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Task shifting between health care providers is seen as a strategy for combating increased demands in primary healthcare. This study explored the perceptions and experiences of general practitioners (GPs) and nurses regarding vertical task shifting in Norwegian general practice. We employed a qualitative design. Data were collected through semi-structured interviews with nurses (  = 6) and GPs (  = 5) across six municipalities in Norway. The data were analysed using reflexive thematic analysis. The analysis resulted in two main themes, each with associated subthemes: 1) Trust plays a pivotal role in task shifting processes; (i) Time is essential for cultivating mutual trust, (ii) Increased knowledge and mutual respect strengthen trust in nurses competencies and responsibilities, and 2) Drivers and barriers to vertical task shifting; (i) Organizational structures influence utilization and perceived value of vertical task shifting, (ii) Choosing to work in interdisciplinary teams despite a lack of funding, (iii) Contextual factors and experience influenced attitudes towards vertical task shifting. Trust was described as pivotal to the success of vertical task shifting, with time and collaboration facilitating its development. In several cases, the process of task shifting expanded nurses' roles and strengthened interdisciplinary relationships. However, organizational structures and funding significantly influenced the utilization and perception of task shifting. Attitudes toward task shifting varied based on individual and contextual factors.

Task shifting can improve access, availability, efficiency, and quality of health services in under resourced settings. Task shifting can occur formally or informally within health professions, between health professions, between support staff and health professions, or between lay community members and health professionals. There are currently thousands of Indigenous peoples in Canada's high Arctic, living in remote communities, north of the 60 parallel with limited access to basic medical services. In Nunavut, 25 remote fly-in communities exist in some of the most sparsely populated and harshest conditions on earth. Diminished access to or absence of basic health services such as diagnostic imaging and staff resources in remote communities can have a detrimental effect on patient care, and health outcomes. The existence of a community based diagnostic x-ray training program using a task shifting model addresses a gap in quality and access to services and subsequent treatment for community residents in this region.

The study aimed to investigate if primary health care centers (PHCCs) offering nurse‐managed hypertensive care differ from PHCCs with other types of hypertension care regarding blood pressure levels and other key indicators. In this cross‐sectional study of the hypertension care given in PHCCs in Stockholm County (now called Region Stockholm), we included all 227 PHCCs in the region. To assess the extent of nurses' involvement in the PHCCs hypertension care, a questionnaire was distributed to all PHCCs in Region Stockholm. Data on blood pressure levels was collected from a primary health care quality system (Primary Care Quality). Data on key indicators regarding follow‐up was obtained from the Region Stockholm database on follow‐up (LUD). Blood pressure levels and LUD‐data were then analyzed with regards to whether the PHCC had nurse‐managed hypertension care or not. Our analysis comprised 119 267 patients diagnosed with hypertension registered in any of the regions 227 PHCCs. Of the 81 PHCCs that responded to the questionnaire, 55 reported having nurse‐managed hypertension care, and 26 were classified as having non‐nurse managed hypertension care, while 146 were classified as unknown type of hypertension care. There were no differences in patients reaching desired blood pressure levels between nurse‐managed and non–nurse‐managed hypertension care. Nurse‐led hypertension care units were on par with the other types of PHCCs. Thus, nurse‐led hypertension care seems to be as safe and effective as other types of hypertension care in PHCCs.

The aim was to study if nurse‐managed hypertension care was associated with differences in pharmacotherapy, lifestyle counseling, and prevalence of comorbid cardiometabolic diseases among patients receiving care at primary health care centers. To assess the extent of nurses' involvement in the hypertension care, a questionnaire was distributed to all primary health care centers in Region Stockholm. Age‐adjusted logistic regression models were used to analyze the results, odds ratios with 99% confidence intervals. Data was acquired from VAL, the administrative databases of Region Stockholm in Sweden, encompassing all individuals 30 years or older with a registered hypertension diagnosis who attended to the primary health care center they were registered at. Our analysis comprised 119 267 patients diagnosed with hypertension registered in one of the 224 included primary health care centers. Of the 81 primary health care centers that responded to the questionnaire, 54 reported having nurse‐managed hypertension care. Nurse‐managed hypertension care was not significantly associated with differences in pharmacotherapy or patients’ comorbidity, except for diabetes. Primary health care centers with nurse‐managed hypertension care had a 10% greater adherence to national guidelines for lifestyle counseling (33.5%) compared to those without nurse‐managed hypertension care (22.5%). Regardless of the organizational form of hypertension care management, more men received lifestyle counseling according to guidelines compared to women. In‐house routines for hypertension care, with designated nurses, and booking systems were associated with more lifestyle counseling, which has been associated with signs of better hypertension care.

Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (ie, psychologists and physicians) into digital mental health interventions has become common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other nonclinicians) can help reduce costs and increase accessibility. This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of nonclinician-guided digital mental health interventions. Four databases (MEDLINE, Embase, CINAHL, and PsycINFO) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals that focus on digital intervention were hand searched; gray literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane risk-of-bias tool version 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Nonclinician-guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. Thirteen studies qualified for inclusion. Nonclinician-guided interventions yielded higher posttreatment effectiveness outcomes when compared to conditions involving control programs (eg, online psychoeducation and monitored attention control) or wait-list controls (k=7, Hedges g=-0.73; 95% CI -1.08 to -0.38). There were also significant differences between nonclinician-guided interventions and unguided interventions (k=6, Hedges g=-0.17; 95% CI -0.23 to -0.11). In addition, nonclinician-guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08; 95% CI -0.01 to 0.17). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualifications of the individual performing the intervention, and that the presence of a nonclinician guide improves effectiveness outcomes compared to having no guide. Nonclinician-guided interventions did not yield significantly different adherence outcomes when compared with unguided interventions (k=3, odds ratio 1.58; 95% CI 0.51 to 4.92), although a general trend of improved adherence was observed within nonclinician-guided interventions. Integrating paraprofessionals and nonclinicians appears to improve the outcomes of digital mental health interventions, and may also enhance adherence outcomes (though this trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (ie, psychosocial support, therapeutic alliance, and technical augmentation) and their associated outcomes. PROSPERO International Prospective Register of Systematic Reviews CRD42020191226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=191226.

Background Task shifting and sharing (TS/S) involves the redistribution of health tasks within workforces and communities. Conceptual frameworks lay out the key factors, constructs, and variables involved in a given phenomenon, as well as the relationships between those factors. Though TS/S is a leading strategy to address health worker shortages and improve access to services worldwide, a conceptual framework for this approach is lacking. Methods We used an online Delphi process to engage an international panel of scholars with experience in knowledge synthesis concerning TS/S and develop a conceptual framework for TS/S. We invited 55 prospective panelists to participate in a series of questionnaires exploring the purpose of TS/S and the characteristics of contexts amenable to TS/S programmes. Panelist responses were analysed and integrated through an iterative process to achieve consensus on the elements included in the conceptual framework. Results The panel achieved consensus concerning the included concepts after three Delphi rounds among 15 panelists. The COATS Framework (Concepts and Opportunities to Advance Task Shifting and Task Sharing) offers a refined definition of TS/S and a general purpose statement to guide TS/S programmes. COATS describes that opportunities for health system improvement arising from TS/S programmes depending on the implementation context, and enumerates eight necessary conditions and important considerations for implementing TS/S programmes. Conclusion The COATS Framework offers a conceptual model for TS/S programmes. The COATS Framework is comprehensive and adaptable, and can guide refinements in policy, programme development, evaluation, and research to improve TS/S globally.

Background: This review assessed the cost-effectiveness and implementation strategies of hypertension management by non-physician healthcare workers (NPHCWs) in low- and middle-income countries (LMICs). Methods: A systematic search (inception–May 2024) included adults ≥18 years managed by NPHCWs LMICs, following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Economic evaluations were assessed using Drummond’s checklist and ROBINS-I. Results: Seven studies (2002–2022) conducted across eight countries enrolled 96–10,000 participants and included randomized, modeling, observational, and quasi-experimental designs. NPHCWs included pharmacists, community and village health workers, and nurses. Patients’ mean age ranged 58–71 years, with 57–82% female. Outcomes assessed included cost per mmHg reduction ( $INT 2.25 systolic, $ INT 2.03 diastolic), per controlled patient ( $INT 1.48), annual cost ($ INT 0.22–232.31), cost per disability-adjusted life year (DALY) averted ( $INT 411.39–4709.96), and per quality-adjusted life year (QALY) gained ($ INT 1.04–13.30). Incremental cost-effectiveness ratio (ICERs) varied ($INT 0.41–14,373.97). Strategies included NPHCWs training and community engagement/counseling. Conclusion: Hypertension management by NPHCWs appears cost-effective in LMICs, though more studies are needed for generalizability.

