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

Martínez-González NA, Tandjung R, Djalali S, Rosemann T - Hum Resour Health (2015)

Bottom Line: Trained 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.

View Article: PubMed Central - PubMed

Affiliation: Institute of Primary Care, University of Zurich, University Hospital of Zurich, Pestalozzistrasse 24, CH-8091, Zurich, Switzerland. Nahara.Martinez@usz.ch.

ABSTRACT

Background: Physician-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.

Methods: We 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).

Results: Twelve 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.

Conclusion: Trained 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.

No MeSH data available.


Related in: MedlinePlus

Illustration of the study selection process
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
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Fig1: Illustration of the study selection process

Mentions: Figure 1 shows the flow of study selection. Our literature searches identified 4 589 original records. Based on screening of titles and abstracts, 268 records were eligible for detailed examination of full-text publications; 44 of these were relevant for appraisal, but we excluded 27 for the reasons provided in Additional file 3. Twelve RCTs reported in 17 publications [18–34] met the inclusion criteria.Fig. 1


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

Martínez-González NA, Tandjung R, Djalali S, Rosemann T - Hum Resour Health (2015)

Illustration of the study selection process
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4493821&req=5

Fig1: Illustration of the study selection process
Mentions: Figure 1 shows the flow of study selection. Our literature searches identified 4 589 original records. Based on screening of titles and abstracts, 268 records were eligible for detailed examination of full-text publications; 44 of these were relevant for appraisal, but we excluded 27 for the reasons provided in Additional file 3. Twelve RCTs reported in 17 publications [18–34] met the inclusion criteria.Fig. 1

Bottom Line: Trained 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.

View Article: PubMed Central - PubMed

Affiliation: Institute of Primary Care, University of Zurich, University Hospital of Zurich, Pestalozzistrasse 24, CH-8091, Zurich, Switzerland. Nahara.Martinez@usz.ch.

ABSTRACT

Background: Physician-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.

Methods: We 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).

Results: Twelve 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.

Conclusion: Trained 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.

No MeSH data available.


Related in: MedlinePlus