Evaluation and description of a remote physicians's assistant practice at the Wendover HURA project

In June of 1977 a physician's assistant (PA) was placed in the medically underserved, remote community of Wendover, Utah. In addition, a computerized protocol system designed to assist the remote PA in patient care and clinic management was installed at the. remote clinic. This study evaluated various aspects of the remote physician's assistant practice during the first year of operation, i.e., the utilization by the local community, the quality of medical care delivered, and various characteristics of the remote practice. The community utilization of the remote clinic was approximately 50% of all health care visits of residents according to a community survey. The utilization patterns of this clinic varied according to type of service rendered, ranging from 70% of all traumatic injuries to only 10% of the chronic medical problems. Salt Lake City (110 miles distant) was the site most frequently utilized for medical care second to the Wendover Clinic and accounted for 37% of total utilization. No particular age trends were noted in the utilization of the remote clinic; however, males were noted to use this clinic at a significantly higher rate than females. Predicted patterns of future utilization of the remote clinic revealed a growing confidence in the physician's assistant toward increased rates of utilization. A Utah Professional Review Organization quality-of-care audit revealed that a remote PA using the computerized medical protocol system was capable of rendering quality episodic care for various common disorders such as pharyngitis and otitis media on par with physicians and a PA practicing in a university-affiliated Family Practice Center. However, a problem-oriented record audit of entire patient charts demonstrated that the remote PA and computer system were deficient in comparison to the university-based practitioners in assuring adequate collection of data base information and in documentation of follow-up care. The final aspect of the study, a descriptive analysis of the practice, revealed differences between the remote PA and on-site PAs (physician's assistants working in a physician's office) in such areas as increased obstetrical care loads and acute problems of the skin encountered by the remote PA. Other characteristics of the remote practice, such as referral patterns to specialty physicians, reasons for immediate transportation of patients to emergency rooms and the frequency of various diagnostic tests performed by the remote PA were examined. Documentation of the utilization of the back-up (supervising) physician was made in regard to time commitment involved in medical supervision of the remote PA, telephone consultation patterns and types of patient encounters at the Wendover Clinic.