wow-inequalities/02-data/intermediate/wos_sample/2bb33674c6159b5fac783118713c3006-karimi-shahanjarini/info.yaml

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abstract: 'Background
Having nurses take on tasks that are typically conducted by doctors
(doctor-nurse substitution, a form of `task-shifting'') may help to
address doctor shortages and reduce doctors'' workload and human resource
costs. A Cochrane Review of effectiveness studies suggested that
nurse-led care probably leads to similar healthcare outcomes as care
delivered by doctors. This finding highlights the need to explore the
factors that affect the implementation of strategies to substitute
doctors with nurses in primary care. In our qualitative evidence
synthesis (QES), we focused on studies of nurses taking on tasks that
are typically conducted by doctors working in primary care, including
substituting doctors with nurses or expanding nurses'' roles.
Objectives
(1) To identify factors influencing implementation of interventions to
substitute doctors with nurses in primary care. (2) To explore how our
synthesis findings related to, and helped to explain, the findings of
the Cochrane intervention review of the effectiveness of substituting
doctors with nurses. (3) To identify hypotheses for subgroup analyses
for future updates of the Cochrane intervention review.
Search methods
We searchedCINAHL and PubMed, contacted experts in the field, scanned
the reference lists of relevant studies and conducted forward citation
searches for key articles in the Social Science Citation Index and
Science Citation Index databases, and `related article'' searches in
PubMed.
Selection criteria
We constructed a maximum variation sample (exploring variables such as
country level of development, aspects of care covered and the types of
participants) from studies that had collected and analysed qualitative
data related to the factors influencing implementation of doctor-nurse
substitution and the expansion of nurses'' tasks in community or primary
care worldwide. We included perspectives of doctors, nurses, patients
and their families/carers, policymakers, programme managers, other
health workers and any others directly involved in or affected by the
substitution. We excluded studies that collected data using qualitative
methods but did not analyse the data qualitatively.
Data collection and analysis
We identified factors influencing implementation of doctor-nurse
substitution strategies using a framework thematic synthesis approach.
Two review authors independently assessed the methodological strengths
and limitations of included studies using a modified Critical Appraisal
Skills Programme (CASP) tool. We assessed confidence in the evidence for
the QES findings using the GRADE-CERQual approach. We integrated our
findings with the evidence fromthe effectiveness review of doctor-nurse
substitution using amatrixmodel. Finally, we identified hypotheses for
subgroup analyses for updates of the review of effectiveness.
Main results
We included 66 studies (69 papers), 11 from low-or middle-income
countries and 55 from high-income countries. These studies found several
factors that appeared to influence the implementation of doctor-nurse
substitution strategies. The following factors were based on findings
that we assessed as moderate or high confidence. Patients in many
studies knew little about nurses'' roles and the difference between
nurse-led and doctor-led care. They also had mixed views about the type
of tasks that nurses should deliver. They preferred doctors when the
tasks were more ` medical'' but accepted nurses for preventive care and
follow-ups. Doctors in most studies also preferred that nurses performed
only ` non-medical'' tasks. Nurses were comfortable with, and believed
they were competent to deliver a wide range of tasks, but particularly
emphasised tasks that were more health promotive/ preventive in nature.
Patients in most studies thought that nurses were more easily accessible
than doctors. Doctors and nurses also saw nurse-doctor substitution and
collaboration as a way of increasing people''s access to care, and
improving the quality and continuity of care. Nurses thought that close
doctor-nurse relationships and doctor''s trust in and acceptance of
nurses was important for shaping their roles. But nurses working alone
sometimes found it difficult to communicate with doctors. Nurses felt
they had gained new skills when taking on new tasks. But nurses wanted
more and better training. They thought this would increase their skills,
job satisfaction and motivation, and would make them more independent.
Nurses taking on doctors'' tasks saw this as an opportunity to develop
personally, to gain more respect and to improve the quality of care they
could offer to patients. Better working conditions and financial
incentives also motivated nurses to take on new tasks. Doctors valued
collaborating with nurses when this reduced their own workload. Doctors
and nurses pointed to the importance of having access to resources, such
as enough staff, equipment and supplies; good referral systems;
experienced leaders; clear roles; and adequate training and supervision.
But they often had problems with these issues. They also pointed to the
huge number of documents they needed to complete when tasks were moved
from doctors to nurses.
