title: Task-Shifting From Physicians to Nurses in Primary Care and its Impact on Resource Utilization: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: Task-shifting from physicians to nurses has gained increasing interest in health policy but little is known about its efficiency. This systematic review was conducted to compare resource utilization with task-shifting from physicians to nurses in primary care. Literature searches yielded 4,589 citations. Twenty studies comprising 13,171 participants met the inclusion criteria. Meta-analyses showed nurses had more return consultations and longer consultations than physicians but were similar in their use of referrals, prescriptions, or investigations. The evidence has limitations, but suggests that the effects may be influenced by the utilization of resources, context of care, available guidance, and supervision. Cost data suggest physician-nurse salary and physician's time spent on supervision and delegation are important components of nurse-led care costs. More rigorous research involving a wider range of nurses from many countries is needed reporting detailed accounts of nurses' roles and competencies, qualifications, training, resources, time available for consultations, and all-cause costs.
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Nahara Anani
authors.initials: NA
authors.lastname: Martínez-González
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital of Zurich, Zurich, Switzerland thomas.rosemann@usz.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Sima
authors.initials: S
authors.lastname: Djalali
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Flore
authors.initials: F
authors.lastname: Huber-Geismann
authors.affiliation: Institute of Primary Care, University of Zurich, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Ryan
authors.initials: R
authors.lastname: Tandjung
mesh_terms: D032022:Delegation, Professional; D006291:Health Policy; D006801:Humans; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic
keywords: health care costs; meta-analysis; physician–nurse substitution; physician–nurse task-shifting; resource utilization; systematic review