Protocols for Physician Assistants

Abstract Physician assistants used problem-oriented protocols in management of patients with diabetes and hypertension. The protocols directed the physician assistant in determining what data to collect, and whether the patients required a physician's care at that visit. Physicians verified the ability of the physician assistants to collect history and physical-examination data accurately, noting false-positive findings on 11 per cent of 381 visits, and false-negative findings on 1 per cent of visits. Subsequently, physicians selected certain patients as "suitable" to be managed by the physician assistants. "Suitable" patients were then randomly assigned to be seen by the physician assistants (experimental visits) or physicians (control visits) on return visits. On 37 per cent of experimental visits over an 11-month period, the patients went home without seeing a physician. Physicians accepted the protocol disposition decision in 94 per cent of the cases. Patients accepted the system, as reflected by their attendance rate at the clinic. (N Engl J Med 290:307–312, 1974)