ArticleBMC family practice2018
Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study.
Article in BMC family practice, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.
- 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
- Views of Advanced Nurse Practitioners on Their Roles and Responsibilities in Community Care for Home-Dwelling Patients: A Qualitative Descriptive Study.Nursing open · 2026Article
- Examples of Systemic Solutions for Skill-Mix Issues-An Analysis of International Experiences with a Focus on Rural Areas.Healthcare (Basel, Switzerland) · 2026Review
- Task sharing for the management of non-communicable diseases in a humanitarian setting: An innovative approach in a low-middle income country (LMIC).Public health in practice (Oxford, England) · 2025Article
- Patients' experience of integrated nursing care in general practices in Switzerland: a mixed-methods study.Family practice · 2025Article
- The patient experience of skill mix changes in primary care: an in-depth study of patient 'work' when accessing primary care.Journal of public health (Oxford, England) · 2023Article
- Patient perspective on task shifting from general practitioners to medical practice assistants - a quantitative survey in Germany.BMC primary care · 2023Article
- The added value of the nurse practitioner: An evolutionary concept analysis.Nursing open · 2023Article
- Evaluating task shifting to the clinical technologist in Dutch healthcare: A mixed methods study.PloS one · 2023Article
- Role dimensions of practice nurses and interest in introducing advanced nurse practitioners in general practice in Ireland.Health science reports · 2022Article
- Barriers and facilitators to the implementation of nurse's role in primary care settings: an integrative review.BMC nursing · 2021Article
- Complexity as a factor for task allocation among general practitioners and nurse practitioners: a narrative review.BMC family practice · 2020Review
- Advanced practice nurses' and general practitioners' first experiences with introducing the advanced practice nurse role to Swiss primary care: a qualitative study.BMC family practice · 2019Article
- Skill mix change between physicians, nurse practitioners, physician assistants, and nurses in nursing homes: A qualitative study.Nursing & health sciences · 2019Article
- Association Between Clinician Specialization in Nursing Home Care and Nursing Home Clinical Quality Scores.Journal of the American Medical Directors Association · 2019Article
- General practice in UK newspapers: an empirical analysis of over 400 articles.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMore and more older adults desire to and are enabled to grow old in their own home, regardless of their physical and mental capabilities. This change, together with the growing number of older adults, increases the demand for general practitioners (GPs). However, care for older people lacks prestige among medical students and few medical students are interested in a career in care for older people. Innovative solutions are needed to reduce the demand for GPs, to guarantee quality of healthcare and to contain costs. A solution might be found in skill mix change by introducing nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs). The aim of this study was to describe how skill mix change is organised in daily practice, what influences it and what the effects are of introducing NPs, PAs or RNs into primary healthcare for older people.
methodsIn total, 34 care providers working in primary healthcare in the Netherlands were interviewed: GPs (n = 9), NPs (n = 10), PAs (n = 5) and RNs (n = 10). Five focus groups and 14 individual interviews were conducted. Analysis consisted of open coding, creating categories and abstraction.
resultsIn most cases, healthcare for older people was only a small part of the tasks of NPs, PAs and RNs; they did not solely focus on older people. The tasks they performed and their responsibilities in healthcare for older people differed between, as well as within, professions. Although the interviewees debated the usefulness of proactive structural screening on frailty in the older population, when implemented, it was also unclear who should perform the geriatric assessment. Interviewees considered NPs, PAs and RNs an added value, and it was stated that the role of the GP changed with the introduction of NPs, PAs or RNs.
conclusionsThe roles and responsibilities of NPs, PAs and RNs for the care of older people living at home are still not established. Nonetheless, these examples show the potential of these professionals. The establishment of a clear vision on primary healthcare for older people, including the organisation of proactive healthcare, is necessary to optimise the impact of skill mix change.
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Registered trials
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