In June of 1977 a physician's assistant (PA) wa3 placed in the medically underserved, remote co~nunity 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 cormnunity, the quality of medical care delivered, and various

more »

... tics 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) I;.;ras 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 rElte than females. Predicted patterns of future utilization of the remote clinic revealed a growing confidence in the physician's assistant tmvard increased rates of utilization. A Utah Professional R.::::vie~·.7 Organization qual tty-of-care audit revealed that a remote PA using the computerized medical protocol system was capable of rendering qual.ity episodic care for various COTIL.' 1lon disorders such as pharyngitis and otitis media on par with p11ysicians 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 cOlnputer 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 SUcil areas as increased obstetrical care loads and acute problems of the sKin encountered by the remote FA. Other characteristics of the remote practice, such as referral patterns to specialty physicians, reasons for immediate transportation of patients to emergency rooms and tIle frequency of various diagn~stic tests performed by the remote PA vJere examined. Documentation of the utilization of the back-up