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

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'
type: article
unique-id: WOS:000466276500002
usage-count-last-180-days: '3'
usage-count-since-2013: '35'
web-of-science-categories: Medicine, General \& Internal
year: '2019'