SynthesisBMC health services research2014
Substitution of physicians by nurses in primary care: a systematic review and meta-analysis.
Synthesis in BMC health services research, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 113 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
113 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Task shifting from general practitioners to other health professionals in out-of-hours primary care - a systematic literature review on content and quality of task shifting.The European journal of general practice · 2024Pooled it
- Pooled it
- Task shifting in primary care to tackle healthcare worker shortages: An umbrella review.The European journal of general practice · 2021Pooled it
- Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis.The Cochrane database of systematic reviews · 2019Pooled it
- Nurses as substitutes for doctors in primary care.The Cochrane database of systematic reviews · 2018Pooled it
- The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review.Human resources for health · 2017Pooled it
- Pooled it
- Relations between task delegation and job satisfaction in general practice: a systematic literature review.BMC family practice · 2016Pooled it
- Trial
- Task shifting of cardiovascular risk assessment and communication by nurses for primary and secondary prevention of cardiovascular diseases in a tertiary health care setting of Northern India.BMC health services research · 2020Trial
- Trial
- The impact of substituting general practitioners with nurse practitioners on resource use, production and health-care costs during out-of-hours: a quasi-experimental study.BMC family practice · 2016Trial
- Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes by Nurses Is Non-Inferior to Endoscopic Placement by Gastroenterologists: A Multicenter Randomized Controlled Trial.The American journal of gastroenterology · 2016Trial
- Adherence to Competing Strategies for Colorectal Cancer Screening Over 3 Years.The American journal of gastroenterology · 2016Trial
- Task shifting from general practitioners to nurses and the association with patient flow and resource use in out-of-hours primary care clinics: a descriptive register-based study.Scandinavian journal of primary health care · 2026Article
- Effects of a Digital Decision Support System on Diabetes Management in a Real-World Home Care Setting: Prospective Quasi-Experimental Feasibility and Implementation Study.JMIR nursing · 2026Article
- Review
- Collaborative Primary-Care Workforce Models: An Integrative Review of Evidence Informing RN Prescriber Integration with Family Physicians and Nurse Practitioners.Healthcare (Basel, Switzerland) · 2026Review
- Development and validation of a questionnaire measuring healthcare professionals' individual perceptions of advanced practice nurses' contributions to team functioning: a modified international Delphi approach.International journal of nursing studies advances · 2026Article
- The High Cost of American Health Care: Understanding the Deeper Roots of the Crisis.Health care analysis : HCA : journal of health philosophy and policy · 2026Article
53 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn many countries, substitution of physicians by nurses has become common due to the shortage of physicians and the need for high-quality, affordable care, especially for chronic and multi-morbid patients. We examined the evidence on the clinical effectiveness and care costs of physician-nurse substitution in primary care.
methodsWe systematically searched OVID Medline and Embase, The Cochrane Library and CINAHL, up to August 2012; selected and critically appraised published randomised controlled trials (RCTs) that compared nurse-led care with care by primary care physicians on patient satisfaction, Quality of Life (QoL), hospital admission, mortality and costs of healthcare. We assessed the individual study risk of bias, calculated the study-specific and pooled relative risks (RR) or standardised mean differences (SMD); and performed fixed-effects meta-analyses.
results24 RCTs (38,974 participants) and 2 economic studies met the inclusion criteria. Pooled analyses showed higher overall scores of patient satisfaction with nurse-led care (SMD 0.18, 95% CI 0.13 to 0.23), in RCTs of single contact or urgent care, short (less than 6 months) follow-up episodes and in small trials (N ≤ 200). Nurse-led care was effective at reducing the overall risk of hospital admission (RR 0.76, 95% CI 0.64 to 0.91), mortality (RR 0.89, 95% CI 0.84 to 0.96), in RCTs of on-going or non-urgent care, longer (at least 12 months) follow-up episodes and in larger (N > 200) RCTs. Higher quality RCTs (with better allocation concealment and less attrition) showed higher rates of hospital admissions and mortality with nurse-led care albeit less or not significant. The results seemed more consistent across nurse practitioners than with registered or licensed nurses. The effects of nurse-led care on QoL and costs were difficult to interpret due to heterogeneous outcome reporting, valuation of resources and the small number of studies.
conclusionsThe available evidence continues to be limited by the quality of the research considered. Nurse-led care seems to have a positive effect on patient satisfaction, hospital admission and mortality. This important finding should be confirmed and the determinants of this effect should be assessed in further, larger and more methodically rigorous research.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.