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Table 5 Summary of scoping review

From: Patient satisfaction with physician assistant/associate care: an international scoping review

Author (last name of first author and year)Location (country, state, and city if known)Year of dataStudy design or methodologyFindings, notes, critique, etc.
Litman 1972
[17]
USA—Iowa and Minnesota1970Telephone Survey/interview by research staff following a visit to a PA.
N = 253 households.
Site: rural hospitals, PA specialty unspecified.
PAs: N/A (general perception study of what the patient thought about the PA).
Q: What is the public perception of the PA?
In total, 2/3 interviewed indicated a willingness to see a PA, 16% would not see a PA. The patient’s view relies heavily on endorsement of the physician and less agreement over specific services; 94% OK with PA taking history and physical examination, 76% in favor of ER procedures. Greatest opposition of PA was in maternity care. One third (34%) were unwilling or very unwilling to be screened by PA if they could see a physician instead. But 83% were okay with the PA referring them to specialist.
Strunk 1973
[19]
USA—California (Los Angeles)NSAttitude scale of 30 items.
N = 300 patients waiting in the clinic
Site: outpatient clinic.
PAs: N/A (general acceptance study of what the patient thought about the PA)
Q: Are PAs acceptable to patients?
Acceptance was higher in patients with some exposure to college, middle class, non-married; 67% overall agreed PAs are a way to improve nations’ health. In fact, 41% responded that PAs should be doing more than routine visits; 67% willing to be seen by a PA “if they felt they knew what they were doing”.
Nelson 1974
[20]
USA—Upper New England1972Patient satisfaction questionnaire:
N = 449 patients
Site: 18 outpatient primary care clinics.
PAs: 18 Medex trainees
Q: How satisfied are patients with the services provided by (Medex) PAs?
A sample of 900 patients seen in 18 practices of upper New England PCPs with a questionnaire. When asked about their opinions of PAs no demonstrable differences were found between respondents and non-respondents; 372 had experience with MEDEX trained PAs, 77 did not. In total 91% were satisfied with the encounter (99% very/somewhat, 87%/100% very satisfied/somewhat) with the physical examination. A total of 89% found the PA very competent; only 1% reported incompetent or not confident in them.
Komaroff 1974
[21]
USA—Massachusetts (Boston)1970–1972Protocol-driven diabetes and hypertension management was reviewed by physicians.
N = 441 patients
Site: medical clinic
PAs: Number not reported
Q: Does the level of care provided by PAs meet patient acceptance?
Patients were randomly assigned to “health assistant” functioning as a PA. In total 441 patient visits were studied for protocol adherence by the HA. Of 286 patients assigned, 6% declined to be routed into the protocol system. Of 53 patients who were told they did not have to see the doctor, only 1 asked to be seen; only 2.2% of total visits did patients seek medical attention in between visits.
Charles 1974
[22]
USA—California (San Francisco)1972 and 1973Case study; PAs using clinical algorithms.
N = 1159 visits spanning one year.
Site: VA “drop-in” clinic.
PAs were assessed after 3 months of working in the VA. Data collected on site.
PAs: 5
Q: Do patients accept care by a PA?
Two separate studies were undertaken; each looked at data recorded by a doctor vs. a PA; patient’s acceptance of the PA was 99% (only 2 patients refused to see the PA). One comment was that the PA spent more time with the patient than physicians.
Maxfield 1975
[23]
USA—New England -Maine, New Hampshire1974Questionnaire (paper) sent to patients who had been seen in an emergency room staffed with PAs.
N = 237 patients
Site: Emergency Department
PAs: 3
Q: Are patients satisfied with PA care in the ED?
91/237 questionnaires were received from patients (38%). With no exception all reported high satisfaction with PAs.
Storms 1979
[24]
USA—Maryland (Baltimore)1975Patient satisfaction questionnaire:
N = 449 patients
Site: 18 outpatient primary care clinics.
PAs: 18
Q: Do patients accept care provided by a PA?
Only 4.1% of the sample had seen an NP or PA; overall acceptance was similar between both groups, though slightly favored to NPs.
Jolly 1980
[25]
US (national)1976, 1977Quantitative and qualitative survey of Air Force service members and families.
N = patient number is unclear
Site: 4 base military treatment facilities
PAs: 23
Q: Are patients satisfied with PA care on a panel system?
