Identification of the role of the physician's assistant in Oregon utilizing the Delphi technique Public Deposited

http://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/f1881q174

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  • This study, conducted with the cooperation of the Oregon Comprehensive Health Planning Agency, Salem, had a threefold purpose: (1) to identify the role of the physician's assistant (PA) in Oregon, (2) to provide substantive data for recommendations regarding changes in PA licensure, and (3) to provide information which may be useful for the development of PA training programs. The Delphi survey method was utilized and an expert panel of 28 jurors was selected on the basis of five criteria to respond to a series of three questionnaires with controlled feedback. Professions represented on the panel included eleven medical doctors, two medical educators, five nurses, one nurse educator, three nurse practitioners, three physicians' assistants, one member of the Oregon Board of Medical Examiners, one hospital administrator, and one medical sociologist. Committee members were asked to indicate their agreement or disagreement on a six-point scale to 40 specific items grouped according to five major issues: (1) the need for a PA in Oregon; (2) the core functions of a PA; (3) the degree of independence of the PA; (4) the relationship of the PA to a physician, nurse, and nurse practitioner; and (5) the background and training of a PA. The mean, standard deviation, and interquartile range (IQR) were calculated for each item of the questionnaire. Those items which had IQR's totally within either an agree or disagree category were considered to have reached consensus. Comparisons utilizing t-tests were performed between the means of items on questionnaires #1 and #3, the means of professional group responses in questionnaire #3, and the means of preferred backgrounds for a PA training program. Using the IQR as a measure of consensus, 25 (63%) of the items reached consensus in the third questionnaire. Sixteen (40%) of the items reached agree consensus regarding independent acts that a PA may perform. A list of 11 general tasks that a PA could perform independently was determined. Consensus was reached that a PA stationed at a distant location from the supervising physician could function through consultation and referrals. There was also consensus that a PA program is needed in Oregon, and that its development would not cause further fragmentation of the primary health care delivery system. No definitive consensus was developed regarding the PA's relationship to a nurse or to a nurse practitioner. Professional group differences were identified and discussed. In general, the most significant differences of opinion observed were between nurses and PA's. The committee suggested that if an Oregon PA training program is developed, it should be directed toward the backgrounds of registered nurses and former medical corpsmen. However, the committee also expressed the view that it may be possible to train individuals of varying backgrounds so long as they meet the admission standards of the program. The committee further recommended that the development of equivalency examinations would be helpful in the PA candidate selection process. While the use of the Delphi survey method did not lead to a significant change of opinion among the respondents, the technique was useful in indicating existing consensus among the various professional groups participating in this study.
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