Athabasca University, Athabasca, Canada.
Canadian Health Workforce Network, Ottawa, Canada.
Hum Resour Health. 2023 Sep 4;21(1):72. doi: 10.1186/s12960-023-00848-y.
Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions.
We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework.
This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners.
We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.
健康从业者监管（HPR）系统越来越被认为在支持卫生人力的可用性、可及性、质量和可持续性，同时促进患者安全方面发挥着重要作用。本综述旨在确定关于 HPR 的设计、实施和有效性的证据，以为政策决策提供信息。
我们对 2010 年至 2021 年期间发表的文献进行了综合分析。系统地检索了 14 个数据库，并根据改进的 Donabedian 框架提取和综合数据。
这项大规模综述综合了与 HPR 相关的一系列学术（n=410）和灰色文献（n=426）的证据。我们根据我们的结构-过程-结果概念框架，按照一系列 HPR 主题组织，确定了关键主题和发现。HPR 的治理改革正在朝着多专业监管机构、增强问责制和基于风险的方法方向发展；然而，由于缺乏标准化的 HPR 分类法，HPR 模式之间的比较变得复杂。尽管在跨境认可资格和注册可移植性方面仍然存在挑战，但 HPR 可以支持政府的劳动力战略。实践范围的改革适应现代卫生系统可以提高获得服务的机会和质量。针对低风险卫生职业的替代法定注册可以改善服务并保护公众，而标准化的评估框架可以帮助加强监管。HPR 过程的结果和有效性方面仍存在知识差距，包括继续专业发展模式、国家许可考试、卫生从业者教育计划的认证、强制性报告义务、补救计划以及传统和补充医学从业者的法定注册。
我们确定了对政府、监管机构和卫生系统领导者有价值的关键主题、问题和证据差距。我们还确定了证据基础的局限性，在解释和推断各司法管辖区和职业的结果时应谨慎。主题和发现反映了高收入英语国家的利益和关注点，这些国家是大多数文献的来源地。大多数研究都是描述性的，因此证据的确定性较低。为了为监管设计和改革提供信息，研究资助者和政府应优先考虑关于监管结果的证据，包括我们在综述中确定的创新方法。此外，需要采取系统的方法来跟踪和评估监管干预措施和创新对实现卫生人力和卫生系统目标的影响。