Three levels of satisfaction reported. Acceptance and satisfaction were high throughout. The percentage of respondents who felt the PA could handle specific problems declined depending on the complexity of the problem.
Smith 1981
[26]
US—Iowa1979Sixteen question survey of patients following visit with PA.
N = 196 completed
Site: Multi-specialty clinic
PAs: 4
Q: Are patients satisfied with care provided by a PA?
In total, 92% always or usually satisfied with care by the medical team, 78% usually or always satisfied with team approach. Patients are almost always willing to be seen by the PA if they know the physician is supervising the PA.
Hla 1983
[27]
US—North CarolinaNSPatients interviewed by a nurse following a visit to the clinic where a PA was seen.
N = 191 patients.
Site: General outpatient clinic, hypertension patients.
PAs: 1
Q: Are patients satisfied with care provided by a PA on a medical team?
Compared 191 patient visits with PA management and 200 without PA management of blood pressure. Similar patient characteristics. No significant differences in patient satisfaction.
Oliver 1986
[28]
US—Iowa1984-1985Patient interview and questionnaire (hybrid model) following a visit to a PA.
N = 308 patients.
Site: Seven outpatient clinics and two satellite clinics, primary care.
PAs: 11
Q: Are patients satisfied with care provided by a PA regarding competency, interpersonal skills?
The questionnaires explored satisfaction, competency, interpersonal skills, time on a 1-5 Likert scale. The results: 4.81 mean for interpersonal skills, 81.5% completely satisfied; PA competency similar at 4.6 mean; 4.48 mean completely or satisfied with time. Females, patients with higher education, and those with more contact with PAs tend to rate PAs higher than all others.
Brady 2004
[29]
US—Oregon (Forest Grove)2004Interviews and patient questionnaire, using a validated survey at time of exit from clinic.
N = 100 patients.
Site: Outpatient clinic, family medicine.
PAs: 2
Q: Are patients satisfied with care provided by a PA?
Overall, 73% of patients generally satisfied with the care from PA; N = 2 PAs;
Overall satisfaction was 4.757/5. In total 94/100 of those interviewed gave a 4 or 5 for overall satisfaction of the encounter with the PA.
Hooker 2005
[14]
US—National2000 = 2001Cross-sectional survey of Medicare (> 64 years old) patients who received care from a doctor, PA or NP.
N = 146,880 completed surveys
Clinic/specialty unspecified.
PAs: 2234
Q: Are patients satisfied with care provided by a PA?
Through a series of survey questions, 95% of all beneficiaries (elderly) said they were happy with their provider regardless of type (doctor, PA, NP). Overall most (95%) said there was little or no problem to find a provider that they were happy with.
Rodi 2006
[30]
US—New Hampshire2004Pre- and post-visit surveys with PA or doctor
N = 87 completed (pre), and 91 completed (post)
Site: Outpatient, fast-track clinic
PAs: Number not reported
Q: Are patients satisfied with care provided by a PA?
In essence this study demonstrates that a fast-track unit staffed by PAs can improve patient satisfaction and decrease LOS. The primary driver is LOS. The patient’s perception of the PA improved when the LOS was shorter.
Farmer 2008
[18]
UK—Scotland2006–2008Patient interviewed by a researcher as they exited the clinic where a PA was seen.
N = 20.
Site: Multiple settings and specialties.
PAs: 15
Q: Are patients satisfied with care provided by a PA?
All 20 patients interviewed were satisfied with the treatment they had received in the setting that day (very satisfied: 11; satisfied: 9). Four specifically emphasized high satisfaction with the PA. Twelve thought that they had received faster service than usual and 8 thought that the speed of the service was similar to what they would normally receive. Where service was faster, some patients attributed this to the involvement of PAs.
Roy 2008
[31]
US—Massachusetts (Boston)2005–2006Retrospective cohort study, Press-Gainey survey determining satisfaction
N = 992
Site: PA/hospitalist service vs. house staff service (without PA) N = 4202.
PAs: 3
Q: Are patients satisfied with care provided by a PA as part of hospitalist team?
Patients were similarly satisfied with their care on the PA + Hospitalist service as on the house staff services without the PA. The study did not directly ask patients about PAs. Patients were similarly satisfied with care on PA-hospitalist service when compared with house staff only service.
Dhuper 2009
[32]
US—New York (Brooklyn)1998–2000Satisfaction survey questionnaire administered monthly to a of N = 1000 patients convenience sample.
