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Moulton JE, Botfield JR, Subasinghe AK, Withanage NN, Mazza D. Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review. J Clin Nurs 2024; 33:2971-3017. [PMID: 38500016 DOI: 10.1111/jocn.17106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
AIM To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care. DESIGN This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. DATA SOURCE/REVIEW METHODS Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models. RESULTS One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy. CONCLUSION Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective. IMPACT Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally. REPORTING METHOD This review is reported against the PRISMA-ScR criteria. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION The study protocol is published in BJGP Open (Moulton et al., 2022).
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Affiliation(s)
- Jessica E Moulton
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
- Family Planning NSW, Sydney, New South Wales, Australia
| | - Asvini K Subasinghe
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Nishadi Nethmini Withanage
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Notting Hill, Victoria, Australia
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Okpechi IG, Chukwuonye II, Ekrikpo U, Noubiap JJ, Raji YR, Adeshina Y, Ajayi S, Barday Z, Chetty M, Davidson B, Effa E, Fagbemi S, George C, Kengne AP, Jones ESW, Liman H, Makusidi M, Muhammad H, Mbah I, Ndlovu K, Ngaruiya G, Okwuonu C, Samuel-Okpechi U, Tannor EK, Ulasi I, Umar Z, Wearne N, Bello AK. Task shifting roles, interventions and outcomes for kidney and cardiovascular health service delivery among African populations: a scoping review. BMC Health Serv Res 2023; 23:446. [PMID: 37147670 PMCID: PMC10163711 DOI: 10.1186/s12913-023-09416-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 04/18/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Human resources for health (HRH) shortages are a major limitation to equitable access to healthcare. African countries have the most severe shortage of HRH in the world despite rising communicable and non-communicable disease (NCD) burden. Task shifting provides an opportunity to fill the gaps in HRH shortage in Africa. The aim of this scoping review is to evaluate task shifting roles, interventions and outcomes for addressing kidney and cardiovascular (CV) health problems in African populations. METHODS We conducted this scoping review to answer the question: "what are the roles, interventions and outcomes of task shifting strategies for CV and kidney health in Africa?" Eligible studies were selected after searching MEDLINE (Ovid), Embase (Ovid), CINAHL, ISI Web of Science, and Africa journal online (AJOL). We analyzed the data descriptively. RESULTS Thirty-three studies, conducted in 10 African countries (South Africa, Nigeria, Ghana, Kenya, Cameroon, Democratic Republic of Congo, Ethiopia, Malawi, Rwanda, and Uganda) were eligible for inclusion. There were few randomized controlled trials (n = 6; 18.2%), and tasks were mostly shifted for hypertension (n = 27; 81.8%) than for diabetes (n = 16; 48.5%). More tasks were shifted to nurses (n = 19; 57.6%) than pharmacists (n = 6; 18.2%) or community health workers (n = 5; 15.2%). Across all studies, the most common role played by HRH in task shifting was for treatment and adherence (n = 28; 84.9%) followed by screening and detection (n = 24; 72.7%), education and counselling (n = 24; 72.7%), and triage (n = 13; 39.4%). Improved blood pressure levels were reported in 78.6%, 66.7%, and 80.0% for hypertension-related task shifting roles to nurses, pharmacists, and CHWs, respectively. Improved glycaemic indices were reported as 66.7%, 50.0%, and 66.7% for diabetes-related task shifting roles to nurses, pharmacists, and CHWs, respectively. CONCLUSION Despite the numerus HRH challenges that are present in Africa for CV and kidney health, this study suggests that task shifting initiatives can improve process of care measures (access and efficiency) as well as identification, awareness and treatment of CV and kidney disease in the region. The impact of task shifting on long-term outcomes of kidney and CV diseases and the sustainability of NCD programs based on task shifting remains to be determined.
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Affiliation(s)
- Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Canada.
