Substitution of elderly care

Laurant , Miranda

Substitution of care, where care for general practitioners or specialists elderly care shifts to qualified nurses, nurse practitioners (NPs) and phyisician assistants (Pas), in the care for the elderly is still in its infancy. It is unclear how substitution in primary care and nursing homes is organised, what (medical) tasks are shifted to PAs, NPs and bachelor nurses, and what the (experienced) effects of substitution of care are.
Miranda Laurant (IQ healthcare) and collegues conducted a systematic literature review, focus group interviews and case studies in 7 nursing homes to answer these research questions. They concluded that different models of subsitution of care exists, also the independent practice of PAs and NPs varies. PAs and NPs are not employed according to their full potential. In order to make better use of the possibilities offered by qualified registered-nurses (BN), NPs and PAs it is important that a) there is clarity amongst different professionals and managers about the legal frameworks of the various professionals taking over medical tasks from physicians, b) in healthcare organizations, a continuum in a mix of professionals is required. This mix of skills should be based on a view of quality of elderly care and a strategic personnel policy, and c) organisations should pay attention to properly integration of the different functions (i.e. PA, NP and RN) in their organization in order to optimally deploy the capabilities of the various professionals taken care of the elderly.

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