Site: Inpatient hospitalist service.
PAs: 23
Q: Are patients satisfied with care provided by a PA on a medical team?
Comparison of PA/hospitalist vs. Resident/hospitalist models; 95% of patients satisfied with care by providers during 1998-2000 (PA/hospitalist) compared with 96% from 1996-1998 (Resident/hospitalist.). Findings were not statistically significant.
Tataw 2011
[33]
US—California (Los Angeles)2002–2004Telephone interviews with parents of children who received general medical and sub-specialty care. The questionnaires explored satisfaction, competency, interpersonal skills, and time on a 1-5 Likert scale.
N = 71
Site: Pediatrics clinical service, primary care and sub-specialty.
PAs: Number not reported
Q: Are patients as satisfied with care provided by a PA as a doctor?
Satisfaction measured between PA and doctor. No statistically significant differences in satisfaction scores. Satisfaction, based on summated scores, revealed that parents were slightly more satisfied with services provided by a PA than a doctor.
Berg 2012
[34]
US—Kansas2007–2008Prospective, cross-sectional study using telephone surveys of recently discharged level I (emergent) and level II (urgent) trauma patients 4 weeks upon discharge.
N = 251
Site: ER/Trauma
PAs: Number not reported
Q: Are patients satisfied with care provided by a PA?
Overall satisfaction 5.04 with PA (Likert scale 1-6). Findings were divided between interpersonal care and technical care. Patients more likely to indicate satisfaction in other areas if satisfied with interpersonal care.
Drennan 2014
[35]
UK—England2011–2012Mixed methods—interviews and surveys specific to patient satisfaction.
N = 539, 34 interviews.
Site: Primary care
PAs: Number not reported specific to satisfaction
Q: Are patients satisfied with care provided by a PA?
Patients and relatives described PAs as positively as the GP. Many of the respondents did not understand who and what a PA was, often mistaking them for doctors.
Appleton-Dyer 2015
[36]
NZ (South Island)2013–2015Paper surveys were collected at the time of visit from sites where a PA was part of a demonstration project.
N = 511.
Site: Outpatient clinics, primary care and urgent care “drop-in” clinics.
PAs: 26
Q: Do patients accept PAs and are patients satisfied with care provided by a PA?
In total 220 surveys identified the PA. There were no significant differences at the 0.05 level between the PA and any other health professional. This suggests that patients are just as satisfied with the care they receive from a PA as they are with other health professionals.
Johnson 2016
[37]
USNSA patient satisfaction survey was distributed to patients receiving care from PAs at the time of the visit.
N = 87
Site: Outpatient orthopedic clinic.
PAs: Number not reported
Q: Are patients satisfied with care provided by a PA?
Waiting time, technical skill, interpersonal manner and overall satisfaction with the PA was 6.9 (on 7-point Likert scale)
Meijer 2017
[15]
NL—Friesland2015European Union standardized Consumer Quality Index - mailed form sent to the patient within 2 weeks of an encounter at a physician’s office or clinic.
N = 92 for physicians, N = 110 for PAs
Site: Outpatient clinics, primary care.
PAs: Number not reported.
Q: Are patients satisfied with care provided by a PA vs a doctor?
For the most part patients were as satisfied with PAs as they were with physicians. The one exception is that female patients seen by GPs were less satisfied than with PAs. The gender of the PA or physician was not collected. PA and physician visits were compared.
Drennan 2019
[38]
UK—3 regions2016–2017Patient interviews about their experience with a PA.
N = 28
Site: Six hospitals, acute care
PAs: 43
Q: What is the impact of PAs on the patient experience?
“Patients and relatives described PAs positively, but most did not understand who and what a PA was, often mistaking them for doctors”
Joyce 2019
[39]
IR—Dublin2017Patient satisfaction survey.
N = 74 completed surveys; 22 seen by PAs and 52 by doctor
Site: Outpatient hospital clinic
PAs: 4
Q: Are patients satisfied with care provided by a PA?
Satisfaction with care survey -- no difference in the patient satisfaction ratings between PAs and doctors
  1. Note: IR Ireland, Republic, PA physician assistant/associate, PCP primary care provider, VA Veterans Administration [or Veteran Affairs], NL the Netherlands, NZ New Zealand, NS not stated in the manuscript, LOS length of stay