Answering the Call: Using Physician Assistants in Prehospital Environments to Reduce ED and EMS overutilization by 'superusers'
AAPA ePoster library. Thompson K. 05/17/17; 180480; 31
Katherine Thompson
Katherine Thompson
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Abstract
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Both emergency departments (EDs) and the emergency medical services (EMS) are suffering from increased patient populations and reduced resources due to a perfect storm of variables. Vulnerable populations often contribute to a small group of users known as 'superusers' who are utilizing these services at much higher rates than the average person. This project was undertaken to explore how physician assistants (PAs) can work within prehospital care environments to help alleviate some of this overutilization and to improve the uncoordinated care that many superusers receive from the healthcare services. In 2005, the number of Americans with at least one chronic medical condition was 133 million. By 2020, this number is expected to climb to at least 157 million.1 The healthcare system in the United States is underprepared to coordinate care for those with complex healthcare needs, especially where those needs intersect with chronic mental health problems. Limited emergency resources, long waits in EDs, inflexible primary care hours, and difficulty accessing and maintaining appropriate and coordinated care all contribute to this growing crisis. This is especially timely and concerning today, with the implementation of the Affordable Care Act and the indication that new legislation will bring more changes with the new presidency. These factors particularly impact the 'superuser' population, which is a homogenous group of individuals nationwide who rely upon EDs and EMS for their healthcare management. Most often, superusers are male, receiving public benefits, older, and frequently have any combination of psychiatric illness, homelessness, and substance abuse amongst their medical and psychosocial problems.2,3,4,5 The homeless population is affected disproportionately by extreme uncoordinated care, theoretically because of the extreme psychosocial stressors of being homeless, including drug and substance abuse, mental health conditions, and difficult and dangerous living conditions. One of the most flexible proposed solutions to superuser intervention is the use of community healthcare providers who can intersect and impact superusers where they live. This is a particularly powerful form of intervention for the homeless superuser population because they do not keep their appointments at primary care clinics for a variety of reasons: they cannot obtain adequate transportation, they fear law enforcement or social work involvement in their lifestyle choices,...
Both emergency departments (EDs) and the emergency medical services (EMS) are suffering from increased patient populations and reduced resources due to a perfect storm of variables. Vulnerable populations often contribute to a small group of users known as 'superusers' who are utilizing these services at much higher rates than the average person. This project was undertaken to explore how physician assistants (PAs) can work within prehospital care environments to help alleviate some of this overutilization and to improve the uncoordinated care that many superusers receive from the healthcare services. In 2005, the number of Americans with at least one chronic medical condition was 133 million. By 2020, this number is expected to climb to at least 157 million.1 The healthcare system in the United States is underprepared to coordinate care for those with complex healthcare needs, especially where those needs intersect with chronic mental health problems. Limited emergency resources, long waits in EDs, inflexible primary care hours, and difficulty accessing and maintaining appropriate and coordinated care all contribute to this growing crisis. This is especially timely and concerning today, with the implementation of the Affordable Care Act and the indication that new legislation will bring more changes with the new presidency. These factors particularly impact the 'superuser' population, which is a homogenous group of individuals nationwide who rely upon EDs and EMS for their healthcare management. Most often, superusers are male, receiving public benefits, older, and frequently have any combination of psychiatric illness, homelessness, and substance abuse amongst their medical and psychosocial problems.2,3,4,5 The homeless population is affected disproportionately by extreme uncoordinated care, theoretically because of the extreme psychosocial stressors of being homeless, including drug and substance abuse, mental health conditions, and difficult and dangerous living conditions. One of the most flexible proposed solutions to superuser intervention is the use of community healthcare providers who can intersect and impact superusers where they live. This is a particularly powerful form of intervention for the homeless superuser population because they do not keep their appointments at primary care clinics for a variety of reasons: they cannot obtain adequate transportation, they fear law enforcement or social work involvement in their lifestyle choices,...
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