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Integration of advanced practice providers into the Israeli healthcare system

机译：将高级医疗服务提供者纳入以色列医疗系统

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Many countries around the world have integrated various types of Advanced Practice Providers (APPs) into their healthcare systems. The main motivating factors for recognizing and developing APPs worldwide include physician shortages and the need for improved access or delivery (US, France, Belgium, Scotland, Switzerland), reduced residency hours (US, UK), shortages in underserved regions (US, Canada, Finland, Australia), and cost containment (Germany, Netherlands, UK, US).Israel is experiencing a shortage of physicians in peripheral geographic regions and in critical medical specialties. Recent by-laws approved by the Knesset (Parliament), combined with Israel Ministry of Health (MOH) policies, have thus far been unable to fully address the shortages. To understand the potential contribution of APPs in Israel, we evaluated the international historical foundations and development of APP roles. We assessed how APPs have impacted healthcare in other countries by analyzing public data and published international research about APP education, safety, quality of care, motivators, barriers, and impact. We found that APPs are recognized in dozens of countries, and have similar scopes of practice, graduate level education requirements (in developed countries), and clinical training.At the same time, there is wide variability among countries in the actual function and independence of the advanced practice nurse (APN), particularly the nurse practitioner (NP). APPs have been established as cost effective, safe healthcare providers who improve healthcare access.Israel has begun to introduce APPs, specifically NPs, in a variety of fields, including geriatrics, palliative care and diabetic care. We recommend a rapid expansion of existing and new APP roles into the Israeli healthcare system based on evidence and the recommendations of international evaluations by non-government organizations. By shifting the education to a university setting, mirroring successful, evidence-based, and established APP models found internationally, Israel could lessen the projected Israeli physician shortage, improve healthcare access in specific areas, and bolster existing resources towards a larger and richer pool of healthcare providers in Israel.
机译：世界上许多国家/地区已将各种类型的高级实践提供者（APP）集成到其医疗保健系统中。在全球范围内认可和开发APP的主要动机包括医师短缺和对改善获取或交付的需求（美国，法国，比利时，苏格兰，瑞士），居住时间减少（美国，英国），服务不足地区（美国，加拿大）短缺，芬兰，澳大利亚）和成本控制（德国，荷兰，英国，美国）。以色列在外围地理区域和关键医学专科领域的医生短缺。议会（议会）批准的最新法规，加上以色列卫生部（MOH）的政策，迄今仍无法完全解决短缺问题。为了了解APP在以色列的潜在贡献，我们评估了APP的国际历史基础和发展。我们通过分析公共数据评估了APP对其他国家的医疗保健的影响，并发表了有关APP教育，安全性，护理质量，激励因素，障碍和影响的国际研究。我们发现APP在许多国家都得到认可，并且具有相似的实践范围，研究生水平的教育要求（在发达国家）和临床培训，与此同时，各国之间在APP的实际功能和独立性方面存在很大差异。高级执业护士（APN），尤其是执业护士（NP）。应用程序已被确立为具有成本效益，安全的医疗服务提供者，可改善医疗服务的获取。以色列已开始在包括老年病，姑息治疗和糖尿病治疗在内的各个领域引入应用程序，特别是NP。我们建议根据证据和非政府组织的国际评估建议，将现有和新的APP角色迅速扩展到以色列医疗系统中。通过将教育转移到大学环境，镜像成功的，循证的和已建立的国际应用程序模式，以色列可以减轻以色列医生预计的短缺，改善特定地区的医疗保健机会，并支持现有资源，以扩大和增加以色列的医疗保健提供者。

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