title: Physician substitution by mid-level providers in primary healthcare for older people and long-term care facilities: protocol for a systematic literature review.
abstract: OBJECTIVE
  This protocol describes a systematic review that evaluates the effects of physician substitution by mid-level providers (nurse practitioners, physician assistants or nurses) in primary healthcare for older people and long-term care facilities. The secondary aim is to describe facilitators and barriers to the implementation of physician substitution in these settings.
  
  
  BACKGROUND
  Healthcare for older people is undergoing major changes, due to population ageing and reforms that shift care to the community. Besides, relatively few medical students are pursuing careers in healthcare for older people. Innovative solutions are needed to guarantee the quality of healthcare and to contain costs. A solution might be shifting care from physicians to mid-level providers. To date, no systematic review on this topic exits to guide policymaking.
  
  
  METHODS
  A quantitative systematic literature review using Cochrane methods.
  
  
  METHODS
  The following databases will be searched for original research studies that quantitatively compare care provided by a physician to the same care provided by a mid-level provider: PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL and Web of Science. Study selection, data extraction and quality appraisal will be conducted independently by two reviewers. Data synthesis will consist of a qualitative analysis of the data. Funding of the review was confirmed in August 2013 by the Ministry of Health, Welfare and Sport of the Netherlands.
  
  
  CONCLUSIONS
  This review will contribute to the knowledge on effects of physician substitution in healthcare for older people and factors that influence the outcomes. This knowledge will guide professionals and policy administrators in their decisions to optimize healthcare for older people.
authors.affiliation: Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Marleen H
authors.initials: MH
authors.lastname: Lovink
authors.affiliation: Radboud university medical center, Nijmegen, The Netherlands.
authors.forename: Anke
authors.initials: A
authors.lastname: Persoon
authors.affiliation: HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Anneke J A H
authors.initials: AJ
authors.lastname: van Vught
authors.affiliation: Radboud university medical center, Nijmegen, The Netherlands.|Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands.
authors.forename: Raymond T C M
authors.initials: RT
authors.lastname: Koopmans
authors.affiliation: Radboud university medical center, Nijmegen, The Netherlands.|University of Southampton, UK.
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.affiliation: Radboud university medical center, Nijmegen, The Netherlands.|HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors.forename: Miranda G H
authors.initials: MG
authors.lastname: Laurant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration*; D008297:Male; D009426:Netherlands; D009722:Nurse Practitioners / Q000458:organization & administration*; D009735:Nursing Homes / Q000458:organization & administration*; D010823:Physician Assistants / Q000458:organization & administration*; D010820:Physicians / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D000078202:Systematic Reviews as Topic
keywords: long-term care facilities; nurse practitioner; physician assistant; physician substitution; primary healthcare for older people; systematic review