Background Increasing patient loads, healthcare inflation and ageing population have put pressure on the healthcare system. Artificial intelligence and machine learning innovations can aid in task shifting to help healthcare systems remain efficient and cost effective. To gain an understanding of patients’ acceptance toward such task shifting with the aid of AI, this study adapted the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), looking at performance and effort expectancy, facilitating conditions, social influence, hedonic motivation and behavioural intention. Methods This was a cross-sectional study which took place between September 2021 to June 2022 at the National Heart Centre, Singapore. One hundred patients, aged ≥ 21 years with at least one heart failure symptom (pedal oedema, New York Heart Association II-III effort limitation, orthopnoea, breathlessness), who presented to the cardiac imaging laboratory for physician-ordered clinical echocardiogram, underwent both echocardiogram by skilled sonographers and the experience of echocardiogram by a novice guided by AI technologies. They were then given a survey which looked at the above-mentioned constructs using the UTAUT2 framework. Results Significant, direct, and positive effects of all constructs on the behavioral intention of accepting the AI-novice combination were found. Facilitating conditions, hedonic motivation and performance expectancy were the top 3 constructs. The analysis of the moderating variables, age, gender and education levels, found no impact on behavioral intention. Conclusions These results are important for stakeholders and changemakers such as policymakers, governments, physicians, and insurance companies, as they design adoption strategies to ensure successful patient engagement by focusing on factors affecting the facilitating conditions, hedonic motivation and performance expectancy for AI technologies used in healthcare task shifting.

Background Nurse prescribing of medicines is increasing worldwide, but there is limited research in Europe. The objective of this study was to analyse which countries in Europe have adopted laws on nurse prescribing. Methods Cross-country comparative analysis of reforms on nurse prescribing, based on an expert survey (TaskShift2Nurses Survey) and an OECD study. Country experts provided country-specific information, which was complemented with the peer-reviewed and grey literature. The analysis was based on policy and thematic analyses. Results In Europe, as of 2019, a total of 13 countries have adopted laws on nurse prescribing, of which 12 apply nationwide (Cyprus, Denmark, Estonia, Finland, France, Ireland, Netherlands, Norway, Poland, Spain, Sweden, United Kingdom (UK)) and one regionally, to the Canton Vaud (Switzerland). Eight countries adopted laws since 2010. The extent of prescribing rights ranged from nearly all medicines within nurses’ specialisations (Ireland for nurse prescribers, Netherlands for nurse specialists, UK for independent nurse prescribers) to a limited set of medicines (Cyprus, Denmark, Estonia, Finland, France, Norway, Poland, Spain, Sweden). All countries have regulatory and minimum educational requirements in place to ensure patient safety; the majority require some form of physician oversight. Conclusions The role of nurses has expanded in Europe over the last decade, as demonstrated by the adoption of new laws on prescribing rights.

Background HIV status disclosure remains a major challenge among children living with perinatally acquired HIV with many taking treatment up to adolescence without knowing their serostatus. This non-disclosure is influenced by factors like fear of the negative consequences of disclosure. Since HIV status disclosure has been found to have good effects including improving treatment adherence and better mental health outcomes, there is a need to design interventions aimed at improving disclosure rates among children living with HIV. This study aims at adapting a clinic-based pediatric HIV status disclosure intervention and tasking shifting from healthcare workers to caregiver peer supporters in Eastern Uganda. Methods The adaptation process involved consultations with caregivers, healthcare workers involved in the care of children living with HIV, researchers in this field, intervention developers, and other experts and stakeholders. This was done through conducting FGDs with HCWs, caregivers, and peer supporters and consultations with researchers in the field of HIV. The original intervention manual was translated to Lusoga which is the commonly spoken dialect in this region. Collected qualitative data were analyzed using an inductive approach to develop themes and subthemes. Written informed consent will be obtained from all participants before participation in the study. Results A total of 28 participants were involved in the FGDs, while two pediatricians and two HIV researchers/specialists were consulted. Six themes were generated in relation to all suggested changes to the original manual which were related to: (1) sociocultural beliefs/norms/perceptions (5 FGDs), (2) boosting caregiver’s confidence for disclosure (5FGDs), (3) disclosure mode, environment, and person (4 FGDs), (4) health facility/system related changes (3 FGDs), (5) reorganization/paraphrasing (3FGDs) and (6) age appropriateness (2FGDs). Conclusion This study emphasized that whereas some aspects of intervention can apply to various contexts, there is a need for cross-cultural adaptation of interventions before being implemented in settings where they were not developed.