Kolokium Penolong Pegawai Perubatan Pahang 2018, IIUM, Kuantan Pahang, 28 April 2018
Perbandingan dengan paramedical practitioners di luar negara
Dr Alias Mahmud, PhD Senior Lecturer Department of Emergency Medicine Medical Faculty, UKM Medical Centre Kuala Lumpur
Apakah Paramedical Practitioners ?
The Paramedical Practitioners (WHO ISCO CODE: 2240) Paramedical Practitioners
Physician Assistant USA UK AUS CANADA NETHERLANDS OTHERS
Paramedic (Primary Care, Advanced Care) USA UK AUS CANADA NETHERLANDS OTHERS
Assistant Medical Officer
Medical Feldsher
Malaysia Tanzania Sri Langka
Russia and other former USSR countries
• Menyediakan khidmat nasihat, diagnostik, rawatan dan pencegahan yang lebih terhad dalam skop dan kerumitan daripada apa yang dilakukan oleh doktor • Mereka bekerja secara autonomi atau dengan pengawasan yang terhad daripada doktor. • Melaksanakan prosedur klinikal, terapeutik dan pembedahan untuk merawat dan mencegah penyakit, kecederaan, dan gangguan fizikal atau mental kepada komuniti tertentu.
Source: Classification of health workforce statistics, WHO, Geneva)
Daripada video tersebut, pada pandangan anda adakah terdapat persamaan dengan Profesion PPP?
SEJARAH 1786 - Diperkenalkan oleh kepada Syarikat Hindia Timur di Pulau Pinang 1823 - Bertugas di PP, Melaka dan Singapura (NNS) - Sub Assistant Surgeon - Apotekari/ P. Apotekari - Dresser 1963 - Dikenali sebagai Pembantu Rumah Sakit 1970 – Hospital Assistant (HA) 1985 – Pembantu Perubatan 2007 - Penolong Pegawai Perubatan
1965 – Dr Eugene A. Stead • • • •
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Duke University, North Carolina, USA Kekurangan Physician Awalnya khusus utk lelaki (military corpsman) Berkembang dengan pesat – beberapa negara menggunakan model PA USA (Kanada, Australia, UK, Belanda dll). Jumlah PA di USA (2017) -123,000
1969 - 1st paramedic program 1970s - NREMT 1977 - National Standard Curriculum • Tahap EMS • Emergency Medical Responder (EMR) • Emergency Medical Technician (EMT) (EMT-B) • Advanced EMT (AEMT) (EMT-I) • Paramedic • Jumlah EMS Professionals di USA (2011) - 826,111
1956 – American Association OF Medical Assistant (AAMA) 1962 - The certifying Board for CMAs 1973 – Curriculum Review Board 2008 – CMA (AAMA) • Jumlah MA in USA (2017) – 525, 805
Penolong Pegawai Perubatan
Penolong Pegawai Perubatan Peranan di Perubatan AMO GENERALIST
AMO SPECIALIST
HIGH TECH PROCEDURES (SUBJECT MATTER EXPERT/TECHNICAL EXPERT)
BASIC PROCEDURES
• • • • • • • • •
Criteria • Pos Basic/Advanced Dip • Credentialed • Degree/Master • Kursus Dalam Negara/Luar Negara • Pengalaman (5 – 10 Tahun )
Emergency – Emergency Tech Pre Hospital Care – Phc Tech Cardiothorasic - Cardioperfusionist Cardiology - Cardiotech Nephrology – Renal Perfusionist Neurophysiology –Neurophysiology Tech Orthopedics - Orthotech Forensic – Forensic Tech And Others
Bilangan PPP: 15, 602 (Health Facts, 2017) Sumber: Pelan Pembangunan Profesion PPP 2016-2030, LPP (2017)
Penolong Pegawai Perubatan Peranan di Kesihatan Awam SCREENING –to prevent and promote (AMO GENERALIST) 1. Triaging 2. Screening
CLINICAL PROCEDURES (AMO SPECIALIST) 1. 2. 3. 4. 5. 6.
