the alberta physician assistant demonstration project n.e gibson msc, md facp, frcpc medical lead...

The Alberta Physician Assistant Demonstration Project

N.E Gibson MSc, MD FACP, FRCPC

Medical Lead

AHS PA Demonstration Project

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Conflicts

• Contracted with Frontline Medics to read EKGs

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Background

• This audience doesn’t need PA’s explained• Some familiarity in Alberta through Military and U.S.

trained Physicians• Gaps in health care coverage both in primary as well as

secondary and tertiary care– Fewer rural MDs and NPs– Fewer Residents available due to work hour rules

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Project Mandate

• Funded for two years from June 2013, some sliding to the right as new hires appear

• Ten PAs across 5 zones• Ability to add externally funded PAs as part of the

project

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Mission

• To establish the Physician Assistant as a part of a comprehensive strategy in developing collaborative care teams for quality patient care

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Goal

• The Project’s primary goal is to develop, implement and evaluate a physician assistant role in various health care settings across Alberta. The aim is to integrate PAs as unregulated providers, who are supervised by physicians, as part of the collaborative care team which will deliver quality health care.

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Objectives

• Objective #1– Develop a comprehensive project plan for

recruitment and deployment of PAs in Alberta • Objective #2

– Recruit and deploy 10 PAs to a variety of clinical settings with the Alberta Health care system.

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Objectives

• Objective #3– Evaluate the impact of PAs in various settings on

health care providers, patients and the health care system with a focus on:• Impact on collaborative care teams including

physician supervisor and PA• Clinical capacity of the settings• Patient outcomes

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Objectives

• Objective #4– Establish a plan for sustainable service delivery

models which include PAs as members of the collaborative care team.

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Important Assumptions

• This demonstration project will not jeopardize the capacity and quality of the current training and supervision commitments to residents, nurse practitioners and nurses.

 • Physician assistants will practice as unregulated providers and will not covered by

the Alberta Health Professions Act, 2011.  

• PAs recruited to the project will comply with the CPSA guidelines

• The PA competencies and roles will be adapted from the Canadian Association of Physician Assistants (CAPA) Scope of Practice and National Competency Profile and Defining the Physician Assistant Role in Ontario by Health Force Ontario.

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Important Assumptions

• Restricted activities that PAs are asked to complete will comply with the CPSA Standard: Supervision of Restricted Activities; Standard #4.

 • Physician assistants will be out of scope employees of AHS and may work with AHS

partners. (e.g. Covenant Health, PCN’s, Family Medicine).

 • PAs will maintain a dual accountability to physicians and employer (AHS).

• AHS has adequate comprehensive liability insurance to cover all employees

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Project Plan

• Ten PAs to start• Attempt to cover variety of environments• Detailed discussion with sites:

– Supervising Physician– Nursing staff– Administration– Other involved Health Care Professionals

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Supervising Physician

• Linchpin to the project• Detailed needs assessment initially• Comprehensive Roles and Responsibilities• Detailed Job Description and matched with PA skill set• Develop skill set throughout the relationship to meet

service needs

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Remuneration

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Evaluation

• Conducted by AHS Health Systems & Workforce Research Unit

• Based on 360 degree methodology• Mostly subjective criteria• Evaluation plan in place

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Evaluation

• Team effectiveness, team member perceptions of roles, team satisfaction.

• Physicians and PA satisfaction and workload surveys• # of patients seen/procedures conducted by physicians

and PAs• Wait time for services (pre and post), this will be

dependent on the setting. • Patient reported outcomes (e.g. EQ-D5 scale)• # of incidents related to PA role.

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Challenges to Date

• Health professional interface– Pharmacists– Registered Nurses

• Job descriptions• Recruitment• Regulation status

– Unregulated– Registration awkward

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Project Team

• Tanya Knorren BA, BN, MN– Senior Consultant, Provincial Medical Affairs

• Dwayne Nagy RN, BScN, MN(c)– Project Coordinator, Provincial Medical Affairs

• Neil Gibson BSc, MSc, MD, FACP, FRCPC– Medical Lead, Provincial PA Project

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Questions