Physician substitution by mid-level providers in primary healthcare for older people and long-term care facilities: protocol for a systematic literature review

Marleen H Lovink; Anke Persoon; Anneke J A H van Vught; Raymond T C M Koopmans; Lisette Schoonhoven; Miranda G H Laurant

doi:10.1111/jan.12759

Physician substitution by mid-level providers in primary healthcare for older people and long-term care facilities: protocol for a systematic literature review

J Adv Nurs. 2015 Dec;71(12):2998-3005. doi: 10.1111/jan.12759. Epub 2015 Sep 18.

Authors

Marleen H Lovink¹, Anke Persoon¹, Anneke J A H van Vught², Raymond T C M Koopmans^{1

3}, Lisette Schoonhoven^{1

4}, Miranda G H Laurant^{1

2}

Affiliations

¹ Radboud university medical center, Nijmegen, The Netherlands.
² HAN University of Applied Sciences, Nijmegen, The Netherlands.
³ Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands.
⁴ University of Southampton, UK.

PMID: 26383740
DOI: 10.1111/jan.12759

Abstract

Aim: 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.

Design: 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.

Discussion: 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.

Keywords: long-term care facilities; nurse practitioner; physician assistant; physician substitution; primary healthcare for older people; systematic review.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Female
Homes for the Aged / organization & administration*
Humans
Long-Term Care / organization & administration*
Male
Netherlands
Nurse Practitioners / organization & administration*
Nursing Homes / organization & administration*
Physician Assistants / organization & administration*
Physicians / organization & administration*
Primary Health Care / organization & administration*
Systematic Reviews as Topic