Substitution of doctors by nurses in primary care

Laurant, Miranda; Reeves, David; Hermens, Rosella; Braspenning, Jose; Grol, Richard; Sibbald, Bonnie

doi:10.1002/14651858.cd001271.pub2

Cited by 489 publications

(202 citation statements)

References 62 publications

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“…In the majority of previous studies on LBP, however, personal patient information has been provided by a physician. In some other fields of medicine, self-care has also been promoted by a nurse or other healthcare professional without losing the effectiveness of the intervention (35,36). We included employees who were generally healthy and able to continue working.…”

Section: Strengths and Weaknesses Of The Studymentioning

confidence: 99%

Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial

Rantonen¹,

Vehtari²,

Karppinen³

et al. 2013

Scand J Work Environ Health

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Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial by Rantonen J, Vehtari A, Karppinen J, Luoto S, Viikari-Juntura E, Hupli M, Malmivaara A, Taimela S Respondents with mild LB symptoms were randomized into the Back Book (control) Back Book+Advice (intervention) groups. Both occupational health (OH) interventions were effective, but supplementary oral information was not more effective compared to the booklet alone. Policy implications: Patient advice is important in the OH setting, but we need more evidence of the effectiveness of various types of information. Original article Scand J Work Environ Health. 2014;40(2):156-166. doi:10.5271/sjweh.3398 Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial by Jarmo Rantonen, MD, 1 Aki Vehtari, DrTech, 2 Jaro Karppinen, MD, PhD,1, 4 Satu Luoto, MD, PhD, MD, PhD, 1 Markku Hupli, MD, PhD, 3 Antti Malmivaara, MD, PhD, 5 Simo Taimela, MD, PhD 6,7 Rantonen J, Vehtari A, Karppinen J, Luoto S, Viikari-Juntura E, Hupli M, Malmivaara A, Taimela S. Face-to-face information combined with a booklet versus a booklet alone for treating mild low-back pain: a randomized controlled trial. Scand J Work Environ Health. 2014;40(2):156-166, doi:10.5271/sjweh.3398 AffiliationObjective The aim of this study was to determine the effectiveness of face-to-face information for the treatment of mild low-back pain (LBP) in an occupational health (OH) setting. MethodsWe conducted a 48-month randomized controlled trial (RCT) with two 1:1 allocated parallel groups of forestry company employees. Eligibility criteria included permanent employment, age <57 years, and mild LBP [visual analogue scale (VAS) 10-34 mm] in a survey. The intervention group received the Back Book, an information booklet on how to manage LBP, with an additional face-to-face review of the booklet by an OH nurse. The control group received the booklet only. Primary outcomes were physical impairment (Roland-Morris 18-item (RM-18) Disability Questionnaire), LBP (VAS 100 mm), health-related quality of life [15-dimensional quality of life (15-D)] during two years and sickness absence (SA) up to four years. Participants were assigned using block randomization with a computer-generated scheme. ResultsThe RCT comprised 181 participants (72% male, mean age 44 years). There were no differences between the treatment arms in any of the primary outcomes at any time point. At 24 months, the mean group differences (intervention versus control) were: RM-18: 0 [95% confidence interval (95% CI) -1-1], VAS: 3 mm (95% CI -3-8), and 15-D 0.00 (95% CI -0.02-0.02). The difference in cumulative sickness absence days at 48 months were -3 (95% CI -28-21) for total and 1 (95% CI -3-5) for LBP specific sick leaves. Exploratory analysis revealed no differences at subgroup-levels either.Conclusions Face-to-face patient information by an OH nurse in addition to a booklet was not more eff...

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Section: Strengths and Weaknesses Of The Studymentioning

confidence: 99%

Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial

Rantonen¹,

Vehtari²,

Karppinen³

et al. 2013

Scand J Work Environ Health

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“…Compared with patients who received enhanced usual care, patients under the care of the NP/CHW teams had significantly greater improvements in clinical health outcomes and perceptions of the quality of their care [27] . A systematic review comparing care provided by nurses and primary care doctors in primary care settings (i.e., not limited to CHCs) found no differences in patient health outcomes or processes of care, although nurses spent more time with patients [28] .…”

Section: Figure 2 Chcs That Offer and Would Like To Expand Nursing Hmentioning

confidence: 99%

An adequate nursing workforce is essential to health centers and their expected growth under health reform

Shin

Sharac

2013

JNEP

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Community health centers serve as an important source of care to a patient population of 20.2 million patients that is largely low-income and insured by Medicaid or uninsured. The Patient Protection and Affordable Care Act (ACA) allocated $11 billion in funds through 2015 to community health centers (CHCs) to grow their capacity. Nurses are essential to the ability of CHCs to provide care to a patient population at higher risk for chronic health problems. This article draws on federal CHC staffing data and CHC growth estimates to examine the nursing workforce challenges that will need to be overcome in delivering care to 20 million new patients.

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“…Non-doctors can lead 70% of consultations and much PHC can be nurse-led, with doctors as consultants in their own organisations. 10 However, there appeared to be reluctance to change roles and concerns about whether this would be effective. There were obvious concerns about the supply of human resources, especially PHC-trained nurses, with competition from government.…”

Section: Improved Managementmentioning

confidence: 99%

“…GPs will require innovative thinking concerning organisational changes to build economies of scale. 9,10 There were innovative suggestions around virtual practices and multidisciplinary teams as potentially more valuable than doctor practice groups.…”

Section: Improved Managementmentioning

confidence: 99%

Introducing a national health insurance system in South Africa: A general practitioner’s bottom-up approach to costing

2012

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Substitution of doctors by nurses in primary care

Cited by 489 publications

References 62 publications

Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial

Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial

An adequate nursing workforce is essential to health centers and their expected growth under health reform

Introducing a national health insurance system in South Africa: A general practitioner’s bottom-up approach to costing

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