General medical services by non-medical health professionals: a systematic quantitative review of economic evaluations in primary care

Abstract

BackgroundPrevious systematic reviews have found that nurses and pharmacists can provide equivalent, or higher, quality of care for some tasks performed by GPs in primary care. There is a lack of economic evidence for this substitution.AimTo explore the costs and outcomes of role substitution between GPs and nurses, pharmacists, and allied health professionals in primary care.Design and settingA systematic review of economic evaluations exploring role substitution of allied health professionals in primary care was conducted. Role substitution was defined as ‘the substitution of work that was previously completed by a GP in the past and is now completed by a nurse or allied health professional’.MethodThe following databases were searched: Ovid MEDLINE, CINAHL, Cochrane Library, National Institute for Health and Care Excellence (NICE), and the Centre for Reviews and Dissemination. The review followed guidance from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).ResultsSix economic evaluations were identified. There was some limited evidence that nurse-led care for common minor health problems was cost-effective compared with GP care, and that nurse-led interventions for chronic fatigue syndrome and pharmacy-led services for the medicines management of coronary heart disease and chronic pain were not. In South Korea, community health practitioners delivered primary care services for half the cost of physicians. The review did not identify studies for other allied health professionals such as physiotherapists and occupational therapists.ConclusionThere is limited economic evidence for role substitution in primary care; more economic evaluations are needed.

Physiotherapist and Podiatrist Independent Prescribing in the United Kingdom: A quasi experimental study

“…There is increasing emphasis on establishing systems, rather than single episodes of care, that dissolve traditional boundaries (96,97) to support the increasing number of people with long-term conditions. There is limited evidence available with which to compare our study findings (32,41,51,52,91). Despite positive findings that NMP is safe, and provides beneficial clinical outcomes (32,34,79), the impact on the health economy, as reported in two recent systematic reviews examining clinical and cost effectiveness, remains unclear (51,52,91).…”

“…There is limited evidence available with which to compare our study findings (32,41,51,52,91). Despite positive findings that NMP is safe, and provides beneficial clinical outcomes (32,34,79), the impact on the health economy, as reported in two recent systematic reviews examining clinical and cost effectiveness, remains unclear (51,52,91). The authors, as in this study, highlight the difficulty in separating NMP effects from the contributions of healthcare team members, and a lack of adequately powered randomised controlled trials examining NMP across clinical specialities, professions and settings (31,51).…”

“…Whilst PP-SP helps streamline service delivery (44,45), IP is expected to bring additional benefits in line with nurse and pharmacist prescribing (46,47). Exploration of clinical and cost effectiveness in this area is however limited and has to date lead to inconclusive findings (48)(49)(50)(51)(52)(53). As most evidence relates to nurses and pharmacists, it is important to evaluate the impact of prescribing by allied health professionals (AHPs) in order to inform commissioning and implementation of NMP services where they are beneficial.…”

A Comparative Case Study of Prescribing and Non-Prescribing Physiotherapists and Podiatrists

“…There is limited evidence available with which to compare our study ndings (32,41,51,52,85). Despite positive ndings that NMP is safe, and provides bene cial clinical outcomes (32,34,62), the impact on the health economy, as reported in two recent systematic reviews examining clinical and cost effectiveness, remains unclear (51,52,85). The authors, as in this study, highlight the di culty in separating NMP effects from the contributions of healthcare team members, and a lack of adequately powered randomised controlled trials examining NMP across clinical specialities, professions and settings (31,51).…”

“…Whilst PP-SP helps streamline service delivery (44,45), IP is expected to bring additional bene ts in line with nurse and pharmacist prescribing (46,47). Exploration of clinical and cost effectiveness in this area is however limited and has to date lead to inconclusive ndings (48)(49)(50)(51)(52)(53). As most evidence relates to nurses and pharmacists, it is important to evaluate the impact of prescribing by allied health professionals (AHPs) in order to inform commissioning and implementation of NMP services where they are bene cial.…”