For this systematic review of economic evaluations exploring role substitution of allied health professionals in primary care, role substitution was defined as ‘the substitution of work that was previously completed by a GP in the past and is now completed by a nurse or allied health professional’. Studies were excluded if the authors did not explicitly state within the article that role substitution was taking place. To be included in the review, the study design of the included articles had to be a full economic evaluation, either cost-effectiveness, cost-benefit, cost-utility, cost-minimisation, or cost-consequence analysis. The population assessed was patients consulting in primary care; the intervention was role substitution by allied health professionals including nurses, pharmacists, physiotherapists, and occupational therapists; the comparator was GP-led care; the outcomes were economic evaluations; and the setting was primary care.
How this fits in
Previous systematic reviews have found that nurses can provide equivalent, or higher, quality of care for some tasks performed by GPs. Evidence is lacking for role substitution in other allied health professional groups such as physiotherapists and occupational therapists. There is also a lack of economic evidence for this role substitution, and a number of reviews have concluded that future research should address this. Despite the shortage of evidence, role substitution is becoming commonplace in primary care.
