The impact of physician–nurse task shifting in primary care on the course of disease: a systematic review

Abstract

BackgroundPhysician–nurse task shifting in primary care appeals greatly to health policymakers. It promises to address workforce shortages and demands of high-quality, affordable care in the healthcare systems of many countries. This systematic review was conducted to assess the evidence about physician–nurse task shifting in primary care in relation to the course of disease and nurses’ roles.MethodsWe searched MEDLINE, Embase, The Cochrane Library and CINAHL, up to August 2012, and the reference list of included studies and relevant reviews. All searches were updated in February 2014. We selected and critically appraised published randomized controlled trials (RCTs).ResultsTwelve RCTs comprising 22 617 randomized patients conducted mainly in Europe met the inclusion criteria. Nurse-led care was delivered mainly by nurse practitioners following structured protocols and validated instruments in most studies. Twenty-five unique disease-specific measures of the course of disease were reported in the 12 RCTs. While most (84 %) study estimates showed no significant differences between nurse-led care and physician-led care, nurses achieved better outcomes in the secondary prevention of heart disease and a greater positive effect in managing dyspepsia and at lowering cardiovascular risk in diabetic patients. The studies were generally small, of varying follow-up episodes and were at risk of biases. Descriptive details about roles, qualifications or interventions were also incomplete or not reported.ConclusionTrained nurses may have the ability to achieve outcome results that are at least similar to physicians’ for managing the course of disease, when following structured protocols and validated instruments. The evidence, however, is limited by a small number of studies reporting a broad range of disease-specific outcomes; low reporting standards of interventions, roles and clinicians’ characteristics, skills and qualifications; and the quality of studies. More rigorous studies using validated tools could clarify these findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-015-0049-8) contains supplementary material, which is available to authorized users.

Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries

“…Task shifting can produce equivalent or superior outcomes for many diseases and health interventions including non-communicable diseases [5], HIV/AIDS [6, 7], contraceptive distribution [8], and others [5, 9]. …”

The role of physician oversight on advanced practice nurses’ professional autonomy and empowerment

“…One solution for this shortage of providers has been the development and increased utilization of nonphysician PCPs such as advanced practice registered nurses (APRNs; Maier, 2015;Pulcini, Jelic, Gul, & Yuen, 2010;Sheer & Wong, 2008). Evidence demonstrates that APRNs who practice as independent care providers are producing similar patient outcomes to primary care physicians (Fund & Swanson-Hill, 2014;Horrocks, Anderson, & Salisbury, 2002;Laurant et al, 2009;Martinez-Gonzalez, Tandjung, Djalali, & Roseman, 2015;Newhouse et al, 2011). Consequently, researchers and policymakers alike have been advocating for the expanded practice and autonomy of APRNs to assume an enhanced role in health care.…”

Integration of nurses in general practice: A thematic synthesis of the perspectives of general practitioners, practice nurses and patients living with chronic illness

“…• This paper deepens our understanding of traditional role concepts legal frameworks and reimbursement schemes as limiting barriers to a more integrated interprofessional collaboration which is required by current and future challenges in primary health care workload, decreases healthcare costs, improves satisfaction of both patient and healthcare provider (HCP) and provides equivalent or improved quality of care (Gielen, Dekker, Francke, Mistiaen, & Kroezen, 2014;Laurant et al, 2018;Martínez-González et al, 2014;Martínez-González, Tandjung, Djalali, & Rosemann, 2015;Parker, Maresco-Pennisi, Clifton, Shams, & Young, 2016;Riisgaard, Nexoe, Le, Sondergaard, & Ledderer, 2016;Watts & Lucatorto, 2014).…”

“…Nevertheless, a better understanding of the potential contribution of nurses working in general practice is needed (Ball, Maben, & Griffiths, ). Research has demonstrated that this task shift generates similar or better health outcomes for a broad range of patient conditions, relieves the GP’s workload, decreases healthcare costs, improves satisfaction of both patient and healthcare provider (HCP) and provides equivalent or improved quality of care (Gielen, Dekker, Francke, Mistiaen, & Kroezen, ; Laurant et al, ; Martínez‐González et al, ; Martínez‐González, Tandjung, Djalali, & Rosemann, ; Parker, Maresco‐Pennisi, Clifton, Shams, & Young, ; Riisgaard, Nexoe, Le, Sondergaard, & Ledderer, ; Watts & Lucatorto, ). A recent overview of systematic reviews by Matthys Remmen, & Van Bogaert, () demonstrated that collaboration between physicians and nurses may have a positive impact on a range of patient outcomes and on a variety of pathologies when embedded within integrated interprofessional collaboration care models with adequately educated nurses (Matthys et al, ).…”