Pre Hospital Care Wound care ECHO Cardiography Ultrasound Funduscope and others
OUTREACH PROGRAM PROVIDER (AMO SPECIALIST)
WELLNESS PROGRAM MANAGER (AMO SPECIALIST) • Coordinates Wellness Programs SPECIFIC ROLES • NCD Educator – Clinic level • Care Coordinator – Pre Clinic level (Wellness focus services) e.g. 1 PPP covers 300-500 people in a district)
Sumber: Pelan Pembangunan Profesion PPP 2016-2030, LPP (2017)
Extend health care in rural and Sub urban/urban areas 1. 2. 3. 4.
Bed ridden patients Psychiatric Palliative care Procedures • Catheterization • Ryles tube • Chronic Dressing 5. And Others
Penolong Pegawai Perubatan Latihan
PhD Master Degree
Diploma
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DMA DMHS
36 bulan
PB Cert/ Advanced Diploma • • • • • •
ADEC ADRC ADHM ADCV ADIC Lain2
6-12 bulan
• • Pre Registration Degree • EMED (UKM) • BMHS (OUM) • BSCH (UMS) Related Degree (10)
18-48 bulan
•
MS (PH) (UKM) MSDM (UTM/UPM/ UTM/UUM) Lain2
12-36 bulan
Bidang Berkaitan dengan PPP
30-60 bulan
Physician Assistant (PA)
Physician Assistant (PA) PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal healthcare provider. (AAPA, 2017)
‘…a new healthcare professional who, while not a doctor, works to the medical model, with the attitudes, skills and knowledge base to deliver holistic care and treatment within the general medical and/or general practice team under defined levels of supervision’. (The Department of Health, England, 2017)
What do PAs do?
• Take medical histories • Conduct physical exams • Diagnose and treat illness • Order and interpret tests • Develop treatment plans • Prescribe medication • Counsel on preventive care • Perform procedures • Assist in surgery • Make rounds in hospitals and nursing homes • Do clinical research
Physician Assistant - USA
Source: https://www.aapa.org
Physician Assistant - USA
Source: https://www.aapa.org
Population Statistics
Source: Global Health Workforce and Physician Assistants, GHEC. https://www.cugh.org/
Source: Global Health Workforce and Physician Assistants, GHEC. https://www.cugh.org/
Paramedic
Netherlands
USA
Australia
Canada
United Kingdom
Paramedic
What is Paramedic?
A paramedics paraprofessional whose primary focus is to provide advanced emergency medical care for critical and emergency patients who access Emergency Medical Services (EMS). (USA Paramedic)
A paramedic is an autonomous practitioner who has the knowledge, skills and clinical expertise to assess, treat, diagnose, supply and administer medicines, manage, discharge and refer patients in a range of urgent, emergency, critical or out of hospital settings. (UK Paramedic)
A Paramedic is a health professional who provides rapid response, emergency medical assessment, treatment and care in the out of hospital environment (Paramedics Australasia, 2016).
Paramedic Level & Training (USA) EMR
• Formerly First Responder • Provide Basic Care
EMT
• Formerly EMT-B • Primary Provider level in EMS
AEMT
• Formerly EMT-I • Some Advanced Procedures
Paramedic
• Highest level – perform advanced procedures • Independently but under guidance of physician
Paramedic Level & Training (USA)
Paramedic Skills by certification level
National EMS Scope Of Practice Model, National Highway Traffic Safety Administration (NHTSA), (2007)
Paramedic Skills by certification level
National EMS Scope Of Practice Model, National Highway Traffic Safety Administration (NHTSA), (2007)
Paramedic
Role definitions (Paramedic UK) Specialist Paramedic A specialist paramedic is a paramedic who has undertaken, or is working towards a post-graduate diploma (PGDip) in a subject relevant to their practice. They will have acquired and continue to demonstrate an enhanced knowledge base, complex decision making skills, competence and judgement in their area of specialist practice.
PhD MSc PGCert/ BSc. PGDip
Advanced Paramedic An advanced paramedic is an experienced paramedic who has undertaken, or is working towards a master’s degree in a subject relevant to their practice. They will have acquired and continue to demonstrate an expert knowledge base, complex decision making skills, competence and judgement in their area of advanced practice. A consultant paramedic is a paramedic who is working towards or has completed a PhD clinical/professional doctorate and applies a highly developed theoretical and practical knowledge over a wide range of clinical, scientific, technical and/or management functions, which include; clinical/professional leadership; expert practice; policy and service development, research and evaluation; and education and professional development.
