Task shifting in primary care to tackle healthcare worker shortages: An umbrella review

Abstract

Background Task shifting is an approach to help address the shortage of healthcare workers through reallocating human resources but its impact on primary care is unclear. Objectives To provide an overview of reviews describing task shifts from physicians to allied healthcare workers in primary care and its impact on clinical outcomes. Methods Six electronic databases were searched up to 15 December 2020, to identify reviews describing task shifting in primary care. Two reviewers independently screened the references for relevant studies, extracted the data and assessed the methodological quality of included reviews using AMSTAR-2. Results Twenty-one reviews that described task shifting in primary care were included. Task shifted include provision of care for people with chronic conditions, medication prescribing, and health education. We found that task shifting could potentially improve several health outcomes such as blood pressure, HbA1c, and mental health while achieving cost savings. Key elements for successful implementation of task shifting include collaboration among all parties, a system for coordinated care, provider empowerment, patient preference, shared decision making, training and competency, supportive organisation system, clear process outcome, and financing. Conclusion Evidence suggests that allied healthcare workers such as pharmacists and nurses can potentially undertake substantially expanded roles to support physicians in primary care in response to the changing health service demand. Tasks include providing care to patients, independent prescribing, counselling and education, with comparable quality of care.

“Just give them a choice”: Patients' perspectives on starting medications for opioid use disorder in the ED

“…Some of our findings triangulated the known literature and recently reported clinicians' perspectives. Most participants did not know buprenorphine could be prescribed from the ED—likely because the vast majority of patients are not offered it 10,35 . Participants felt clinicians needed more training and EDs needed to have mechanisms in place to assure smooth follow‐up—barriers clinicians have endorsed in previous studies 14,15,17–19 .…”

“…Most participants did not know buprenorphine could be prescribed from the ED-likely because the vast majority of patients are not offered it. 10,35 Participants felt clinicians needed more training and EDs needed to have mechanisms in place to assure smooth follow-up-barriers clinicians have endorsed in previous studies. 14,15,[17][18][19] Clinicians have noted concerns about diversion, and patients noted this as well.…”

Brief on Primary Care Part 3: Lessons Learned for Strengthened Primary Care in the Next Phase of the COVID-19 Pandemic

“…Creative approaches such as task shifting are needed in primary care teams to preserve skilled professionals for work in which their higher skills are needed. 19 For example, non-clinical staff in primary care settings could be used to both reduce administrative burden on PCCs, 20 and support care reconnection due to pandemic disruptions. 21 Further, community-embedded workers (such as community ambassadors and community health workers) can support culturally safe practices and/or address social needs that impact health; 22 other roles such as health promoters/ health prevention practitioners can build on pandemic outreach strategies.…”

“…23 Evidence suggests potential cost-effectiveness of these new roles in primary care delivery. 19 However, further study is needed in Ontario, as these creative approaches to staffing are likely best suited to models in which care can be meaningfully aligned with the needs of the community, and managed through rostering or attachment to primary care teams. Community engagement in developing expanded primary care teams might be fruitful.…”

“…2 Since HHR challenges will require a long time horizon to fully address, creative approaches to task shifting and sharing will be necessary. 19 More regulated health professionals, such as nurse practitioners, nurses, pharmacists, mental health workers, and physician assistants with expertise in primary care, will be needed. In addition, creative approaches to team extension across geography will be necessary.…”