Abstract
BackgroundWorkforce 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.ResultsForty-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.ConclusionWhen 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.
Highlights
Workforce shortages in Australia are occurring across a range of health disciplines but are most acute in general practice
The substitution of doctors by nurses was effective in disease management and health promotion for older people with chronic disease but the vote-counting method of analysis does not permit an estimate of the effect size
In the current policy environment the results of this review provide health service providers, managers and policy-makers with evidence to support the role of the multidisciplinary team and task substitution in the management of people with chronic disease in primary care
Summary
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. In Australia, workforce shortages are occurring across a range of health disciplines, including general practitioners and practice nurses. Most sectors of the healthcare workforce are affected but it is acute in primary care [4,5]. These shortages are occurring against a background of an ageing population with an increasing prevalence of chronic disease and higher consumer expectation [5]
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