Task shifting from general practitioners to nurses and the association with patient flow and resource use in out-of-hours primary care clinics: a descriptive register-based study

BACKGROUND: This study aims to describe patterns of patient flow and resource use in out-of-hours (OOH-PC) clinics with high versus low levels of task shifting from general practitioners (GPs) to nurses. METHODS: This descriptive register-based study used data from OOH-PC clinics in the Central Denmark Region. Clinics with high levels of task shifting had nurses independently managing pa-tients with minor conditions, whereas in clinics with low levels of task shifting nurses mainly per-formed preparatory tasks. Measures of patient flow included GP time per contact, initial and total waiting time, contact time with a health professional, and treatment time. Resource use measures in-cluded diagnostic tests, X-rays, injury-related procedures, prescriptions, hospital referrals, and fol-low-up contacts. RESULTS: A total of 451,714 contacts were included. The proportion of contacts independently man-aged by nurses was 4% in clinics with low task shifting and 20% in clinics with high task shifting. Clinics with low task shifting had more GP time per contact (median 8 minutes IQR 5-11 vs. 6 minutes IQR 2-11) and longer total waiting time (31 minutes IQR 14-52 vs. 26 minutes IQR 11-49) than clinics with high task shifting. Median contact time (8 minutes) was similar across clin-ic types. Rates of diagnostic testing, X-ray referrals, prescriptions, and follow-up contacts were comparable. CONCLUSIONS: This study indicates that OOH-PC clinics with high levels of task shifting release more GP time and reduce waiting times while maintaining similar consultation lengths and overall resource use. CLINICAL TRIAL NUMBER: Not applicable.