ABSTRACT
Medical field has changed considerably with pressures added on mainly by soaring costs, a decline in the workforce strength and patient expectations. The solution that healthcare systems have come up with is the induction of physician associates (PAs) into the workforce. We aim to compare and contrast PAs with other members of the healthcare teams such as nurses, doctors and assistant physicians to demonstrate the vital role PAs play in the current healthcare environment. With the increased patient load and shrinking medical workforce, there are fears that chronic disease management in primary and secondary care will be threatened. Therefore, health policymakers thought of developing a new mid-level practitioner role (such as PAs, ANPs and APs) that will augment physicians to cater for ever-growing complex medical needs of the patients. The role of PAs is comparable to many healthcare professionals, and one can say that the success of PA programmes has paved the way for the development of different other mid-level practitioner development initiatives. All these roles are there to support primary and secondary care physicians in both inpatient and outpatient settings in helping the patients. PAs are a force multiplier within the healthcare sector and can be seen as a valid solution to staff shortages faced by the healthcare systems around the world. We recommend further studies looking into different aspects of the role of a PA that could further provide our readers with clarity with regard to PAs.
ABSTRACT
BACKGROUND: Atrial fibrillation, a progressively rising global health problem, is also rising in Hemophiliacs due to an increase in life expectancy in them. While treating Hemophiliacs with AF, deciding eligibility, choosing the anticoagulant based on risk-benefit ratio are tough decisions for physicians to make. This review paper aims to explore and compare existing studies, reviews and consensus papers to assess the safety of different Novel Oral Anticoagulants (NOACS) in this population. METHODS: Thorough literature search was conducted on Pubmed using Atrial Fibrillation, Hemophilia A, Oral anticoagulants, stroke prevention, Dabigatran, factor Xa inhibitors as keywords separately and in combinations. Papers in English language only from the past 5 years were selected for review. After removing duplicate results, 80 papers were selected and after applying different exclusion criteria and according to relevance, 40 papers were finalized for review. RESULTS: The keywords AF, Stroke prevention, oral anticoagulants, Hemophilia a, Factor Xa inhibitors and Dabigatran gave 24899, 13619, 8964, 3503, 2850, 2799 results, respectively. Combination keywords also showed some papers and out of short-listed 80 relevant papers 35 were finalized. Reviewing and analyzing these papers revealed no clinical trials in hemophiliacs with AF in the past 5 years and 5 clinical trials comparing NOACs with Warfarin in general population. Rest were systematic reviews, consensus papers and meta-analyses on management in this group. A few compared these drugs for AF in the general population but not specifically in Hemophiliacs and others. consensus papers developed suggestions for management and showed that NOACs are superior to Warfarin but need individual evaluation in Hemophiliacs with AF. CONCLUSIONS: Patients with Hemophilia can also have thrombo-embolism despite their bleeding tendency and NOACs are a better option in them because of less need for monitoring, no food interactions and fewer drug interactions. This comparative review emphasized the need for more work to develop proper guidelines for thrombo-prophylaxis management in this specific group.
