (Millwood) 2013; 32(11): 1942-1948 PMCID: PMC3909681.
| Crossref | Google Scholar | PubMed |

Yang Y, Long Q, Jackson SL, et al. Nurse Practitioners, Physician Assistants, and Physicians are comparable in managing the first five years of diabetes. Am J Med 2018; 131(3): 276-283.e2 PMCID: PMC5817031.
| Crossref | Google Scholar | PubMed |

Dankers-de Mari EJCM, van Vught AJAH, Visee HC, et al. The influence of government policies on the nurse practitioner and physician assistant workforce in the Netherlands, 2000-2022: a multimethod approach study. BMC Health Serv Res 2023; 23(1): 580 PMCID: PMC10242803.
| Crossref | Google Scholar | PubMed |

Pany MJ, Chen L, Sheridan B, et al. Provider teams outperform solo providers in managing chronic diseases and could improve the value of care. Health Aff (Millwood) 2021; 40: 435-444 PMCID: PMC9166311.
| Crossref | Google Scholar | PubMed |

10  Hooker RS, Kuilman L. Physician Assistant Practice around the world. J Am Acad Physician Assist 2020; 33(9): 14-18.
| Google Scholar |

11  Moote M, Krsek C, Kleinpell R, et al. Physician Assistant and Nurse Practitioner utilization in academic medical centers. Am J Med Qual 2019; 34(5): 465-472.
| Crossref | Google Scholar | PubMed |

12  Howarth SD, Johnson J, Millott HE, et al. The early experiences of Physician Associate students in the UK: a regional cross-sectional study investigating factors associated with engagement. PLoS One 2020; 15: e0232515.
| Crossref | Google Scholar | PubMed |

13  Gibson J, McBride A, Checkland K, et al. General practice managers’ motivations for skill mix change in primary care: results from a cross-sectional survey in England. J Health Serv Res Policy 2023; 28(1): 5-13 PMCID: PMC9850398.
| Crossref | Google Scholar | PubMed |

14  Roland M, Barber N, Howe A, et al. The future of primary care creating teams for tomorrow. Report by the Primary Care Workforce Commission. Health Education England. July 2015.  [cited 4 March 2024]. Available at https://napc.co.uk/wp-content/uploads/2017/09/Future_of_primary_care.pdf]

15  Bodenheimer T, Laing BY. The teamlet model of primary care. Ann Fam Med 2007; 5(5): 457-61 PMCID: PMC2000308.
| Crossref | Google Scholar | PubMed |

16  Scheinbaum S. Health coaching in primary care: considerations for collaborative practice. Spring: Holistic Primary Care; 2018. 19(1). 4. https://holisticprimarycare.net/topics/practice-development/health-coaching-in-primary-care-considerations-for-collaborative-practice/

17  Irving M, Mortensen N, Wallace M, et al. In adults with type 2 diabetes mellitus, does the addition of a health coach to the primary care team improve outcomes compared with usual care? Evidence-Based Pract 2022; 25(4): 1-2 Irving.
| Crossref | Google Scholar |

18  Selak V, Stewart T, Jiang Y, et al. Indigenous health worker support for patients with poorly controlled type 2 diabetes: study protocol for a cluster randomised controlled trial of the Mana Tū programme. BMJ Open 2018; 8: e019572.
| Crossref | Google Scholar |

19  Harwood M, Tane T, Broome L, et al. Mana Tū: a whānau ora approach to type 2 diabetes. N Z Med J 2018; 131(1485): 76-83.
| Google Scholar | PubMed |

20  Tane T, Selak V, Hawkins K, et al. Māori and Pacific peoples’ experiences of a Māori-led diabetes programme. N Z Med J 2021; 134(1543): 79-89.
| Google Scholar | PubMed |

21  Hartzler AL, Tuzzio L, Hsu C, et al. Roles and functions of community health workers in primary care. Ann Fam Med 2018; 16(3): 240-245 PMCID: PMC5951253.
| Crossref | Google Scholar | PubMed |

22  Chima CC, Swanson B, Anikpezie N, et al. Alleviating diabetes distress and improving diabetes self-management through health coaching in a primary care setting. BMJ Case Rep 2021; 14(4): e241759 PMCID: PMC8061809.
| Crossref | Google Scholar | PubMed |

23  Halter M, Drennan VM, Joly LM, et al. Patients’ experiences of consultations with physician associates in primary care in England: a qualitative study. Health Expect 2017; 20(5): 1011-1019 PMCID: PMC5600217.
| Crossref | Google Scholar | PubMed |

24  Hooker RS, Moloney-Johns AJ, McFarland MM. Patient satisfaction with physician assistant/associate care: an international scoping review. Hum Resour Health 2019; 17: 104.
| Crossref | Google Scholar | PubMed |

25  van den Brink GTWJ, Hooker RS, Van Vught AJ, et al. The cost-effectiveness of physician assistants/associates: a systematic review of international evidence. PLoS One 2021; 16(11): e0259183 PMCID: PMC8559935.
| Crossref | Google Scholar | PubMed |

26  Sheringham J, King A, Plackett R, et al. Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review. BMC Health Serv Res 2021; 21(1): 644 PMCID: PMC8254243.
| Crossref | Google Scholar | PubMed |

27  Halter M, Drennan V, Chattopadhyay K, et al. The contribution of physician assistants in primary care: a systematic review. BMC Health Serv Res 2013; 13(1): 223.
| Crossref | Google Scholar | PubMed |

28  de Lusignan S, McGovern AP, Tahir MA, et al. Physician associate and general practitioner consultations: a comparative observational video study. PLoS One 2016; 11(8): e0160902.
| Crossref | Google Scholar | PubMed |

29  Smith VA, Morgan PA, Edelman D, et al. Utilization and costs by primary care provider type: are there differences among diabetic patients of Physicians, Nurse Practitioners, and Physician Assistants? Med Care 2020; 58(8): 681-688.
| Crossref | Google Scholar | PubMed |

30  Cottrell E, Silverwood V, Strivens-Joyce A, et al. Acceptability of physician associate interns in primary care: results from a service evaluation. BMC Fam Pract 2021; 22(1): 250.
| Crossref | Google Scholar | PubMed |

31  Brooks PB, Fulton ME. Driving high-functioning clinical teams: an advanced practice registered nurse and physician assistant optimization initiative. J Am Assoc Nurse Pract 2020; 32(6): 476-487.
| Crossref | Google Scholar | PubMed |

32  Drennan VM, Halter M, Joly L, et al. Physician associates and GPs in primary care: a comparison. Brit J Gen Pract 2015; 65(634): e344-e350.
| Crossref | Google Scholar | PubMed |

33  Brown M, Laughey W, Finn GM. Physician Associate students and primary care paradigmatic trajectories: perceptions, positioning and the process of pursuit. Educ Prim Care 2020; 31(4): 231-239.
| Crossref | Google Scholar | PubMed |

34  Howarth SD, Storr E, Lenton C, et al. Implementing the Safe and Effective Clinical Outcomes (SECO) simulation to prepare physician associate students for practice. Educ Prim Care 2019; 30(6): 387-391 AN: 140355186.
| Crossref | Google Scholar | PubMed |

35  Nelson PA, Bradley F, Martindale A-M, et al. Skill-mix change in general practice: a qualitative comparison of three ‘new’ non-medical roles in English primary care. Br J Gen Pract 2019; 69(684): e489-e498.
| Crossref | Google Scholar | PubMed |

36  Roland M, Barber N, Howe A, et al. Who’s who in General Practice? Research can help practices introduce new roles. Health and Social Care Services Research; 2023. 10.3310/nihrevidence_61223