Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review

Abstract

Aim: To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care.

Design: This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews.

Data source/review methods: Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models.

Results: One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy.

Conclusion: Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective.

Impact: Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally.

Reporting method: This review is reported against the PRISMA-ScR criteria.

Patient or public contribution: No patient or public contribution.

Protocol registration: The study protocol is published in BJGP Open (Moulton et al., 2022).

Keywords: delivery of healthcare; general practice; midwifery; nursing; primary health care; scoping review; task-sharing; telehealth; telemedicine.