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74 Cards in this Set

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When was the first PA Class? And where?
Started 1965 graduated in 1967 from Duke University.
Why did the PA concept emerge?
* Strategy to cope with a shortage of physicians.
* Increased demand for health care services.
* Mal-distribution of providers
Who was included in the first PA class?
3 Navy Corpsmen
What changes in the healthcare delivery added to success of the PA concept?
Scientific breakthroughs, new medical specialities and subspecialities, overgrowth of hospitals and hospital services.
What did President Johnson contribute?
"Great Society Program" was the beginning of the "war on poverty" an attempt by the federal government to reach out to the underserved.
What is the Health Manpower Act?
Developed and funded new programs
What was the original concept?
* Brief duration of generalist training
*Physician supervised
* Medical Model (basic sciences courses followed by clinical skill development)
What is AAPA?
American Academy of Physician Assistants
What is KAPA?
Kansas Academy of Physicians Assistants
What is the PA scope of practice?
The physician delegates to the PA, only those acts which the physician believes can be competently performed by the PA based on the PA's background, education, skill, and experience.
What is the PA credentialing process?
* Attend and graduate from an accredited PA program.
* Pass the NCCPA exam
* State Registration and Licensure
* 100 CME hours every 2 years, 50 from Cateogory 1 and 2
* Recertification exam every 6 years.
Define culture.
The integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group.
What is cultural competency?
* A set of academic and personal skills that allows us to increase our understanding and appreciation of cultural differences between groups.
* We need to be culturally competent in health care for people of diverse backgrounds, homelands, languages, and beliefs.
What are some "other" healing beliefs held by cultures.
* "Hot/cold" beliefs - not related to temperature.
* Dermabrasive procedures: coining or spooning
* "Cupping" - forming ecchymosis
What are some western medical influences that other cultures may not accept?
* Venicpuncture
* Surgery
* Injections
* Western medicine - may be too potent and pt's may reduce amount
What are some different cultures? Subcultures?
* Hispanic, Asian, Middle Eastern, Native American, etc.
* Women, homo's, Teens, Gangs, Rural, Inner city, etc.
What are some global health care issues?
* HIV and AIDS
* TB
* SARS
* Biological terrorism
* Avian flu
What is COGME?
Council on Graduate Medical Education
What is HIPAA?
Health Insurance Portability and Accountability Act of 1996
What are the 3 areas of primary care?
* Family Medicine
* Pediatrics
* General Internal Medicine
What are 3 issues confronting the PA Profession?
* Medical Information - widely available on the internet. Which is accurate?
* Profit - Stockholders, companies, and highly paid practitioners are all stake holders. The patient's welfare comes first.
* Loss of Autonomy - managed care, malpractice suits...?
What is NCCPA?
National Commission on Certification of Physician Assistants
What is ARC-PA?
Accreditation Review Commission on Education for the Physician Assistant - Accrediting body for PA Programs
What is SAAPA?
Student Academy of American Academy of Physician Assistant
How much does medicare pay?
Services provided by the PA's in all practice settings at the rate of 85% of the physician fee schedule.
How much does medicaid pay?
State determined. In Kansas 75% of the physician fee.
What is "Incident To"?
Reimbursement of 100% by medicare if: 1) seen in office, 2) physician sees patient on initial visit and establishes diagnosis.
What is the surgery fee paid by medicaid?
85% of the first-assistant fee (.85 x 16 = 13.6%)
What are the roles of PA's in primary care?
* Pt makes appointment with PA
* PA makes decisions for care
* PA develops ongoing relationships
* May care for entire family
* Earned income easily identified
* Broad knowledge - know a little about a lot
What are the roles of PA's in specialty practices?
* PA is more of an extension of the physician
* Usually do not have own patients
* Provide peripheral care or support services
* Harder to identify income to practice
* Can be challenging to develop ongoing relationships
* Focused knowledge - know a lot about a little
What are the 4 main bioethical principles?
* Autonomy
* Beneficence
* Nonmaleficence
* Justice
What kinds of PA degrees can you get?
* Master's
* Bachelor's
* Associates
* Cartificates
* Programs range from 12-57 months
What are the PA Education Models?
* Hospital based - all clinical training
* Full time, part time options
* Combined military programs
* Four year curriculum
* Medex model - 18 months community based
* ND - 12 months,one physician, only RN's admitted
Who funds PA institutions?
* State funded
* Private institutions
* Federal Training Grants
* Other - private foundations, industry
Describe PA faculty?
60% are PA's
40% are non-PA's
How many CME hours are required for PA's?
100 hours every 2 years
* 50 are cateogory 1 - preapproved
* 50 are cateogory 2 - self learning; on your honor
What are malpractice issues PA's get involved with?
