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Task shifting from general practitioners to nurses and the association with patient flow and resource use in
Katrine Bjørnshave Bomholt1,2,3, Mette Amalie Nebsbjerg1,2,4, Claus Høstrup Vestergaard1
1Research Unit for General Practice, Aarhus, Denmark.
Background:
This study aims to describe patterns of patient flow and resource use in out-of-hours (OOH-PC) clinics with high versus low levels of task shifting from general practitioners (GPs) to nurses.
Methods:
This descriptive register-based study used data from OOH-PC clinics in the Central Denmark Region. Clinics with high levels of task shifting had nurses independently managing pa-tients with minor conditions, whereas in clinics with low levels of task shifting nurses mainly per-formed preparatory tasks. Measures of patient flow included GP time per contact, initial and total waiting time, contact time with a health professional, and treatment time. Resource use measures in-cluded diagnostic tests, X-rays, injury-related procedures, prescriptions, hospital referrals, and fol-low-up contacts.
Results:
A total of 451,714 contacts were included. The proportion of contacts independently man-aged by nurses was 4% in clinics with low task shifting and 20% in clinics with high task shifting. Clinics with low task shifting had more GP time per contact (median 8 minutes [IQR 5-11] vs. 6 minutes [IQR 2-11]) and longer total waiting time (31 minutes [IQR 14-52] vs. 26 minutes [IQR 11-49]) than clinics with high task shifting. Median contact time (8 minutes) was similar across clin-ic types. Rates of diagnostic testing, X-ray referrals, prescriptions, and follow-up contacts were comparable.
Conclusions:
This study indicates that OOH-PC clinics with high levels of task shifting release more GP time and reduce waiting times while maintaining similar consultation lengths and overall resource use.
Clinical Trial Number:
Not applicable.
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