May, 2017 - SUPPORT Summary of a systematic review | print this article |

Does collaboration among health and social care professionals improve practice or patient outcomes?

Interprofessional collaboration is the process by which two or more health or social care professionals work together to improve the delivery of health and social care and health outcomes. Practice based interventions to promote interprofessional collaboration (i.e. better work interactions and teamworking among providers) in healthcare delivery are intended to respond to the needs of restructuring, reorganisation, and cost containment, and to the increasing complexity of healthcare knowledge and work.

Key messages

 

  • Four types of interprofessional collaboration interventions were identified by the review: externally facilitated interprofessional activities, interprofessional meetings, interprofessional checklists and interprofessional rounds.
  • It is uncertain if externally facilitated interprofessional activities improve collaborative working, team communication, coordination, patient assessed quality of care or continuity of care.
  • The use of externally facilitated interprofessional activities or interprofessional meetings may slightly improve adherence to recommended practices and prescription of drugs.
  • None of the included studies assessed outcomes related to patient mortality, morbidity or complication rates.
  • Interprofessional checklists, interprofessional rounds and externally facilitated interprofessional activities may slightly improve overall use of resources and slightly decrease length of hospital stay and costs.
  • The studies included in the review were very varied in terms of the types of professionals included, the tasks performed, the degree of interaction, and the populations and health issues considered. In addition, all of the studies were conducted in high income countries.

 

Background

Interprofessional collaboration (IPC) is the process by which two or more health or social care professionals work together to deliver health and social care. Such collaboration is widely promoted on the assumption that by working well together healthcare providers will improve their performance and thereby improve the quality of the health and social care that they deliver.

 

This summary is based on a systematic review focusing on interventions introduced to a practice setting with the explicit objective of improving collaboration between two or more health and/or social care professionals (e.g. midwives, nurses, doctors/physicians, pharmacists, physiotherapists, psychologists, and social workers).

 



About the systematic review underlying this summary

Review objectives:To assess the impact of practice based interventions to improve collaboration between professionals on patient satisfaction, health outcomes and the effectiveness and the ef-ficiency of the healthcare provided.
Type of What the review authors searched for What the review authors found
Study designs & interventions Randomised trials that evaluate practice-based interventions that are designed to improve collaboration between two or more health and/or social care professionals. 9 randomised trials: 8 studies compared an IPC intervention with no intervention and evaluated the effects of different practice-based IPC interventions: externally facilitated interprofessional activities (4 studies), interprofessional rounds (2), interprofessional meetings (1), and interprofessional checklists (1). One study compared one type of interprofessional meeting with another type of interprofessional meeting.
Participants Healthcare teams/groups composed of more than one type of health and social care professional, in any patient population. Teams/groups involving a combination of doctors, nurses, pharmacists, nutritionists/dietitians, social workers, case managers, physical therapists, speech pathologists, occupational therapists, service support staff and managers.
Settings Any health or social care setting

Acute care or general hospital care (6 studies), telemetry unit of a community hospital [technology that allows remote measurement and reporting of information] (1), nursing home (1) and family medicine practices (1).

Country settings: Australia (2), Belgium (1), Sweden (1), United States of America (USA) (4) and the United Kingdom (UK) (1).
Outcomes Patient/client health measures (e.g. mortality, cure rates); healthcare process outcomes (e.g. readmission rates, continuity of care, use of resources; patient or family satisfaction; interprofessional collaboration.) All studies reported at least one patient/client or healthcare process outcome. Four studies assessed collaborative behaviour.
Date of most recent search: November 2015
Limitations: This is a well-conducted systematic review with only minor limitations. 

 

Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017 Forthcoming.

Summary of findings

The review found nine studies of practice-based interprofessional teams/groups, all conducted in high-income countries. Six of the studies were conducted in acute care or general hospitals.

 1) Practice based interventions to improve collaboration between different health and social care professionals compared to usual care or no intervention

Eight studies assessed this comparison.

 

  • It is uncertain if externally facilitated interprofessional activities improve collaborative working, team communication, coordination, patient assessed quality of care or continuity of care because the certainty of this evidence is very low.
  • The use of externally facilitated interprofessional activities or interprofessional meetings may slightly improve adherence to recommended practices and prescription of drugs. The certainty of this evidence is low.
  • None of the included studies assessed outcomes related to patient mortality, morbidity or complication rates.
  • Interprofessional checklists, interprofessional rounds and externally facilitated interprofessional activities may slightly improve overall use of resources and slightly decrease length of hospital stay and costs. The certainty of this evidence is low.