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.
| | - Ijezie I Chukwuonye
- Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Udeme Ekrikpo
- Division of Nephrology, University of Uyo, Akwa Ibo State, Uyo, Nigeria
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Yemi R Raji
- Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Yusuf Adeshina
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Samuel Ajayi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Zunaid Barday
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Malini Chetty
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Bianca Davidson
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Emmanuel Effa
- Department of Medicine, University of Calabar, Calabar, Nigeria
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Stephen Fagbemi
- Department of Epidemiology, Ondo State Ministry of Health, Ondo, Nigeria
| | - Cindy George
- Non-Communicable Disease Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Disease Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Erika S W Jones
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Hamidu Liman
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Mohammad Makusidi
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Hadiza Muhammad
- Division of Nephrology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ikechukwu Mbah
- Dept of Medicine College of Med and Health Sciences, Bingham University, Jos, Nigeria
| | - Kwazi Ndlovu
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | | | - Chimezie Okwuonu
- Department of Internal Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | | | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ifeoma Ulasi
- Department of Medicine, University of Nigeria, Ituku Ozalla, Enugu State, Nigeria
| | - Zulkifilu Umar
- Department of Epidemiology, Ondo State Ministry of Health, Ondo, Nigeria
| | - Nicola Wearne
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
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Garg S, Tripathi N, Datla J, Zapata T, Mairembam DS, Bebarta KK, Krishnendhu C, de Graeve H. Assessing competence of mid-level providers delivering primary health care in India: a clinical vignette-based study in Chhattisgarh state. HUMAN RESOURCES FOR HEALTH 2022; 20:41. [PMID: 35550154 PMCID: PMC9097044 DOI: 10.1186/s12960-022-00737-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The global commitment to primary health care (PHC) has been reconfirmed in the declaration of Astana, 2018. India has also seen an upswing in national commitment to implement PHC. Health and wellness centres (HWCs) have been introduced, one at every 5000 population, with the fundamental purpose of bringing a comprehensive range of primary care services closer to where people live. The key addition in each HWC is of a mid-level healthcare provider (MLHP). Nurses were provided a 6-month training to play this role as community health officers (CHOs). But no assessments are available of the clinical competence of this newly inducted cadre for delivering primary care. The current study was aimed at providing an assessment of competence of CHOs in the Indian state of Chhattisgarh. METHODS The assessment involved a comparison of CHOs with rural medical assistants (RMAs) and medical officers (MO), the two main existing clinical cadres providing primary care in Chhattisgarh. Standardized clinical vignettes were used to measure knowledge and clinical reasoning of providers. Ten ailments were included, based on primary care needs in Chhattisgarh. Each part of clinical vignettes was standardized using expert consultations and standard treatment guidelines. Sample size was adequate to detect 15% difference between scores of different cadres and the assessment covered 132 CHOs, 129 RMAs and 50 MOs. RESULTS The overall mean scores of CHOs, RMAs and MOs were 50.1%, 63.1% and 68.1%, respectively. They were statistically different (p < 0.05). The adjusted model also confirmed the above pattern. CHOs performed well in clinical management of non-communicable diseases and malaria. CHOs also scored well in clinical knowledge for diagnosis. Around 80% of prescriptions written by CHOs for hypertension and diabetes were found correct. CONCLUSION The non-physician MLHP cadre of CHOs deployed in rural facilities under the current PHC initiative in India exhibited the potential to manage ambulatory care for illnesses. Continuous training inputs, treatment protocols and medicines are needed to improve performance of MLHPs. Making comprehensive primary care services available close to people is essential to PHC and well-trained mid-level providers will be crucial for making it a reality in developing countries.
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Chhattisgarh, Raipur India
| | | | - Jayathra Datla
- State Health Resource Centre, Chhattisgarh, Raipur India
| | - Tomas Zapata
- WHO, South East Asia Regional Office, New Delhi, India
| | | | | | - C. Krishnendhu
- State Health Resource Centre, Chhattisgarh, Raipur India
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