Interprofessional collaboration: Effects of practice-based interventions on professional practice and healthcare outcomes

Continuing Education, University of Toronto, Senior Scientist, Institute for Clinical Evaluative Sciences, Room G1 06, 1075 Bayview Ave, Toronto, ON, Canada, M4N 3M5.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2009; 3(3):CD000072. DOI: 10.1002/14651858.CD000072.pub2
Source: PubMed

ABSTRACT Poor interprofessional collaboration (IPC) can negatively affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes.
To assess the impact of practice-based interventions designed to change IPC, compared to no intervention or to an alternate intervention, on one or more of the following primary outcomes: patient satisfaction and/or the effectiveness and efficiency of the health care provided. Secondary outcomes include the degree of IPC achieved.
We searched the Cochrane Effective Practice and Organisation of Care Group Specialised Register (2000-2007), MEDLINE (1950-2007) and CINAHL (1982-2007). We also handsearched the Journal of Interprofessional Care (1999 to 2007) and reference lists of the five included studies.
Randomised controlled trials of practice-based IPC interventions that reported changes in objectively-measured or self-reported (by use of a validated instrument) patient/client outcomes and/or health status outcomes and/or healthcare process outcomes and/or measures of IPC.
At least two of the three reviewers independently assessed the eligibility of each potentially relevant study. One author extracted data from and assessed risk of bias of included studies, consulting with the other authors when necessary. A meta-analysis of study outcomes was not possible given the small number of included studies and their heterogeneity in relation to clinical settings, interventions and outcome measures. Consequently, we summarised the study data and presented the results in a narrative format.
Five studies met the inclusion criteria; two studies examined interprofessional rounds, two studies examined interprofessional meetings, and one study examined externally facilitated interprofessional audit. One study on daily interdisciplinary rounds in inpatient medical wards at an acute care hospital showed a positive impact on length of stay and total charges, but another study on daily interdisciplinary rounds in a community hospital telemetry ward found no impact on length of stay. Monthly multidisciplinary team meetings improved prescribing of psychotropic drugs in nursing homes. Videoconferencing compared to audioconferencing multidisciplinary case conferences showed mixed results; there was a decreased number of case conferences per patient and shorter length of treatment, but no differences in occasions of service or the length of the conference. There was also no difference between the groups in the number of communications between health professionals recorded in the notes. Multidisciplinary meetings with an external facilitator, who used strategies to encourage collaborative working, was associated with increased audit activity and reported improvements to care.
In this updated review, we found five studies (four new studies) that met the inclusion criteria. The review suggests that practice-based IPC interventions can improve healthcare processes and outcomes, but due to the limitations in terms of the small number of studies, sample sizes, problems with conceptualising and measuring collaboration, and heterogeneity of interventions and settings, it is difficult to draw generalisable inferences about the key elements of IPC and its effectiveness. More rigorous, cluster randomised studies with an explicit focus on IPC and its measurement, are needed to provide better evidence of the impact of practice-based IPC interventions on professional practice and healthcare outcomes. These studies should include qualitative methods to provide insight into how the interventions affect collaboration and how improved collaboration contributes to changes in outcomes.

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Available from: Merrick Zwarenstein, Jul 25, 2015
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    • "The few studies that have been undertaken on " the team approach " have resulted in the conclusion that " supervision implies [that] the physician is ultimately responsible for the overall care of the patient " (Crecelius, 2011, p. 8; see also, Martin et al., 2004). True interprofessional collaboration, necessary to meet challenges in modern health care systems, results from valuing the expertise and contributions various health care professionals bring to patient care (Casanova et al., 2007; Leever et al., 2010; Schmacke, 2010; Schneider, 2012; Zwarenstein et al., 2009). But analysis of nursing in the United Kingdom shows that even after 10 years of university undergraduate and graduate nursing programs, nursing there continues to struggle for recognition as a " full " profession (Meerabeau, 2001, p. 427; Gillett, 2012). "
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    ABSTRACT: "To better understand why cooperation between health care professionals is still often problematic, we carried out 25" "semistructured face-to-face expert interviews with physicians and nurses in different rural and urban areas in northern Germany. Using Mayring’s qualitative content analysis method to analyze the data collected, we found that doctors and nurses interpreted interprofessional conflicts differently. Nursing seems to be caught in a paradoxical situation: An increasing emphasis is placed on achieving interprofessional cooperation but the core areas of nursing practice are subject to increasing rationalization in the current climate of health care marketization. The subsequent and systematic devaluation of nursing work makes it difficult for physicians to acknowledge nurses’ expertise. We suggest that to ameliorate interprofessional cooperation, nursing must insist on its own logic of action thereby promoting its professionalization; interprofessional cooperation cannot take place until nursing work is valued by all members of the health care system."
    01/2015; 2:1-15. DOI:10.1177/2333393614565185
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    • "In a small Swiss study, staff members had discordant perceptions and unmet expectations about each other's roles, and limited knowledge of the other's profession [57]. Nonetheless, a Cochrane review of randomised controlled trials (RCTs) of interventions promoting interprofessional collaboration found that they could only be labelled " promising " , rather than " proven " [58]. The review's inclusion criteria may have been overly restrictive [59], and some of this literature will therefore be discussed in more detail below. "
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    ABSTRACT: Despite its place at the heart of inpatient medicine, the evidence base underpinning the effective delivery of medical ward care is highly fragmented. Clinicians familiar with the selection of evidence-supported treatments for specific diseases may be less aware of the evolving literature surrounding the organisation of care on the medical ward. This review is the first synthesis of that disparate literature. An iterative search identified relevant publications, using terms pertaining to medical ward environments, and objective and subjective patient outcomes. Articles (including reviews) were selected on the basis of their focus on medical wards, and their relevance to the quality and safety of ward-based care. Responses to medical ward failings are grouped into five common themes: staffing levels and team composition; interdisciplinary communication and collaboration; standardisation of care; early recognition and treatment of the deteriorating patient; and local safety climate. Interventions in these categories are likely to improve the quality and safety of care in medical wards, although the evidence supporting them is constrained by methodological limitations and inadequate investment in multicentre trials. Nonetheless, with infrequent opportunities to redefine their services, institutions are increasingly adopting multifaceted strategies that encompass groups of these themes. As the literature on the quality of inpatient care moves beyond its initial focus on the intensive care unit and operating theatre, physicians should be mindful of opportunities to incorporate evidence-based practice at a ward level.
    European Journal of Internal Medicine 11/2014; DOI:10.1016/j.ejim.2014.10.013 · 2.30 Impact Factor
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    • "A recent Cochrane intervention review with the focus on interprofessional collaboration [20] , including two round studies, concluded that interprofessional collaboration can improve healthcare processes and outcomes, but that more studies are needed to draw generalizable inferences. Studies including qualitative methods were recommended by Cochrane to provide further insights [20] . "
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    10/2014; 3(6):127-142. DOI:10.5430/jha.v3n6p127
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