title: What evidence is there to support skill mix changes between GPs, pharmacists and practice nurses in the care of elderly people living in the community?
abstract: BACKGROUND
  Workforce shortages in Australia are occurring across a range of health disciplines but are most acute in general practice. Skill mix change such as task substitution is one solution to workforce shortages. The aim of this systematic review was to explore the evidence for the effectiveness of task substitution between GPs and pharmacists and GPs and nurses for the care of older people with chronic disease. Published, peer reviewed (black) and non-peer reviewed (grey) literature were included in the review if they met the inclusion criteria.
  
  
  RESULTS
  Forty-six articles were included in the review. Task substitution between pharmacists and GPs and nurses and GPs resulted in an improved process of care and patient outcomes, such as improved disease control. The interventions were either health promotion or disease management according to guidelines or use of protocols, or a mixture of both. The results of this review indicate that pharmacists and nurses can effectively provide disease management and/or health promotion for older people with chronic disease in primary care. While there were improvements in patient outcomes no reduction in health service use was evident.
  
  
  CONCLUSIONS
  When implementing skill mix changes such as task substitution it is important that the health professionals' roles are complementary otherwise they may simply duplicate the task performed by other health professionals. This has implications for the way in which multidisciplinary teams are organised in initiatives such as the GP Super Clinics.
authors.affiliation: Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dennis
authors.affiliation: University Department of Rural Health (UDRH), University of Newcastle, Locked Bag 9783, New England Mail Sorting Centre, NSW, 2348, Australia.
authors.forename: Jenny
authors.initials: J
authors.lastname: May
authors.affiliation: Broken Hill University Department of Rural Health, University of Sydney, PO Box 457, Broken Hill, NSW, 2880, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Perkins
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Zwar
authors.affiliation: National Primary Care Research and Development Centre (NPCRDC), University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Sibbald
authors.affiliation: Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
authors.forename: Iqbal
authors.initials: I
authors.lastname: Hasan