[Granting extended responsibilities to nurses and pharmacists--is it desirable and possible?].

UNLABELLED: In the recent past, changes have occurred that have increased the overall burden on health services, particularly in the community. It has also become apparent that Israel stands at the threshold of a significant doctor deficit which will become a problem within a decade. The first signs are already noticeable, in a shortfall of residents in some specialties. The possibility of granting certain extended responsibilities to nurses and pharmacists, could reduce potential distress, and improve the quality of care, its availability and patient satisfaction.

LITERATURE REVIEW: A number of studies have investigated the effect of granting responsibilities to nurses that have traditionally been those of physicians. Extensive reviews have been published on the subject. Most of the research found that patient satisfaction increased. Some of the studies even noted an advantage in reaching therapeutic targets for chronic illnesses such as hypertension and hyperlipidemia. No studies indicated increased risk for patients managed by nurses, although there was no consensus about economic savings. With regard to pharmacists, the patients they managed for chronic illnesses gained better control, while in most of the studies there was a reduced uptake of other health services.

DISCUSSION: The suggested change entails hope for the nursing and medical professions, particularly for doctors in the community. It demands extensive organization including legislation, nurse training, and establishing methods of coordination and team work. There are potential threats particularly in the realms of the doctor-patient relationship and the physician's authority. Any change should be gradual and accompanied by broad research.