Task shifting in primary care to tackle healthcare worker shortages: An umbrella review

Abstract

Background: Task shifting is an approach to help address the shortage of healthcare workers through reallocating human resources but its impact on primary care is unclear.

Objectives: To provide an overview of reviews describing task shifts from physicians to allied healthcare workers in primary care and its impact on clinical outcomes.

Methods: Six electronic databases were searched up to 15 December 2020, to identify reviews describing task shifting in primary care. Two reviewers independently screened the references for relevant studies, extracted the data and assessed the methodological quality of included reviews using AMSTAR-2.

Results: Twenty-one reviews that described task shifting in primary care were included. Task shifted include provision of care for people with chronic conditions, medication prescribing, and health education. We found that task shifting could potentially improve several health outcomes such as blood pressure, HbA1c, and mental health while achieving cost savings. Key elements for successful implementation of task shifting include collaboration among all parties, a system for coordinated care, provider empowerment, patient preference, shared decision making, training and competency, supportive organisation system, clear process outcome, and financing.

Conclusion: Evidence suggests that allied healthcare workers such as pharmacists and nurses can potentially undertake substantially expanded roles to support physicians in primary care in response to the changing health service demand. Tasks include providing care to patients, independent prescribing, counselling and education, with comparable quality of care.

Keywords: Umbrella review; barriers and facilitators; health care organisation and systems; primary care; task shift.

Figure 1.

Study identified and included into the current review.

Figure 2.

Elements for successful task shift.