De impact en organisatie van taakherschikking in de ouderenzorg

Summary

The impact and organization of skill mix change in healthcare for older people. Substituting physicians with nurse practitioners, physician assistants or nurses
Marleen Lovink

AIM: To provide insight into the impact and organization of substituting physicians with nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs) in healthcare for older people.
METHOD: Different methods included a systematic literature study, individual and focus group interviews with professionals in primary healthcare and nursing homes, and a multiple case study skill mix change in nursing homes.
FINDINGS: NPs and PAs are able to substitute physicians largely autonomously while maintaining quality healthcare. RNs do not fulfil medical tasks autonomously, but are able to assist physicians with medical care. NPs, PAs and RNs have an added value as they contribute to quality healthcare, provide personcentred care and strengthen the care team. Substituting physicians with NPs, PA or RNs provides opportunities for physicians to fulfil a more coordinating role and a role as clinical expert.
CONCLUSION and DISCUSSION: Substituting physicians with NPs, PA or RNs is a possible solution for the high workload and shortage of physicians in healthcare for older people. However, a limited focus on substitution does no justice to person-centred care. A vision on how to organize person-centred healthcare for older people should be the starting point of care and this vision should be translated into the most optimal skill mix.

Keywords: Nurse practitioner, nursing homes, physician assistant, primary health care, skill mix change