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首页> 外文期刊>BMC Family Practice >Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study
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Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study

机译：一般从业者，护士从业者，医师助理和护士的技能变化，老年人的主要医疗保健：一个定性研究

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More and more older adults desire to and are enabled to grow old in their own home, regardless of their physical and mental capabilities. This change, together with the growing number of older adults, increases the demand for general practitioners (GPs). However, care for older people lacks prestige among medical students and few medical students are interested in a career in care for older people. Innovative solutions are needed to reduce the demand for GPs, to guarantee quality of healthcare and to contain costs. A solution might be found in skill mix change by introducing nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs). The aim of this study was to describe how skill mix change is organised in daily practice, what influences it and what the effects are of introducing NPs, PAs or RNs into primary healthcare for older people. In total, 34 care providers working in primary healthcare in the Netherlands were interviewed: GPs (n?=?9), NPs (n?=?10), PAs (n?=?5) and RNs (n?=?10). Five focus groups and 14 individual interviews were conducted. Analysis consisted of open coding, creating categories and abstraction. In most cases, healthcare for older people was only a small part of the tasks of NPs, PAs and RNs; they did not solely focus on older people. The tasks they performed and their responsibilities in healthcare for older people differed between, as well as within, professions. Although the interviewees debated the usefulness of proactive structural screening on frailty in the older population, when implemented, it was also unclear who should perform the geriatric assessment. Interviewees considered NPs, PAs and RNs an added value, and it was stated that the role of the GP changed with the introduction of NPs, PAs or RNs. The roles and responsibilities of NPs, PAs and RNs for the care of older people living at home are still not established. Nonetheless, these examples show the potential of these professionals. The establishment of a clear vision on primary healthcare for older people, including the organisation of proactive healthcare, is necessary to optimise the impact of skill mix change.
机译：越来越多的成年人渴望并使能够在自己的家中变老，无论他们的身心能力如何。这种变化与越来越多的老年人一起增加了对一般从业者（GPS）的需求。然而，对老年人的照顾缺乏医学生的声望，很少有医学生对老年人的职业生涯感兴趣。需要创新的解决方案来减少对GPS的需求，以保证医疗保健质量并包含成本。通过介绍护士从业者（NPS），医师助理（PAS）或注册护士（RNS），可以在技能组合变更方面找到解决方案。本研究的目的是描述如何在日常实践中组织技能混合变化，有什么影响，以及将NPS，PAS或RNS引入老年人的原发性医疗保健的原因。共有34个在荷兰的小学医疗保健提供者接受采访：GPS（n？=？9），nps（n？=？10），pas（n？=？5）和rns（n？=？10 ）。进行了五个焦点小组和14个个人访谈。分析包括开放编码，创建类别和抽象。在大多数情况下，老年人的医疗保健只是NPS，PAS和RNS任务的一小部分;他们并不专注于老年人。他们所表演的任务以及他们在老年人的医疗保健方面的职责不同，以及职业之间的不同之处。虽然受访者在实施时辩论了主动结构筛查的有用性，但实施时，尚不清楚谁应该履行老年评估。受访者认为NPS，PAS和RN是一个附加值，并表示GP的作用随着NPS，PAS或RNS的引入而变化。仍然没有建立NPS，PAS和RNS为住宅的老年人提供的角色和责任仍未建立。尽管如此，这些例子显示了这些专业人员的潜力。为更优化技能混合变化的影响，必须为更老年人提供明确愿望的老年人的初级医疗保健愿景。

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