| アブストラクト | BACKGROUND: The Additional Roles Reimbursement Scheme (ARRS) launched in England in 2019 to expand the multidisciplinary primary care workforce, but its impact on workload since implementation is unclear. AIM: To examine changes in workload complexity associated with ARRS implementation. DESIGN AND SETTING: A longitudinal cohort study was conducted, which used the Clinical Practice Research Datalink (CPRD) Aurum. In total, 3 530 628 consultations were analysed involving GPs, nurses, or direct patient care (DPC)-ARRS roles for 420 986 patients from 369 English practices in 2018 and 2021. METHOD: Multilevel logistic regression assessed associations between 17 patient and consultation complexity factors and being seen by a DPC-ARRS role, adjusting for year, age, sex, region, deprivation, and consultation mode. RESULTS: Complex consultations with DPC-ARRS-eligible roles increased from 15.8% in 2018 to 18.8% in 2021. Diagnostically capable ARRS roles were more likely than GPs to conduct the first consultation after diabetes diagnosis (odds ratio [OR] 1.4, 95% confidence interval [CI] = 1.3 to 1.5) and consultations with >/=2 preventive tasks (OR 5.6, 95% CI = 5.5 to 5.8), but less likely to manage chronic pain (OR 0.8, 95% CI = 0.7 to 0.9), dementia (OR 0.4, 95% CI = 0.3 to 0.4), mental illness (OR 0.4, 95% CI = 0.3 to 0.5), learning disabilities (OR 0.3, 95% CI = 0.3 to 0.4), consultations with >/=3 medicines prescribed (OR 0.6, 95% CI = 0.5 to 0.6), consultations resulted in emergency admission (OR 0.7, 95% CI = 0.6 to 0.8), and consultations with >/=2 diagnoses coded (OR 0.5, 95% CI = 0.5 to 0.5). Patients with interpreter needs (OR 1.2, 95% CI = 1.1 to 1.3), experiencing recent homelessness (OR 1.4, 95% CI = 1.1 to 1.7), or >/=3 long-term conditions (OR 1.1, 95% CI = 1.1 to 1.1) were more likely to be seen by diagnostic ARRS staff. CONCLUSION: Following ARRS implementation, primary care activity was delivered by a broader workforce managing increasingly complex care. Further research should assess the safety, quality, and system impacts of ARRS roles. |
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| ジャーナル名 | The British journal of general practice : the journal of the Royal College of General Practitioners |
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| Pubmed追加日 | 2026/2/24 |
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| 投稿者 | Hong, Jialan; Edwards, Peter Jonathan; Kashyap, Mavin Nathan; McLeod, Hugh; Salisbury, Chris; Walsh, Nicola; Bennett, Ben; Ward, Isobel L; Macleod, John; Penfold, Christopher; Redaniel, Maria Theresa |
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| 組織名 | National Institute for Health Research Applied Research Collaboration West (NIHR;ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol,;UK jialan.hong@bristol.ac.uk.;Population Health Sciences, Bristol Medical School, University of Bristol,;Bristol, UK.;UK.;School of Health and Social Wellbeing, College of Health, Science and Society,;University of the West of England, Bristol, UK.;Health Innovation West of England, Bristol, UK.;National Cancer Registry Ireland, Cork, Ireland. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/41730680/ |
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