Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study

Maier, Claudia B.; Aiken, Linda H.

doi:10.1093/eurpub/ckw098

Cited by 290 publications

(281 citation statements)

References 18 publications

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“…This is a global trend in many countries where the doctor-nurse relationship is consistently changing, and it has been identified by WHO (2007) as a strategy to alleviate progressive shortages of physicians, to improve the quality and efficiency of healthcare systems and to reduce the increasing costs of public health. Recent studies (Maier, 2015;Maier & Aiken, 2016;Martínez-González et al, 2014) show that in many Organization for Economic Cooperation and Development (OECD) countries, such as the United States, Australia, Canada, England, Finland, and Netherlands, there is a tendency toward extensive task-shifting from physicians to nurses in the field of primary care, supported by different national regulatory reforms. However, even in this setting, the Italian case shows a delay in professional change, highlighting the strength of the medical profession in maintaining its professional boundaries in all workplace settings (Toth, 2015).…”

Section: Professional Paths and Institutional Constraintsmentioning

confidence: 99%

Professionalization without Autonomy: The Italian Case of Building the Nursing Profession

Sena

2017

P&P

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Abstract:The nursing professionalization is still a work in progress, especially because forms of medical dominance and conflicts with other health professions often undermine its professional autonomy. This article contributes to the understanding of the relationship between professionalization and autonomy building in the health professions by presenting the case of Italian nursing, where medical dominance, supported by the legal system, is the main factor preventing nursing from achieving professional autonomy. The work aims particularly to understand how professionalization and professional autonomy can follow two parallel and sometimes opposite paths toward building the nursing profession, and the role of academic knowledge and specialized roles to legitimize and strengthen professional autonomy. The analysis draws on the literature addressing professionalization, professional autonomy, and medical dominance, as well as various sources on Italian nursing. They include national legislation, research literature, and national sociological surveys on Italian nurses.

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Section: Professional Paths and Institutional Constraintsmentioning

confidence: 99%

Professionalization without Autonomy: The Italian Case of Building the Nursing Profession

Sena

2017

P&P

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“…The nurse practitioner (aka advance practice nurse) movement is underway in at least a dozen countries. [71] One argument is that PAs may not be needed if the NP movement continues to grow. The counter-argument is that the opportunity cost of PA education is allopathic in orientation, and considerably less expensive than what it takes to first produce an RN and then an NP.…”

Section: Adopters Of Pa Developmentmentioning

confidence: 99%

Determinants of the physician assistant/associate concept in global health systems

Cawley

Hooker

2018

IJH

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Introduction: A global shortage of doctors has led to strategies to improve access to care. The physician assistant/associate (PA) was established in North America and Africa in the 1960s in response to medical shortages. PA activity was cataloged to understand what determines their utilization in a country’s health system.Methods: A mixed-method study design began with searching the available literature regarding the development of PAs worldwide. Key words included “physician assistants”, “non-physicians”, “physician associates”, and “advanced practice providers”. Additional data was through an online search of reports; personal communications with researchers, policymakers, government officials, and practitioners in each country; visits by the authors to a number of the countries; and a review of official documents. In each country interviews included educators, policymakers and government officials who had direct involvement with the introduction of the PA concept, and clinically active PAs. Domain analyses were based on stratification of differences among countries: global region, income, physician to population ratio, attitudes of medical professionals, and practice/regulatory authority. Countries were segmented into two categories: well resourced and less well resourced.Results: The history and status of the PA concept into the health systems of 15 states were reviewed. The determinants for the successful incorporation of PAs include prevailing medical needs, a shortage of physicians or an aging physician workforce; support and sponsorship by physician organizations and government agencies; the ability to mobilize and establish a legal and regulatory framework to accommodate PAs; and evidence that their introduction is acceptable to patients, physicians, and other health professionals.Discussion: The introduction of PAs into health systems occurs because their education is less expensive and time intensive than physicians. In addition, graduates are more likely to occupy roles where there is scarcity of doctors such as in rural and underserved areas. In most instances, a physician-dependent role permits their introduction into health systems in a non-threatening manner to doctors and their practices. The utilization of PAs, particularly in primary healthcare roles, increases access to services, is cost-beneficial, and shows a physician-equivalent quality of care.Conclusion: The PA has been a remarkable health workforce policy development that has spread among countries’ health systems and is likely to continue.

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“…Although Brazil seems to stick to old-fashioned, early-20 th century practices, there is good recent international evidence for task-shifting of activities from physicians to nurses. 5 Please, Mr. Doria, read this carefully.…”

Section: Faculdade De Medicina Da Universidade De São Paulo (Fmusp) mentioning

confidence: 99%

Wealth inequality and weak primary care in the city of São Paulo: ingredients for a dysfunctional and ineffective healthcare system

Olmos

2018

Sao Paulo Med. J.

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Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study

Cited by 290 publications

References 18 publications

Professionalization without Autonomy: The Italian Case of Building the Nursing Profession

Professionalization without Autonomy: The Italian Case of Building the Nursing Profession

Determinants of the physician assistant/associate concept in global health systems

Wealth inequality and weak primary care in the city of São Paulo: ingredients for a dysfunctional and ineffective healthcare system

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