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El Ámbito de la Práctica Clínica y la Autonomía de los Asistentes Médicos en los Servicios de Urgencias Urbanos frente a los Rurales
Author(s) -
Sawyer Brandon T.,
Ginde Adit A.
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12367
Subject(s) - medicine , scope (computer science) , scope of practice , autonomy , physician assistants , medical emergency , family medicine , nursing , nurse practitioners , health care , economic growth , law , computer science , political science , economics , programming language
Objectives This was a study of the scope of practice and autonomy of emergency medicine ( EM ) physician assistants ( PA s) practicing in rural versus urban emergency departments ( ED s). Methods Using the American Academy of Physician Assistants ( AAPA ) Masterfile, a random sample of 200 U.S. EM PA s were surveyed, with oversampling of an additional 200 rural PA s. Location was classified by zip code–based rural–urban commuting area codes, and responses were compared about conditions managed, procedures performed, and physician supervision between rural versus urban groups. Results A total of 237 responses were received from PA s in 44 U.S. states, of which (201) were valid responses (105 rural, 96 urban) from PA s currently practicing in ED s (59.3% exclusion‐adjusted response rate). Compared to urban PA s, rural PA s more frequently managed cardiac arrest (67% vs. 44%), stroke (86% vs. 72%), multisystem trauma (83% vs. 70%), active labor (44% vs. 23%), and critically ill children (82% vs. 65%) in the past year. They were more likely to have performed intubation (65% vs. 44%), needle thoracostomy (21% vs. 8%), and tube thoracostomy (46% vs. 26%). Rural PA s more often reported never having a physician present in the ED (38% vs. 0%) and less often reported always having a physician present (50% vs. 98%). Rural PA s were also less likely to report that a physician evaluates more than 75% of their patients (8% vs. 18%) and more likely that a physician never evaluates all of their patients (19% vs. 7%). Conclusions Rural PA s reported a broader scope of practice, more autonomy, and less access to physician supervision than urban PA s.