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Physician-nurse substitution in primary care

Published: 27 July, 2015

What is the effect of physician-nurse substitution in primary care in chronic diseases?

The role of nurses in primary care attracts increasing interest from policymakers hoping to address workload issues while reducing costs, especially in the care of the chronically ill.

It has long been suggested that they should perform greater roles. Nurses’ education keeps evolving to respond to new demands in healthcare, and nurses continue to support physicians in many areas in many countries.

How best then to integrate nurses into a substitution model of care – which involves the transfer of tasks which are traditionally from the domain of doctors to nurses who take autonomous or delegated responsibilities to deliver care? This may take place in a wide range of care settings and/or clinical areas.

An analysis of 14 studies (n=10,743 participants), including 6 conducted in the UK, concludes that:

 “specially trained nurses can provide care that is at least as equivalent to care provided by physicians for the management of chronic diseases, in terms of process of care.”

“no study showed harm of nurse-led care interventions compared to physician-led care”

The authors speculated that “regardless of the healthcare system in which nurses substitute physicians, and given the heterogeneity in patient populations, settings and interventions, the reasons for these effects may be that specific components of nurse training and competency are shared among studies (e.g. patient education). Another possibility is that nurses may adhere to process care guidelines and protocols better than physicians.”


A. Martínez-González et al. The effect of physician-nurse substitution in primary care in chronic diseases: a systematic review Swiss Med Wkly. 2015;145:w14031

Last updated: 21 May, 2018

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