Substituting nurses, nurse practitioners or physician assistants for physicians in long-term care facilities can lead to better care for older patients

Lovink MH, Persoon A, Koopmans RTCM, et al.  Effets de la substitution des infirmières praticiennes, des assistants médicaux ou des infirmières aux médecins concernant les soins de santé pour le vieillissement de la population: une revue systématique de la littérature  J Adv Nurs. 2017 Mar.

Review question

• What are the effects of substituting nurses, nurse practitioners or physician assistants for physicians in long-term care facilities, specifically for the aging population?

Background

• With a quickly aging population, careful consideration must be given to how the healthcare system will adapt to this issue.

• Quite often, nurses, nurse practitioners or physician assistants can substitute for or supplement the services provided by physicians. The benefits of this are reduced costs for the healthcare system, as well as more comprehensive care for the patient.

• Some research has demonstrated that substitution can be effective, but this hasnÕt been demonstrated for the care of older adults specifically. This review sought to explore the effects of this substitution primarily for an aging population.

How the review was done

• A detailed search of six electronic databases for studies published up to August 2015 was conducted. Studies that focused on patients aged 65 or older in long-term care facilities where there was one of the substitutes mentioned were included in the review.

• A total of 19,991 studies were identified in searches, and 28 were included in the review after assessments for eligibility.

• The authors received funding from the Ministry of Health, Welfare and Sport of the Netherlands.

What the researchers found

• In terms of patient outcomes, the review found that substituting nurses, nurse practitioners, or physician assistants for physicians in long-term healthcare settings can result in care that is equal to, and sometimes better than, care provided by physicians.

• Inconclusive evidence was reported regarding the cost-effectiveness of the approach.

• Implementation of the substitution process remains complex, and a number of social, organizational and individual factors must be considered for successful implementation.

Conclusion

• Overall, it was found that substituting nurses, nurse practitioners, or physician assistants for physicians results in comparable (and sometimes better) patient outcomes when compared to care provided by physicians. The evidence regarding the cost-effectiveness of this approach is unclear, and more research may be required to investigate this, as well as to consolidate the findings of the review.