What is the aim of this review?

The aim of this Cochrane Review was to find out what happens when primary healthcare services are delivered by nurses instead of doctors. We collected and analysed all relevant studies to answer this question and found 18 studies for inclusion in the review.

What are the key messages of this review?

Delivery of primary healthcare services by nurses instead of doctors probably leads to similar or better patient health and higher patient satisfaction. Nurses probably also have longer consultations with patients. Using nurses instead of doctors makes little or no difference in the numbers of prescriptions and tests ordered. However, the impacts on the amount of information offered to patients, on the extent to which guidelines are followed and on healthcare costs are uncertain.

What was studied in this review?

In most countries, the population is growing older and more people have chronic disease. This means that the services that primary healthcare workers need to deliver are changing. At the same time, many countries lack doctors and other healthcare workers, or people struggle to pay for healthcare services. By using nurses instead of doctors, countries hope to deliver care of the same quality for less money.

In this review, we searched for studies that compared nurses to doctors for delivery of primary care services. We looked at whether this made any difference in patients’ health, satisfaction, and use of services. We also looked at whether this made any difference in how services were delivered and in how much they cost.

What are the main results of this review?

We included in this review 18 studies, mainly from high-income countries. In some studies, nurses were responsible for all patients who came to the clinic or for all patients who needed urgent consultation. In some studies, nurses were responsible for patients with particular chronic diseases, or were responsible for providing healthcare education or preventive services to certain groups of patients. Included studies compared these nurses to doctors carrying out the same tasks.

Our review shows that nurse-led primary care may lead to slightly fewer deaths among certain groups of patients, compared to doctor-led care. However, the results vary and it is possible that nurse-led primary care makes little or no difference to the number of deaths. In addition, patients probably have similar or better results in areas of health such as heart disease, diabetes, rheumatism, and high blood pressure. Patients also are probably slightly more satisfied with their care and may have a slightly better quality of life when treated by nurses.

This review also shows that, compared to doctors, nurses probably have longer consultations, and their patients are slightly more likely to keep follow-up appointments. Studies found little or no difference in the number of prescriptions and there may be little or no difference in the numbers of tests and investigations ordered, or in patients’ use of other services. The effects of nurse-led primary care on the amount of advice and information given to patients, and on whether guidelines are followed, are uncertain as the certainty of these findings is very low.

Our review suggests that the impacts on the costs of care of using nurses instead of doctors to deliver primary care are uncertain. We assessed the certainty of this finding as very low.

How up-to-date is this review?

We searched for studies that had been published up to March 2017.