Substitution of general practitioners by nurse practitioners in out-of-hours primary care home visits: A quasi-experimental study

Smits, Marleen; Peters, Yonne; Ranke, Sander; Plat, Erik; Laurant, Miranda; Giesen, Paul

doi:10.1016/j.ijnurstu.2019.103445

Cited by 7 publications

(15 citation statements)

References 25 publications

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“…The acceptability of nurse-led care was reported in 24 studies (Billington et al, 2015;Carlisle & Warren, 2013;Chin-Quee et al, 2020;Ciemins et al, 2013;Clarke et al, 2020;Delahunty-Pike et al, 2023;Dierick-Van Daele et al, 2009;Everitt-Penhale et al, 2019;Fulcher et al, 2021;Hunkeler et al, 2000;Macduff et al, 2001;Mammen et al, 2020;Mitchell et al, 2016 (Smits et al, 2020). Providers noted a range of benefits to task-sharing models including increased accessibility of services for patients (Chin-Quee et al, 2020).…”

Section: Acceptabilitymentioning

confidence: 99%

Nurse and midwife involvement in task‐sharing and telehealth service delivery models in primary care: A scoping review

Moulton,

Botfield,

Subasinghe

et al. 2024

Journal of Clinical Nursing

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AimTo synthesise and map current evidence on nurse and midwife involvement in task‐sharing service delivery, including both face‐to‐face and telehealth models, in primary care.DesignThis scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews.Data Source/Review MethodsFive databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse‐led models.ResultsOne hundred peer‐reviewed articles (as 99 studies) were deemed eligible for inclusion. Task‐sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse‐led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost‐effective, and increase system efficiencies with supportive training, clinical set‐up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy.ConclusionNurse‐led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task‐sharing models with nurses to be feasible and effective.ImpactNurse‐led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost‐effective. Increased utilisation of nurse‐led models should be considered to address health system challenges and improve access to essential primary healthcare services globally.Reporting MethodThis review is reported against the PRISMA‐ScR criteria.Patient or Public ContributionNo patient or public contribution.Protocol registrationThe study protocol is published in BJGP Open (Moulton et al., 2022).

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Section: Acceptabilitymentioning

confidence: 99%

Nurse and midwife involvement in task‐sharing and telehealth service delivery models in primary care: A scoping review

Moulton,

Botfield,

Subasinghe

et al. 2024

Journal of Clinical Nursing

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“…Although the number of male nurses has risen with time, the pace is not encouraging: their proportion among registered nurses (RNs) has only increased from 8.2% in 2008 to 11.6% in 2020 (Singapore Nursing Board, 2021 ). The phenomenon is also true among Singapore's advanced practice nurses (APNs), who are nursing leaders spearheading patient care with demonstrable clinical contributions (Laurant et al, 2018 ; Smits et al, 2020 ; Woo et al, 2017 ). The proportion of males among APNs remains disproportionately low: they currently account for less than 5% of the APN workforce (Singapore Nursing Board, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Understanding the gender gap in advanced practice nursing: A qualitative study

Woo

Goh

Zhou

2022

J Nursing Management

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Aims: We aim to explore the perceptions of registered nurses undergoing the advanced practice nurse preparatory programme and of advanced practice nurses towards the recruitment of men into the advanced practice nursing workforce.Background: Given the need to expand and diversify the advanced practice nursing workforce, it is important to recognize the potential implications of gender disparity.It is critical to understand why few males are recruited into the advanced practice nursing preparatory programme and to determine whether gender-related bias is present in the professional development of nurses.Method: We use a descriptive qualitative design. Semi-structured interviews were conducted via Zoom (April to August 2021).Results: Three themes were generated: 'The odds are eventually in the favour of men', 'The APN career-track is unpopular among men', and 'Balancing the gender gap in the APN workforce'. All themes are supported by three subthemes.Conclusions: Although males in nursing enjoy opportunistic advantages in entering the advanced practice nursing workforce, they are not interested in the role and not staying long enough in the nursing profession to become advanced practice nurses.Implications for Nursing Management: Nurse managers should be more cognizant of the different social stereotypes faced by males and females in nursing. With such awareness, they can be more supportive and less biased in career counselling and job appraisals.

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“…Earlier studies suggest that NMPs are able to deliver safe and effective care with positive patient-reported outcomes, high satisfaction, and decreased costs. However, there is limited OOH specific evidence [7][8][9] . One UK trial compared in-hours management of same-day requested assessments, including home visits, between GPs and Advanced Nurse Practitioners (ANPs) and found equivalent outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…However, there is limited OOH specific evidence. 9 – 11 One UK trial compared in-hours management of same-day requested assessments, including home visits, between GPs and ANPs and found equivalent outcomes. 10 A Dutch quasi-experimental study examining task-shifting from GPs to nurses in OOH found similar consultation numbers, but a higher medical complexity in patients treated by GPs.…”

Section: Introductionmentioning

confidence: 99%

“… 10 A Dutch quasi-experimental study examining task-shifting from GPs to nurses in OOH found similar consultation numbers, but a higher medical complexity in patients treated by GPs. 12 Along with the acutely unwell and children aged <5 years, there is evidence that more potentially complex patient groups, such as adults aged >65 years and those with chronic diseases from socioeconomically deprived areas, are accessing care in the evenings. 6 While this may partly be owing to barriers to daytime access, there is also a growing culture of 24-hour service demand contributing to OOH service utilisation behaviour.…”

Section: Introductionmentioning

confidence: 99%

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Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies

et al. 2021

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BackgroundThe current GP workforce is insufficient to manage rising demand in patient care within the out-of-hours (OOH) primary care services. To meet this challenge, non-medical practitioners (NMPs) are employed to fulfil tasks traditionally carried out by GPs. It is important to learn from experiences of task-shifting in this setting to inform optimal delivery of care.AimTo synthesise qualitative evidence of experiences of task-shifting in the OOH primary care setting.Design & settingSystematic review of qualitative studies and thematic synthesisMethodElectronic searches were conducted across CINAHL, PsychInfo, Cochrane, Medline, Embase, and OpenGrey for qualitative studies of urgent or OOH primary care services, utilising task-shifting or role delegation. Included articles were quality appraised and key findings collated through thematic synthesis.Results2497 studies were screened, six met the inclusion criteria. These included interviews with 15 Advanced Nurse Practitioners, 3 Physician Assistants, 2 paramedics, and a focus group of 22 GPs and focus groups with 33 nurses. Key findings highlight the importance of clearly defining and communicating the scope of practice of NMPs and of building their confidence by appropriate training, support and mentoring.ConclusionsWhilst NMPs may have the potential to make a substantial contribution to OOH primary care services, there has been very little research on experiences of task-shifting. Evidence to date highlights the need for further training specific to OOH services. Mentorship and support to manage the sometimes-challenging cases presenting to OOH could enable more effective OOH services and better patient care.

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Substitution of general practitioners by nurse practitioners in out-of-hours primary care home visits: A quasi-experimental study

Cited by 7 publications

References 25 publications

Nurse and midwife involvement in task‐sharing and telehealth service delivery models in primary care: A scoping review

Nurse and midwife involvement in task‐sharing and telehealth service delivery models in primary care: A scoping review

Understanding the gender gap in advanced practice nursing: A qualitative study

Experiences of out-of-hours task-shifting from GPs: a systematic review of qualitative studies

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