 

Practice based interventions to improve collaboration between different health and social care professionals compared to usual care or no intervention

People:  Health or social care teams involving more than one type of health or social care professional
Settings
:  Primary, secondary, tertiary and community-care settings in Australia, Belgium, Sweden, the UK and the USA
Intervention
: Practice-based interventions with the explicit objective of improving collaboration between professionals
Comparison
: Usual care or no intervention
Outcomes Impact Number of participants

Certainty of the evidence

(GRADE)


Patient/client health 
Externally facilitated interprofessional activities may slightly improve stroke patients’ motor function. None of the included studies reported patient mortality, morbidity or complication rates.

464

(1 study)

 

Low

Patient-assessed quality of care
It is uncertain if externally facilitated interprofessional activities improve patient-assessed quality of care because the certainty of this evidence is very low

1185

(1 study)

  Very Low
Clinical processes – adherence to recommended practices The use of externally facilitated interprofessional activities with or interprofessional meetings may slightly improve adherence to recommended practices and prescription of drugs

2576

(3 studies)

Low

Clinical processes – continuity of care It is uncertain if externally facilitated interprofessional activities improve continuity of care because the certainty of this evidence is very low

464

(1 study)

Very Low
Collaborative working If is uncertain whether externally facilitated interprofessional activities improve collaborative working, team communication, and co-ordination because the certainty of this evidence is very low 

1954

(4 studies)

Very Low
Use of resources Interprofessional checklists, interprofessional rounds and externally facilitated interprofessional activities may slightly improve overall use of resources and slightly decrease length of hospital stay and costs

2697

(4 studies)

Low

GRADE: GRADE Working Group grades of evidence (see above and last page)

2) Practice-based interprofessional collaboration interventions compared with alternate IPC intervention

One study undertaken in hospital settings in Australia compared video and audio conferencing, both involving a wide range of health and social care professionals.

 

  • Video conferencing may reduce the average length of treatment and may improve clinical processes, compared to audio conferencing. The certainty of this evidence is low.
  • There may be little or no difference between video and audio conferencing in the number of communications between health professionals. The certainty of this evidence is low.

 

Practice-based interprofessional collaboration interventions compared with alternate IPC intervention

People:  Health or social care teams involving more than one type of health or social care professional
Settings
:  Two hospitals in Australia
Intervention
: Video conferencing involving a range of health and social care professionals
Comparison
: Video conferencing involving a range of health and social care professionals
Outcomes Impact Number of participants

Certainty of the evidence

(GRADE)


Patient/client health 
The included study did not assess this outcome -   -
Clinical process and efficiency
Video conferencing may reduce the average length of treatment, compared to audio conferencing, and may improve process/efficiency outcomes by reducing the number of multidisciplinary conferences needed per patient and patient length of stay

100

(1 study)

Low

Collaborative working There may be little or no difference between video and audio conferencing in the number of communications between health professionals

100

(1 study)

Low

GRADE: GRADE Working Group grades of evidence (see above and last page)

 

 

If is uncertain whether externally facilitated interprofessional activities improve collaborative working, team communication, and co-ordination because the certainty of this evidence is very low

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY

The review identified nine studies evaluating interventions to improve collaboration  between health and social care professionals. These studies differed in terms of the type of professionals, tasks performed, degree of interaction, population or disease of interest, study design, etc.

 

  • We are uncertain about the many of the effects of interventions to promote collaboration  between health professionals. 
  • All the studies were conducted in high-income countries. 

The structures and processes through which health and social care professionals work together vary widely by type of professional, healthcare and geographic setting, scope of work, and healthcare tasks

 

  • The effects and costs of interventions to improve collaboration between professionals are uncertain. Caution should therefore be applied in making decisions on promoting different forms of collaboration
  • Some interventions used to facilitate interprofessional collaboration, such as video and audio conferencing, may not be easily available in some settings
EQUITY

The included studies did not address the issue of

equity directly.

Better collaboration between health and social care professionals may have a positive impact on equity: increased staff satisfaction may, for example, improve the retention of healthcare professionals in underserved areas. Better collaboration may also lead to the use of fewer health resources and may increase access to comprehensive care for all patients 

 

  • These potential positive effects on equity need to be evaluated in rigorous studies
ECONOMIC CONSIDERATIONS
There is little evidence on the costs and cost-effectiveness of interventions to improve collaboration between professionals, and the available evidence is of low certainty.

