Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 2;19(1):51.
doi: 10.1186/s12875-018-0746-1.

Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study

Marleen H Lovink  1 , Anneke J A H van Vught  2 , Anke Persoon  3 , Lisette Schoonhoven  4   5 , Raymond T C M Koopmans  3   6 , Miranda G H Laurant  4   2
Affiliations

Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study

Marleen H Lovink et al. BMC Fam Pract. .

Abstract

Background: More 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.

Methods: In 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.

Results: In 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.

Conclusions: The 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.

Keywords: Nurse practitioner; Older people; Physician assistant; Primary healthcare; Qualitative research; Skill mix change.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The research ethics committee of the region Arnhem Nijmegen in the Netherlands concluded that this study did not fall within the scope of the Medical Research Involving Human Subjects Act (WMO) (registration number 2014/298). Written informed consent was obtained from all interviewees.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. World Health Organization. World report on ageing and health. 2015. Available at: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811_eng.pdf?.... Accessed 2 May 2016.
    1. Pavolini E, Ranci C. Restructuring the welfare state: reforms in long-term care in western European countries. J Eur Soc Policy. 2008;18(3):246–259. doi: 10.1177/0958928708091058. - DOI
    1. Petterson SM, Liaw WR, Phillips RL, Jr, Rabin DL, Meyers DS, Bazemore AW. Projecting US primary care physician workforce needs: 2010–2025. Ann Fam Med. 2012;10(6):503–509. doi: 10.1370/afm.1431. - DOI - PMC - PubMed
    1. Robbins TD, Crocker-Buque T, Forrester-Paton C, Cantlay A, Gladman JR, Gordon AL. Geriatrics is rewarding but lacks earning potential and prestige: responses from the national medical student survey of attitudes to and perceptions of geriatric medicine. Age Ageing. 2011;40(3):405–408. doi: 10.1093/ageing/afr034. - DOI - PubMed
    1. Vergouw D, Heiligers PJ, Batenburg RS. Keuzemonitor Geneeskunde (choice monitor medicine; report in Dutch) Nivel: Utrecht; 2015.

Publication types