Nurses as substitutes for doctors in primary care
Citation: Laurant M, van der Biezen M, Wijers N, et al. Nurses as substitutes for doctors in primary care. Cochrane Database of Systematic Reviews 2018; (7): CD001271
What is this? The COVID-19 pandemic is placing a great strain on health systems and healthcare workers. One way to ease this may be to move the care of some patient groups from more specialised to less specialised health workers, for instance by moving certain tasks from doctors to nurses.
In this Cochrane systematic review, the authors searched for randomised trials evaluating the effects of nurses substituting for doctors. They did their most recent search in March 2017, and identified 17 trials from high-income countries and one trial from a middle-income country. A summary of this review is available here. There is also a linked Cochrane Review of qualitative evidence for factors influencing the implementation of nurses substituting for doctors. A summary of the implementation considerations identified is available here.
What works: Delivery of primary healthcare services by nurses instead of doctors probably leads to similar or better patient health and higher patient satisfaction.
Nurses probably have longer consultations with patients.
Using nurses instead of doctors makes little or no difference in the numbers of prescriptions and tests ordered.
What doesn’t work: Nothing noted.
What’s uncertain: The effects of using nurses instead of doctors on the amount of information offered to patients, the extent to which guidelines are followed and the costs of health care are uncertain.
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