* Lack of adequate supervision - documentation
* Untimely referral
* Not following protocol
Failure to diagnose
* Inadequate examination
* Parental Consent when treating minors
* Restraints and seclusion
* Negligence/abandonment
What is PHI?
Protected Health Information
What are patient rights regarding PHI?
Patient may have/request:
* Restrictions on use of PHI
* Alternative forms of communication
* Access to their own PHI
* Access to disclosure of PHI
* Amendments to their PHI
What are the fundamental principles of medical professionalism?
* Primacy of patient welfare
* Patient autonomy
* Social justice
Define professionalism.
Conduct, aims, or qualities that characterize or mark a profession or a professional person.
What is the ultimate goal of professionalism?
* Honor patients
* Earn their trust
* Provide the best and most appropriate care possible
* Understand and recognize that your personal values and beliefs can impact the care you provide.
What is altruism?
patient interest comes first
What is OSCE?
Objective Structured Clinical Exam
Physician assistants hold in their responsibility...
the health, safety, welfare, and dignity of all human beings.
Physician assistants uphold the tenets of ...
patient autonomy, beneficence, nonmaleficience, and justice
Physician assistants recognize and promote...
the value of diversity.
Physician assistants treat equally...
all persons who seek their care.
Physician assistants hold in confidence...
the information shared in the course of practicing medicine.
Physician assistants assess their personal capabilities and...
limitations, striving always to improve their medical practice.
Physician assistants actively seek to expand...
their knowledge and skills, keeping abreast of advances in medicine.
Physician assistants work with...to provide...
other members of the healthcare team

compassionate and effective care of patients
Physician assistants respect...
their professional relationship with physicians.
Physician assistants share and...
expand knowledge within the profession.
What are the differences between the living will and a durable power of attorney?
* The living will is a statement of personal values, and only applies when a person has been diagnosed as "terminal" by 2 physicians.
The durable power of attorney is useful in cases when one may not be terminal, but will never recover enough to live a life meaningful to them.
Neither takes effect until the person can no longer make, or communicate, decisions for themselves.
What are the 3 advance directives?
* Living will
* Durable power of attorney
* DNR
What is a DNR order, what is included?
* Limits emergency care
* No CPR
* Does NOT limit other medical care, such as antibiotics, pain medications, or comfort carfe
* Can be revoked at any time
* Must be assigned by the attending physician (the pt's PCP)
What is the Patient Determination Act of 1990?
Requires the hospital to provide written information to adult patients re: rights to make decisions regarding their own healthcare
When is a living will effective?
* 2 physicians must examine the patient and determine that the patient has a terminal illness
* They must agree that death will occur whether or not the medical intervention is done.
* The form is not effective if the pt is pregnant
Where should you put copies of the advance directives?
Several places: family physician, hospital, attorney, and family members.
What are patients rights concerning advance directives?
* Information about their medical condition, diagnosis, prognosis, and possible treatments.
* Refuse any treatment
* NOT make advance directives, it's their choice.
When can one change their mind about an advance directive?
Any time
What are rules for licensure in KS?
* Pass NCCPA
* Maintain CME's
* Renew license annually
* Have a supervising physician and a back-up
* Have protocol on record at KSBHA
What must you do concerning hospital credentials?
- Apply to hospital credentials committee for staff priveleges
What are PA's liberties/allwances in the state of KS?
* Two PA's per physician
* Short protocol
* Prescriptive privelege (may require a DEA #)
* Supervised (at least 30 min by phone)
* Physician actively practices medicine within state.
*DR annually reviews drug protocol
* Reports any disciplinary actions
* Signs all pt encounters (at least every 14 days)
* Reviews pt charts within 48 hours of emergent care by PA
What is cultural competency?
A set of academic and personal skills that allows us to increase our understanding and appreciation of cultural differences between groups
What is APAP?
Association of Physician Assistant Programs.
What is the purpose of HIPAA?
* To allow people to keep their insurance when they change jobs
* Prevent health care fraud and abuse
* To promote electronic healthcare transactions and streamline claims processing
* PRIVACY - protect patient information
What did COGME commission?
AGPAW - Advisory Group on Physician Assistants and the Workforce
What are AGPAW's recommendations?
* Increase federal support for PA programs
* Funding should give priority to PA programs that succeed in placing PA's in primary care settings
* Policy initiatives should include removing legislative obstacles to PA clinical practice on federal and state levels
Who said, "Education is what survives when what has learned has been forgotten" ?
BF Skinner
When was the national certification exam first given?
1973
Who is eligible to take the certification exam
All graduates of an accredited PA program (This was placed into effect in 1986)
When did the ARC-PA begin?
1971