Roles of nonphysician clinicians as autonomous providers of patient care
Roles of nonphysician clinicians as autonomous providers of patient care
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DOI：
10.1001/jama.280.9.795
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发表时间：
1998-09-02
影响因子：
120.7
通讯作者：
Dietrich, CL
中科院分区：
文献类型：
--
作者：
Cooper, RA;Henderson, T;Dietrich, CL
进行了研究，以评估非医师临床医生（npc）在10个学科中的执业特权，这些学科总体上是提供医疗和外科服务的主要非医师贡献者。这些学科包括执业护士、医师助理、护士助产士、脊椎按摩师、针灸师、自然疗法师、验光师、足科医生、护士麻醉师和临床护士专家。在不同学科中，国家授予npc的实践特权存在显著差异。对于大多数学科来说，其特权的大小与每个州的npc数量相关。在最高水平上，国家实践特权授予了高度的自主权和广泛的权力，以提供离散级别的简单初级和专业护理。最近这些特权的发展为npc创造了新的机会；然而，它也正在创造一种多元化，有可能进一步分裂美国的医疗体系。现在是进行监管整合和专业协作的时候了，这样，包括多种学科的卫生保健工作人员才能确保在未来提供一套连贯的患者护理服务。
Studies were undertaken to assess the practice prerogatives of nonphysician clinicians (NPCs) in 10 disciplines that, collectively, are the major nonphysician contributors to the delivery of medical and surgical services. These disciplines include nurse practitioners, physician assistants, nurse-midwives, chiropractors, acupuncturists, naturopaths, optometrists, podiatrists, nurse anesthetists, and clinical nurse specialists. Marked differences were found in the practice prerogatives that states granted NPCs in the various disciplines. For most disciplines, the magnitude of their prerogatives correlated with the numbers of NPCs practicing in each state. At their maximal levels, state practice prerogatives authorized a high degree of autonomy and a broad range of authority to provide discrete levels of uncomplicated primary and specialty care. The recent growth in these prerogatives is fostering new opportunities for NPCs; however, it also is creating a pluralism that has the potential to further fragment the US health care system. It is time for regulatory integration and professional collaboration so that a health care workforce that includes a diversity of disciplines can be assured of providing a coherent set of patient care services in the future.