Ethical Issues With Nurse Practitioner And Physician Ass

本方案是一项描述性、横断面、具有全国代表性的研究，旨在调查非医师从业人员（NPs和PAs）对与初级保健实践相关的伦理问题的看法。初级保健中的NPs在临床实践中表达了围绕正义、权利、责任、无害和慈善等问题的伦理冲突。NPs确定的其他道德冲突包括与管理式医疗机构的安排，专业责任，看到越来越多的病人的压力，以及降低成本的奖金和计费做法。随着预期的NP和PA的趋势大幅增加，对影响道德实践的因素的了解将与塑造NP和PA在提供高质量、高成本效益的卫生保健方面的未来作用有关。此外，作为研究方法目的的一部分，为了评估金钱激励对提高邮寄的自我管理问卷的回复率的有效性，受试者将被随机分配到三个激励组之一。将使用描述性统计和集中趋势（频率、平均值、标准偏差）以及双变量相关性来分析数据。多元回归将用于确定因素，预测伦理冲突在实践和感知交付的优质护理。从2002年11月开始，对美国3900名非医师临床医生进行了邮寄调查，目前正在分析有关道德冲突及其对实践的影响的数据。在随机分配5美元现金奖励的小组中，反应最高，并且已经提交了一份关于随机奖励的手稿。

This protocol is a descriptive, cross-sectional, nationally representative study to investigate nonphysician practitioners' (NPs and PAs) perceptions of ethical issues associated with primary care practice. NPs in primary care have expressed ethical conflicts in clinical practice centering on issues of justice, rights, responsibility, nonmaleficence, and beneficence. Other ethical conflicts identified for NPs include arrangements with managed care organizations, professional accountability, pressure to see an increasing volume of patients, and bonus and billing practices to lower costs. With the projected trends for NPs and PAs substantially increasing, knowledge of factors that influence ethical practice will be relevant in shaping the future role of the NP and PA for the provision of quality cost-effective health care. Additionally, as part of the methodological purpose of the study, to evaluate the effectiveness of monetary incentives to increase response rates to a mailed self-administered questionnaire, subjects will be randomly assigned to one of three incentive groups. Data will be analyzed using descriptive statistics and measures of central tendency (frequencies, mean, standard deviation) as well as bivariate correlations. Multivariate regression will be utilized to determine factors that predict ethical conflict in practice and perceived delivery of quality care. Surveys were mailed, beginning in November 2002 to 3900 Nonphysician clinicians in the U.S. Data on ethical conflicts and impact on practice are currently being analyzed. Response was highest in the group randomized to a $5 cash incentive, and a manuscript on the randomized incentives has been submitted.