A thoroughly excellent systematic review from @trishgreenhalgh.bsky.social on the evidence base around physician associates & anaesthesia associates.
Currently shared as a pre-print a/w publication, I'll summarise her findings.
A 🧵
1/18
Currently shared as a pre-print a/w publication, I'll summarise her findings.
A 🧵
1/18
Comments
- Multi-database searches
- Limited to UK practice
- From the last 10 years
- Research in nature (ie, not descriptions)
This is how we decide if any generalisable conclusions can be drawn.
2/18
Only one on AAs, the rest on PAs.
Generally there was little quantitative data, much of it dates from before PAs were more established, and carried out by the same few research teams.
3/18
Clinical performance:
- PAs had 'operational knowledge' - knowing the local processes gave feeling of safety.
- Clinical competence never actually assessed.
4/18
- Concerns related to PAs generalisable clinical knowledge & positive views related to contribution to the team (eg, continuity of care)
- Didn't look at or show safety vs drs.
5/18
- PAs seen as very protocol driven, need more support, unable to manage significant % of cases independently.
- Concerns about medicolegal accountability.
6/18
- Analysis of costs abandoned due to difficulty separating PA contribution & outcomes from rest of MDT.
- In other cases access to data denied or impractical.
- Managers anecdotally thought PAs⬇️ locum costs.
- Didn't account for supervision time/costs.
7/18