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Providing culturally competent health care

Cultural competence The term cultural competence has a variety of definitions but perhaps the most relevant for physician assistants (PAs) is Betancourt‘s 2002 definition: Cultural competence in health care describes the ability of systems to provide care to patients with diverse values, beliefs, and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs. This definition refers to a system, recognizing that no one…

Patient education

Introduction Patient education is an integral part of every health care interaction. It is one of the most powerful tools that a health care provider can use to influence positive changes in health and wellness for patients. Whether the patient requires a diagnostic study, lifestyle changes, or a medication, the provider can offer the necessary education to the patient. Effective patient education provides patients with the…

Interpersonal and communication skills/people and technology – using technology without alienating patients

Learning objectives 1) Define distracted doctoring and how it influences patient safety outcomes. 2) Describe the “iPatient” and its relationship toward patient-centered care. 3) Identify issues relating to personal electronic device and computer addiction, noise, distraction, and contamination. 4) Describe shared decision making, elements of effective listening, and elements of effective two-way communication. 5) Define the “triangle of trust” and the elements of “the human level”…

Communication issues

“Primum non plus nocere quam succurrere.” Above all else, do not harm more than succor. Introduction The consequences of poor communication in the delivery of health care can be dire, to say the least. Ultimately, poor communication can lead to unwarranted injury and death. A study assessing 10 years of malpractice lawsuits found that breakdowns in communication were one of the top three most prevalent factors…

Considerations for a logical approach to medication prescribing

Objectives Integrate the World Health Organization steps to rational prescribing into the Physician Assistant practice. Synthesize an evidence-based approach to prescribing medication. Analyze research data related to the pharmacodynamics, pharmacokinetics, and patient considerations across the age continuum. Apply the pharmacotherapeutic principles to the development of a medication treatment plan. Describe patient barriers to adherence and the role for motivational interviewing. Identify other professionals who can help…

Chronic care perspectives

Introduction Chronic conditions are the leading causes of illness, disability, and death in the United States today. In 2014, 60% of U. S. adults had at least one chronic disease, and 42% had more than one chronic condition. Diabetes alone affects more than 29 million people in the United States. Recent evidence suggests that the prevalence of chronic diseases and their mortality and morbidity rates have…

The postgenomic era: Genetic & genomic applications for clinical practice

Overview The completion of the Human Genome Project (HGP) has changed how human health and disease is viewed. Physician assistants (PAs) practicing in this postgenomic age of medicine have an important role to play. First, this means PAs can take advantage of the genetic and genomic applications (tools) from the HGP research that are being streamed rapidly into clinical practice. These range from validated family medical…

The political process

Introduction Please do not skip this chapter just because you never intend to become involved in politics. You have entered medicine during a period of rapid and profound changes in health care delivery. Where there is change, there is politics. Although sometimes politics is described in disparaging tones, being involved in politics is nothing to be ashamed of because, in its truest sense, politics is the…

Health care financing and reimbursement

Learning outcomes Discuss the concept of value-based reimbursement in health care and explain how it differs from fee-for-service billing. Define Medicaid and Medicare and explain the differences between Medicare Parts A, B, C, and D. Describe payment arrangements whereby physician assistant (PA) services are attributed to physicians for billing purposes and explain how these arrangements impede the ability to assess the impact of care delivered by…

Assuring quality for physician assistants: Accreditation, certification, licensing, and privileging

Introduction Health insurance plans are becoming broader in regard to the scope of treatments they cover. These changes include mental health and behavioral health parity; fewer restrictions on preexisting conditions; and the coverage of supplemental services, such as physical therapy, massage therapy, acupuncture, and other holistic health services. Insurers want to be certain that clinicians have the appropriate education and background to qualify them to perform…

Physician assistant education: Past, present, and future challenges

Overview of physician assistant education Physician assistant (PA) education has matured and grown significantly since its humble beginning in 1967 when three ex-Navy corpsman students graduated from Duke University. By the end of 2018, the number of programs had grown to nearly 242, with an estimated enrollment of 23,313 students. , The typical PA program is 27 months long with more than 2000 hours of clinical…

International development of the physician assistant profession

Introduction The U.S. physician assistant (PA) profession is rooted firmly in the compressed medical curriculum originally developed by the military to quickly train doctors, medics, and corpsmen. The profession was further influenced by the history of Russian feldshers and the use of Chinese barefoot doctors. The PA movement is expanding globally in response to specific access, quality, and efficiency needs in many countries. Perhaps it is…

Optimal team practice

Introduction Optimal team practice (OTP) has been defined as “PAs, physicians, and other health care professionals working together to provide quality care without burdensome administrative constraints.” The goal of this chapter is to introduce the components that make up OTP and document its evolving history. OTP is the American Academy of Physician Assistants’ (AAPA) policy for establishing future physician assistant (PA) practice. Despite the recommendation, however,…

History of the profession and current trends

Learning objectives Adopt a historic and international view toward the development of PAs and PA-like medical careers. Describe some of the conditions in the U.S. health system that led to the development of the PA profession. Identify the five physicians generally recognized as the founders of the PA profession. Describe the specific roles of each of the four organizations that lead and monitor the physician assistant…

Physician assistant relationship to physicians

Introduction Ever since the physician assistant (PA) profession was developed, one of its defining features has been the relationship between PAs and physicians. When physicians created the PA profession, they envisioned PAs practicing medicine with physician delegation and supervision. Throughout the profession’s more than 50-year history, PAs have consistently embraced the concept of team-based health care. PAs believe that the physician–PA team provides the framework of…

Adoptive Cellular Therapy With Synthetic T Cells as an “Instant Vaccine” for Cancer and Immunity

1 Introduction The fields of vaccinology and adoptive cell transfer (ACT) converge in the shaping of the acquired cellular and humoral responses of the B- and T cells of the immune system toward desired antigens on pathogens or self-targets. However, the approaches differ markedly, with vaccines often requiring immunizations and boosting over a period of months, whereas ex vivo culture of T cells and gene transfer…

Cancer Immunotherapy by Checkpoint Blockade

1 Introduction In the last decades there has come into being, without either flourish of trumpets or serious controversy, a general current of belief in what I have come to call ‘immunological surveillance’. – One can therefore picture a form of surveillance by which the body is being continuously patrolled, as it were, for the appearance of aberrant protein patterns. — M. Burnet The idea that…

Vaccines for Emerging Viral Diseases

1 Introduction Infectious diseases continue to plague mankind and evolve to keep pace with the efforts to control them. Sir William Osler captured the ongoing fear of infectious pathogens when he said, “Humanity has but three great enemies: fever, famine, and war; of these by far the greatest, by far the most terrible, is fever.” Despite the significant impact of antimicrobials and vaccines on public health,…