Browsing by Author "Vught, A.J.A.H. van"

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The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol (vol 14, 43, 2014)
Timmermans, M.C.J. ; Vught, A.J.A.H. van ; Wensing, M. ; Laurant, M.G.H.
2016, Article / Letter to editor (BMC Health Services Research, vol. 16, (2016))
Physician substitution by NPs, PAs and/or nurses in healthcare for older people
Lovink, M.H. ; Persoon, A. ; Koopmans, R.T.C.M. ; Schoonhoven, Lisette ; Vught, A.J.A.H. van ; Laurant, M.G.H.
2016, Article / Letter to editor (Journal of Advanced Nursing, vol. 72, (2016), pp. 96)
Determinants of the sustained employment of physician assistants in hospitals: a qualitative study
Timmermans, M.C.J. ; Vught, A.J.A.H. van ; Maassen, I.T.H.M ; Draaijer, L ; Hoofwijk, AGM ; Spanier, M ; Unen, W. van ; Wensing, M. ; Laurant, M.G.H.
2016, Article / Letter to editor (BMJ Open, vol. 6, iss. 11, (2016))Objectives: To identify determinants of the initial employment of physician assistants (PAs) for inpatient care as well as of the sustainability of their employment. Design: We conducted a qualitative study with semistructured interviews with care providers. Interviews continued until data saturation was achieved. All interviews were transcribed verbatim. A framework approach was used for data analysis. Codes were sorted by the themes, bringing similar concepts together. Setting: This study was conducted between June 2014 and May 2015 within 11 different hospital wards in the Netherlands. The wards varied in medical speciality, as well as in hospital type and the organisational model for inpatient care. Participants: Participant included staff physicians, residents, PAs and nurses. Results: The following themes emerged to be important for the initial employment of PAs and the sustainability of their employment: the innovation, individual factors, professional interactions, incentives and resources, capacity for organisational change and social, political and legal factors. Conclusions: 10 years after the introduction of PAs, there was little discussion among the adopters about the added value of PAs, but organisational and financial uncertainties played an important role in the decision to employ and continue employment of PAs. Barriers to employ and continue PA employment were mostly a consequence of locally arranged restrictions by hospital management and staff physicians, as barriers regarding national laws, PA education and competencies seemed absent.
Physician assistants in medical ward care: a descriptive study of the situation in the Netherlands
Timmermans, M.C.J. ; Vught, A.J.A.H. van ; Van den Berg, M ; Ponfoort, ED ; Riemens, F ; Unen, J. van ; Wobbes, T ; Wensing, M. ; Laurant, M.G.H.
2016, Article / Letter to editor (Journal of Evaluation in Clinical Practice, vol. 22, iss. 3, (2016), pp. 395-402)Rationale, aims and objectivesMedical ward care has been increasingly reallocated from medical doctors (MDs) to physician assistants (PAs). Insight into their roles and tasks is limited. This study aims to provide insight into different organizational models of medical ward care, focusing on the position, tasks and responsibilities of the involved PAs and MDs. MethodsIn this cross-sectional descriptive study 34 hospital wards were included. Characteristics of the organizational models were collected from the heads of departments. We documented provider continuity by examination of work schedules. MDs and PAs in charge for medical ward care (n=179) were asked to complete a questionnaire to measure workload, supervision and tasks performed. ResultsWe distinguished four different organizational models for ward care: medical specialists in charge of admitted patients (100% MS), medical residents in charge (100% MR), PAs in charge (100% PA), both MRs and PAs in charge (mixed PA/MR). The wards with PAs had the highest provider continuity. PAs spend relatively more time on direct patient care; MDs spend relatively more time on indirect patient care. PAs spend more hours on quality projects (P=0.000), while MDs spend more time on scientific research (P=0.030). ConclusionAcross different organizational models for medical ward care, we found variations in time per task, time per bed and provider continuity. Further research should focus on the impact of these differences on outcomes and efficiency of medical ward care.
Physician assistant in de ouderenzorg
Witjes, E. ; Lovink, M.H. ; Vleemink, C. ; Haar, A. ter ; Driesschen, Q. van den ; Vught, A.J.A.H. van
2015, Article / Letter to editor (Tijdschrift voor Ouderengeneeskunde, iss. 6, (2015))
Physician substitution by mid-level providers in primary healthcare for older people and long-term care facilities: protocol for a systematic literature review
Lovink, M.H. ; Persoon, A. ; Vught, A.J.A.H. van ; Koopmans, R.T.C.M. ; Schoonhoven, Lisette ; Laurant, M.G.H.
2015, Article / Letter to editor (Journal of Advanced Nursing, vol. 71, iss. 12, (2015), pp. 2998-3005)Aim. This protocol describes a systematic review that evaluates the effects of physician substitution by mid-level providers (nurse practitioners, physician assistants or nurses) in primary healthcare for older people and long-term care facilities. The secondary aim is to describe facilitators and barriers to the implementation of physician substitution in these settings. Background. Healthcare for older people is undergoing major changes, due to population ageing and reforms that shift care to the community. Besides, relatively few medical students are pursuing careers in healthcare for older people. Innovative solutions are needed to guarantee the quality of healthcare and to contain costs. A solution might be shifting care from physicians to mid-level providers. To date, no systematic review on this topic exits to guide policymaking. Design. A quantitative systematic literature review using Cochrane methods. Methods. The following databases will be searched for original research studies that quantitatively compare care provided by a physician to the same care provided by a mid-level provider: PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL and Web of Science. Study selection, data extraction and quality appraisal will be conducted independently by two reviewers. Data synthesis will consist of a qualitative analysis of the data. Funding of the review was confirmed in August 2013 by the Ministry of Health, Welfare and Sport of the Netherlands. Discussion. This review will contribute to the knowledge on effects of physician substitution in healthcare for older people and factors that influence the outcomes. This knowledge will guide professionals and policy administrators in their decisions to optimize healthcare for older people.
The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol
Timmermans, M.C.J. ; Vught, A.J.A.H. van ; Wensing, M. ; Laurant, M.G.H.
2014, Article / Letter to editor (BMC Health Services Research, vol. 14, (2014))Background: Because of an expected shrinking supply of medical doctors for hospitalist posts, an increased emphasis on efficiency and continuity of care, and the standardization of many medical procedures, the role of hospitalist is increasingly allocated to physician assistants (PAs). PAs are nonphysician clinicians with medical tasks. This study aims to evaluate the effects of substitution of hospital ward care to PAs. Methods/Design: In a multicenter matched controlled study, the traditional model in which the role of hospitalist is taken solely by medical doctors (MD model) is compared with a mixed model in which a PA functions as a hospitalist, contingent with MDs (PA/MD model). Twenty intervention and twenty control wards are included across The Netherlands, from a range of medical specialisms. Primary outcome measure is patients' length of hospital stay. Secondary outcomes include indicators for quality of hospital ward care, patients experiences with medical ward care, patients health-related quality of life, and healthcare providers' experiences. An economic evaluation is conducted to assess the cost implications and potential efficiency of the PA/MD model. For most measures, data is collected from medical records or questionnaires in samples of 115 patients per hospital ward. Semi-structured interviews with healthcare professionals are conducted to identify determinants of efficiency, quality and continuity of care and barriers and facilitators for the implementation of PAs in the role of hospitalist. Discussion: Findings from this study will help to further define the role of nonphysician clinicians and provides possible key components for the implementation of PAs in hospital ward care. Like in many studies of organizational change, random allocation to study arms is not feasible, which implies an increased risk for confounding. A major challenge is to deal with the heterogeneity of patients and hospital departments.

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