Authors'' conclusions
Patients, doctors and nurses may accept the use of nurses to deliver
services that are usually delivered by doctors. But this is likely to
depend on the type of services. Nurses taking on extra tasks want
respect and collaboration from doctors; as well as proper resources;
good referral systems; experienced leaders; clear roles; and adequate
incentives, training and supervision. However, these needs are not
always met.'
affiliation: 'Shakibazadeh, E (Corresponding Author), Univ Tehran Med Sci, Dept Hlth
Educ \& Hlth Promot, Tehran, Iran.
Karimi-Shahanjarini, Akram, Hamadan Univ Med Sci, Dept Publ Hlth, Hamadan, Iran.
Karimi-Shahanjarini, Akram, Hamadan Univ Med Sci, Social Determinants Hlth Res Ctr,
Hamadan, Iran.
Shakibazadeh, Elham, Univ Tehran Med Sci, Dept Hlth Educ \& Hlth Promot, Tehran,
Iran.
Rashidian, Arash, Univ Tehran Med Sci, Sch Publ Hlth, Dept Hlth Management \& Econ,
Tehran, Iran.
Hajimiri, Khadijeh, Zanjan Univ Med Sci, Sch Publ Hlth, Dept Hlth Educ \& Hlth Promot,
Zanjan, Iran.
Glenton, Claire; Lewin, Simon, Norwegian Inst Publ Hlth, Oslo, Norway.
Noyes, Jane, Bangor Univ, Ctr Hlth Related Res, Bangor, Gwynedd, Wales.
Lewin, Simon, South African Med Res Council, Hlth Syst Res Unit, Tygerberg, South
Africa.
Laurant, Miranda, Radboud Univ Nijmegen, Med Ctr, IQ Healthcare, Radboud Inst Hlth
Sci, Nijmegen, Netherlands.
Laurant, Miranda, HAN Univ Appl Sci, Inst Nursing Studies, Nijmegen, Netherlands.
Colvin, Christopher J., Univ Cape Town, Sch Publ Hlth \& Family Med, Div Social
\& Behav Sci, Cape Town, South Africa.'
article-number: CD010412
author: Karimi-Shahanjarini, Akram and Shakibazadeh, Elham and Rashidian, Arash and
Hajimiri, Khadijeh and Glenton, Claire and Noyes, Jane and Lewin, Simon and Laurant,
Miranda and Colvin, Christopher J.
author-email: shakibazadeh@tums.ac.ir
author_list:
- family: Karimi-Shahanjarini
given: Akram
- family: Shakibazadeh
given: Elham
- family: Rashidian
given: Arash
- family: Hajimiri
given: Khadijeh
- family: Glenton
given: Claire
- family: Noyes
given: Jane
- family: Lewin
given: Simon
- family: Laurant
given: Miranda
- family: Colvin
given: Christopher J.
da: '2023-09-28'
doi: 10.1002/14651858.CD010412.pub2
eissn: 1361-6137
files: []
issn: 1469-493X
journal: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
keywords-plus: 'PRIMARY-HEALTH-CARE; RANDOMIZED CONTROLLED-TRIAL; ADVANCED PRACTICE
NURSES; MENTAL-HEALTH; GENERAL-PRACTICE; PATIENTS EXPERIENCES;
SELF-MANAGEMENT; DIABETES CARE; NURSING ROLES; TELEPHONE CONSULTATION'
language: English
number: '4'
number-of-cited-references: '231'
orcid-numbers: 'Colvin, Christopher/0000-0002-8930-7863
Glenton, Claire/0000-0002-7558-7737
Karimi, Akram/0000-0002-2453-1389
Shakibazadeh, Elham/0000-0002-1320-2133
Laurant, Miranda/0000-0002-8826-3352'
papis_id: ba970c8fdbfb4b734ff25635f4fdbc04
ref: Karimishahanjarini2019barriersfacilitators
researcherid-numbers: 'Colvin, Christopher/AAB-8276-2019
Colvin, Christopher/AAQ-1607-2021
Glenton, Claire/GSE-3606-2022
Karimi, Akram/AAA-5080-2021
Shakibazadeh, Elham/X-6430-2018
Rashidian, Arash/E-5061-2011
Laurant, Miranda/H-6488-2015'
tags:
- review
times-cited: '54'
title: 'Barriers and facilitators to the implementation of doctornurse substitution
strategies in primary care: a qualitative evidence synthesis'
2023-10-01 08:15:07 +00:00
type: article
2023-09-28 14:46:10 +00:00
unique-id: WOS:000466276500002
usage-count-last-180-days: '3'
usage-count-since-2013: '35'
web-of-science-categories: Medicine, General \& Internal
year: '2019'