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Mid-level health providers for primary healthcare: a rapid evidence synthesis

Background: Healthcare services, in many countries, are increasingly being provided by cadres not trained as physicians, and these substitute health workers are referred to as mid-level health providers (MLHPs). The objective of this study was to rapidly synthesise evidence on the effectiveness of M...

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Autores principales: Moola, Sandeep, Bhaumik, Soumyadeep, Nambiar, Devaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: F1000 Research Limited 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237370/
https://www.ncbi.nlm.nih.gov/pubmed/34249345
http://dx.doi.org/10.12688/f1000research.24279.2
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author Moola, Sandeep
Bhaumik, Soumyadeep
Nambiar, Devaki
author_facet Moola, Sandeep
Bhaumik, Soumyadeep
Nambiar, Devaki
author_sort Moola, Sandeep
collection PubMed
description Background: Healthcare services, in many countries, are increasingly being provided by cadres not trained as physicians, and these substitute health workers are referred to as mid-level health providers (MLHPs). The objective of this study was to rapidly synthesise evidence on the effectiveness of MLHPs involved in the delivery of healthcare, with a perspective on low- and middle-income countries. Methods: The review team performed an overview of systematic reviews assessing various outcomes for participants receiving care from MLHPs. The team evaluated systematic reviews for methodological quality and certainty of the evidence. Also, the review team consulted relevant stakeholders in India. Results: The final report included seven systematic reviews, with six assessed as moderate to high methodological quality. Mortality outcomes concerning pregnancy and childbirth care services showed no significant differences in care provided by MLHPs when compared with doctors. Pregnancy care provided by midwives was found to improve the quality of care slightly. The risk of failure or incomplete abortion for surgical abortion procedures provided by MLHPs was twice when compared to the procedures provided by doctors. Moderate to high certainty evidence showed that initiation and maintenance of antiretroviral therapy for HIV-infected patients by a nurse or clinical officer slightly reduced mortality. High certainty evidence showed that chronic disease management by non-medical prescribers reduced some important physiological measures compared to medical prescribing by doctors. Conclusions: To date, this is the first rapid overview of the evidence on MLHPs. Low-quality evidence suggests that MLHPs might be suitable to deliver quality pregnancy care. Moderate and high-quality evidence from trials suggests that MLHPs are helpful for chronic disease management and initiation and maintenance of antiretroviral therapy in people with HIV/AIDS. However, the roles and subsequent training and regulation of MLHPs might be different for different care domains.
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spelling pubmed-82373702021-07-08 Mid-level health providers for primary healthcare: a rapid evidence synthesis Moola, Sandeep Bhaumik, Soumyadeep Nambiar, Devaki F1000Res Research Article Background: Healthcare services, in many countries, are increasingly being provided by cadres not trained as physicians, and these substitute health workers are referred to as mid-level health providers (MLHPs). The objective of this study was to rapidly synthesise evidence on the effectiveness of MLHPs involved in the delivery of healthcare, with a perspective on low- and middle-income countries. Methods: The review team performed an overview of systematic reviews assessing various outcomes for participants receiving care from MLHPs. The team evaluated systematic reviews for methodological quality and certainty of the evidence. Also, the review team consulted relevant stakeholders in India. Results: The final report included seven systematic reviews, with six assessed as moderate to high methodological quality. Mortality outcomes concerning pregnancy and childbirth care services showed no significant differences in care provided by MLHPs when compared with doctors. Pregnancy care provided by midwives was found to improve the quality of care slightly. The risk of failure or incomplete abortion for surgical abortion procedures provided by MLHPs was twice when compared to the procedures provided by doctors. Moderate to high certainty evidence showed that initiation and maintenance of antiretroviral therapy for HIV-infected patients by a nurse or clinical officer slightly reduced mortality. High certainty evidence showed that chronic disease management by non-medical prescribers reduced some important physiological measures compared to medical prescribing by doctors. Conclusions: To date, this is the first rapid overview of the evidence on MLHPs. Low-quality evidence suggests that MLHPs might be suitable to deliver quality pregnancy care. Moderate and high-quality evidence from trials suggests that MLHPs are helpful for chronic disease management and initiation and maintenance of antiretroviral therapy in people with HIV/AIDS. However, the roles and subsequent training and regulation of MLHPs might be different for different care domains. F1000 Research Limited 2021-05-10 /pmc/articles/PMC8237370/ /pubmed/34249345 http://dx.doi.org/10.12688/f1000research.24279.2 Text en Copyright: © 2021 Moola S et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Moola, Sandeep
Bhaumik, Soumyadeep
Nambiar, Devaki
Mid-level health providers for primary healthcare: a rapid evidence synthesis
title Mid-level health providers for primary healthcare: a rapid evidence synthesis
title_full Mid-level health providers for primary healthcare: a rapid evidence synthesis
title_fullStr Mid-level health providers for primary healthcare: a rapid evidence synthesis
title_full_unstemmed Mid-level health providers for primary healthcare: a rapid evidence synthesis
title_short Mid-level health providers for primary healthcare: a rapid evidence synthesis
title_sort mid-level health providers for primary healthcare: a rapid evidence synthesis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237370/
https://www.ncbi.nlm.nih.gov/pubmed/34249345
http://dx.doi.org/10.12688/f1000research.24279.2
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