Paramedics Career Framework, NHS Health Education England
Paramedic
MIH-CP is an innovative and evolving model of community-based healthcare designed to provide more effective and efficient services at a lower cost. MIH-CP allows paramedics to function outside their traditional emergency response and transport roles to help facilitate more appropriate use of emergency care resources while enhancing access to primary care for medically underserved populations. MIH-CP intended to serve a range of patients in the out-of hospital setting by providing needs-based at-home integrated acute care, chronic care and prevention services.
Medical Assistant (USA)
Medical Assistant (USA) What is Medical Assistant? A Medical Assistant (MA) is an integral member of the health care delivery team, qualified by Education and experience to work in the administrative office, the examination room and the physician Office laboratory.
Job Descriptions
Medical Assistant (USA)
Medical Assistant (USA) Training of Medical Assistant Medical Terminology • • • • • •
Basic word structure Suffixes and Prefixes Organization of the body Body system Diagnostic test and procedures Common abbreviations and symbols
An Introduction to Medical Office Assisting • • • • • • • •
A brief history of medicine Allied Health Professionals Clinical Essentials Professional traits and Qualities Medical Law and Medical Ethics Legal Documents and HIPAA General Ethical considerations Daily duties and receptionist duties • Managing the work day • Telephone guidelines and written communication • Handing the office mail.
Medical Assistant (USA)
Medical Assistant (USA) MA Certification CMA (AAMA) credential designates a MA who has achieved certification through the Certifying Board of the American Association of Medical Assistants (AAMA). RMA (Registered MA): Medical Assistant certified under American Medical Technologists (AMT). AMT is a nationally and internationally recognized certification agency and membership society for the following allied health professionals: CCMA (Certified Clinical Medical Assistants). Certified under National Health Career Association (NHA). NHA is a national professional certification agency for healthcare workers in the United States. Granting credentials in more than 8 allied health specialties, it is an organizational member of the National Organization for Competency Assurance (NOCA). NCMA (National Certified MA). The National Center for Competency Testing (NCCT) is an independent credentialing organization that has tested healthcare professionals and instructors throughout the United States.
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Clinical Roles •
Take medical histories
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Conduct physical exams
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Order and interpret tests
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Prescribe medication
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Administrating medications
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Perform procedures
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Assist in surgery
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Make rounds in hospitals and nursing homes
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Non Clinical Roles •
Scheduling Appointment
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Managing Medical Record
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Billing & insurance
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Managing finances
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Administrative
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Qualifications
Dip/Bach
Bach/Master
Cert/Dip/Bach
Cert/Dip
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Curriculum model
Medical
Medical
Paramedic
Vocational
KESIMPULAN • Profession PPP mempunyai persamaan peranan dengan PA terutama PPP yang mempunyai diploma lanjutan/ijazah/sarjana dalam bidang sub kepakaran. • Profesion PPP juga mempunyai peranan yang sama paramedik terutama dalam perkhidmatan pra hospital dan ambulan. • Profesion Medical Assistant di AS mempunyai peranan yang lebih rendah dibandingkan dengan profesion PPP.
CADANGAN • Selaras dengan hala tuju PPP, jaringan kerjasama di peringkat antara bangsa perlu digerakkan. Kerjasama meliputi bidang pendidikan, klinikal dan penyelidikan. • Kurikulum program PPP perlu di’mapping’ kan dengan program PA / paramedik di luar negara supaya pengiktirafan / pemindahan kredit boleh dilaksanakan. • Cadangan model profesion PPP seperti dicadangkan di bawah:
Cadangan Model Profesion PPP Medical Assistant Medical Assistant Act ACT 180
By Profession: Medical Assistant
Recognised programme By MAB
Physician Assistant In Hospital & Community Health
By Name: AMO PA Paramedic Clinical Tech Others
Paramedic Associate MA Pre-Hospital Care and Ambulance Services
MIH-CP Training
EMT AHC
Sekian, Terima Kasih
[email protected] [email protected]
University of Dundee Scotland, 2010