The costs of improving collaboration between professionals are likely to vary according to setting, the range of professionals, their ways of working and the tasks performed

 

  • Better interprofessional collaboration may decrease costs and improve the cost-effectiveness of care through, for example, reducing the length of hospital stays and the effectiveness of referrals. Until more evidence is available on the costs and cost-effectiveness of these interventions, implementation decisions will need be made on a case-by-case basis, taking local conditions into account
MONITORING & EVALUATION

For many outcomes, the effects of interventions to improve interprofessional collaboration are uncertain because the certainty of the available evidence is very low or low.

 

Implementation of these interventions should be accompanied by rigorous evaluation. Future studies should describe clearly the intervention/s used to promote collaboration, the professionals,settings and health processes involved, and the outcomes assessed

 

  • More robust evidence is needed before implementation is attempted on a large scale in low-income countries.

 


*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made see: http://www.support-collaboration.org/summaries/methods.htm

 

Additional information

Related literature

Kim S, Bochatay N, Relyea-Chew A, Buttrick E, Amdahl C, Kim L, Frans E, Mossanen M, Khandekar A, Fehr R, Young Mee Lee YM. Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review, J Interprof Care. 2017; 31:3, 282-290.

 

McInnes S, Peters K, Bonney A, Halcomb E. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. J Adv Nurs. 2015;71(9):1973-85.

 

Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev. 2013;3: CD002213.

 

Reeves S, Lewin, Espin S, Zwarenstein M. Interprofessional teamwork for health and social care. London: Wiley-Blackwell. 2010.

 

Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. J Public Health (Oxf). 2015;37(4):716-27.

 

 

This summary was prepared by

Gabriel Rada, Unit for Health Policy and Systems Research, School of Medicine, Pontificia Universidad Católica de Chile and Simon Lewin, Norwegian Institute of Public Health, Norway.

 

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

 

Acknowledgements

This summary has been peer reviewed by: Merrick Zwarenstein, Ekwaro Obuku, and Scott Reeves.

 

This review should be cited as

Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve

professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017;

Forthcoming.

 

The summary should be cited as

Rada G, Lewin S. Does collaboration among health and social care professionals improve professional practice or patient outcomes? A SUPPORT Summary of a systematic review. May 2017. www.supportsummaries.org

 

Keywords

evidence-informed health policy, evidence-based, systematic review, health systems research, health care, low and middle-income countries, developing countries, primary health care, healthcare teams, interprofessional collaboration, cooperative behaviour, interprofessional relations, quality of healthcare

 

This summary was prepared with additional support from:

 

The Health Policy and Systems Research Unit (UnIPSS) is a Chilean research collaboration for the generation, dissemination and synthesis of relevant knowledge about health policy and systems based at the School of Medicine of the P. Universidad Católica de Chile.

 

 

Related literature

Kim S, Bochatay N, Relyea-Chew A, Buttrick E, Amdahl C, Kim L, Frans E, Mossanen M, Khandekar A, Fehr R, Young-Mee Lee YM. Individual, interpersonal, and organisational factors of healthcare conflict: A scoping review, J Interprof Care. 2017; 31:3, 282-290.

 

McInnes S, Peters K, Bonney A, Halcomb E. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. J Adv Nurs. 2015;71(9):1973-85.

 

Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev. 2013;3: CD002213.

Reeves S, Lewin, Espin S, Zwarenstein M. Interprofessional teamwork for health and social care. London: Wiley-Blackwell. 2010.

 

Supper I, Catala O, Lustman M, Chemla C, Bourgueil Y, Letrilliart L. Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. J Public Health (Oxf). 2015;37(4):716-27.

 

 

This summary was prepared by

Gabriel Rada, Unit for Health Policy and Systems Research, School of Medicine, Pontificia Universidad Católica de Chile and Simon Lewin, Norwegian Institute of Public Health, Norway. 

 

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

 

Acknowledgements

This summary has been peer reviewed by: Merrick Zwarenstein, Ekwaro Obuku, and Scott Reeves.

 

This review should be cited as

Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve

professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2017;

Forthcoming.

 

The summary should be cited as

Rada G, Lewin S. Does collaboration among health and social care professionals improve professional practice or patient outcomes? A SUPPORT Summary of a systematic review. May 2017. www.supportsummaries.org

 

Keywords

evidence-informed health policy, evidence-based, systematic review, health systems research, health care, low and middle-income countries, developing countries, primary health care, healthcare teams, interprofessional collaboration, cooperative behaviour, interprofessional relations, quality of healthcare

 

This summary was prepared with additional support from:

 

 

The Health Policy and Systems Research Unit (UnIPSS) is a Chilean research collaboration for the generation, dissemination and synthesis of relevant knowledge about health policy and systems based at the School of Medicine of the P. Universidad Católica de Chile.

 



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