Broadening the scope of task shifting in the organisation of healthcare

Tuyl, Lilian H D van; Vrijhoef, Hubertus; Laurant, Miranda; Bont, Antoinette de; Batenburg, Ronald

doi:10.1177/20534345211039988

Cited by 11 publications

(8 citation statements)

References 15 publications

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“…Within countries, task shifting is more prevalent in practices with an innovating attitude, with more support staff and among GPs who work less hours and older GPs. Given the importance of task shifting and its potential for innovation (Van Tuyl et al, 2021), we recommend an assessment of changes in this area in the countries studied in a new survey.…”

Section: Discussionmentioning

confidence: 99%

Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries

Groenewegen

Boerma

Spreeuwenberg

et al. 2022

Prim Health Care Res Dev

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Aim: To describe variation in task shifting from GPs to practice assistants/nurses in 34 countries and to explain differences by analysing associations with characteristics of the GPs and their practices and features of the health care systems. Background: Redistribution of tasks and responsibilities in primary care are driven by changes in demand, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill-mix of primary care teams. These developments are hampered by barriers between professional domains. Methods: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7,200 general practitioners (GPs) in 34 countries. Task shifting is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are as follows: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are as follows: demand for and supply of care, nurse prescribing, and professionalisation of practice assistants/nurses. Multilevel analysis is used to account for clustering of GPs in countries. Findings: Countries vary in the degree of task shifting. Regarding GP and practice characteristics, use of electronic health records and availability of support staff in the practice are positively associated with task shifting and GPs’ working hours negatively, in line with our hypotheses. Age of the GPs is, contrary to our hypothesis, positively related to task shifting. These variables explain 11% of the variance at GP level. Two country variables are related to task shifting: a lower percentage of practices without support staff in a country and nurse prescribing rights coincide with more task shifting. The percentage of practices without support staff has the strongest relationship, explaining 73% of the country variation.

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Section: Discussionmentioning

confidence: 99%

Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries

Groenewegen

Boerma

Spreeuwenberg

et al. 2022

Prim Health Care Res Dev

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“…roles of PAs and NPs. 2,3 This interest centers on the economic theory that productivity gains could be achieved by altering the labor inputs used in the healthcare sector. 4 The economics of PA and NP employment in the VHA is an element of growing human resource interest.…”

Section: Original Researchmentioning

confidence: 99%

“…Such undertaking occurs in an era characterized by high US healthcare spending and inadequate health outcomes. Our aim was to explore productivity in the vertically integrated healthcare system of the VHA and in the broadening the roles of PAs and NPs 2,3. This interest centers on the economic theory that productivity gains could be achieved by altering the labor inputs used in the healthcare sector 4…”

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confidence: 99%

Assessing the productivity of PAs and NPs

Stefos

Moran

Poe

et al. 2022

Jaapa

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The improvement of healthcare efficiency and productivity is of international interest. Following an expansion phase of physician associate/assistant (PA) and NPs employment, the Department of Veterans Affairs (VA) assessed how and where they were being used. Using data from 134 VA medical centers, annual productivity was examined across 30 medical and surgical specialties spanning primary care, mental health, and surgery. PA productivity differences averaged 82 relative value units per full-time employee per year more than NPs, a difference of 4%. In general, PAs were found in higher productivity ranges than NP counterparts. PAs and NPs have statistically similar productivity levels in primary care and mental health. In specialty medicine and surgery, PAs average higher annual productivity than NPs. This analysis provides some utility for managers regarding workforce composition, given the relative productivity of two types of clinicians.

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“…9 Task shifting of various roles and activities to PAs and NPs has become an increasingly used strategy to manage busy primary care practices. 10 We sought to determine the extent to which FPs performed CAFM-recommended procedures for a Medicare patient cohort and to set the stage for modeling primary care. By documenting the procedural clinical activity of FPs, our goal was to better understand its effect on American primary care and society.…”

Section: Introductionmentioning

confidence: 99%

Family Physicians as Proceduralists for Medicare Recipients

McKenna,

Hooker,

Christian

2024

Ann Fam Med

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PURPOSE Procedures are manual technical skills clinicians perform for their patients. Family physicians (FPs) acquire these skills during residency; most are undertaken in outpatient settings. We performed a retrospective observational cohort study to describe the extent to which FPs perform the core procedures recommended by the Council of Academic Family Medicine (CAFM) and how this might have changed over time. METHODSThe CAFM recommended a list of procedures all FP residents should perform competently after graduation. We modified this list for Medicare beneficiaries to enable matching with Current Procedural Terminology codes. We probed Medicare Part B databases for modified CAFM procedure claims submitted by FPs in 2021 and how these claims changed from 2014 to 2021. RESULTSIn 2021, there were 904,278 modified CAFM procedures filed by 9,410 FPs in the outpatient setting. All procedures were clustered with respect to organ system (eg, musculoskeletal, skin, pulmonary). Beginning in 2014 and continuously through 2021, there was a 33% decrease in outpatient procedures filed and a 36% decrease in the number of FPs filing them.CONCLUSIONS Office-based procedures are integral to a primary care physician's role, although the activity is rarely analyzed. At a time when the Medicare population is growing, the number of available FPs and the number of procedures they perform are not. This decrease might result from the changing scope of FP practice, new referral patterns, task shifting, and/or increased delegation to physician associates and nurse practitioners.

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Broadening the scope of task shifting in the organisation of healthcare

Cited by 11 publications

References 15 publications

Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries

Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries

Assessing the productivity of PAs and NPs

Family Physicians as Proceduralists for Medicare Recipients

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