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

What are the effects of interprofessional education on professional practice and healthcare outcomes?

Delivering effective, high quality patient care is complex and requires that health and social care professionals work together effectively. Interprofessional education – training or learning initiatives that involve more than one profession in joint, interactive learning with the explicit purpose of improving interprofessional collaboration or patient care – is a possible strategy for improving how professionals work together as well as improving professional practice and patient care.

Key messages

  • Interprofessional education may lead to improved outcomes for patients and greater patient satisfaction.
  • Interprofessional education may improve professionals’ adherence to guidelines or standards.
  • It is uncertain whether interprofessional education improves collaborative behaviours among professionals, the competencies of professionals to work together in delivering care or clinical processes.
  • None of the included studies was conducted in low income countries. The extent to which these findings are applicable to these settings is uncertain.

 

 

Background

Good communication and collaboration between health and social care professionals is seen as important to the provision of effective and high quality healthcare. Improved interprofessional collaboration may improve care delivery, health outcomes and patient safety and may help ensure that the skills of healthcare team members are used optimally. Interprofessional education has generated a great deal of interest amongst policymakers, educators and researchers as a mechanism for facilitating collaborative practices and improving professional practice and patient care. Interprofessional education has been defined as initiatives that involve more than one profession in joint, interactive learning with the explicit purpose of improving collaboration between professionals, as well as patient care and patient health and well-being.


About the systematic review underlying this summary

Review objectives: To assess the effects of interprofessional education on professional practice and healthcare outcomes
Type of What the review authors searched for What the review authors found
Study designs & interventions Randomised trials, controlled before after studies and interrupted time series studies of interprofessional education interventions. These included all types of educational, training, learning or teaching initiatives involving more than one profession in joint, interactive learning with the explicit purpose of improving interprofessional collaboration or the health and wellbeing of patients

15 studies: randomised trials (8), controlled before-after studies (5) and interrupted time series studies (2).

The interprofessional education interventions assessed were varied, and included (among others): communication skills training, teamwork and team planning interventions, and behaviour change training (interactive workshops).  

Participants Health and social care professionals

A range of health and social care professionals including (among others): physicians, nurses, nutritionists,  optometrists, social workers, physician assistants, psychiatrists, mental health workers, medicine residents, pharmacy students, obstetricians and anaesthetists

Settings Any health or social care setting

Countries: USA (12), UK (2), Mexico (1)

 

Health care settings: hospital emergency departments, community mental health provider organisations, primary care clinics, and a health maintenance organisation

 

Outcomes Objectively measured or self-reported patient/client outcomes, healthcare process outcomes

Patient outcomes, guideline adherence rates, patient

satisfaction, clinical process outcomes, collaborative

behaviour, medical error rates, professionals competencies
Date of most recent search: August 2011
Limitations: This is a well-conducted systematic review with only minor limitations.

 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 Mar 28; 3:CD002213

Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional

practice and healthcare outcomes. Cochrane Database Syst Rev. 2013 Mar 28; 3:CD002213

Summary of findings

This review included 15 studies assessing the effectiveness of interprofessional education interventions compared to no educational interventions. The studies varied in terms of the objectives and format of the educational intervention, the presence of other interventions in addition to the educational intervention, and the clinical areas and settings in which the interventions were delivered. The interprofessional education component in these studies ranged from a few hours or days to longitudinal programmes that were delivered over one year or more.

 Interprofessional education may lead to improved out comes for patients and greater patient satisfaction. The certainty of this evidence is low.

Interprofessional education may improve the adherence of different professionals to guidelines or standards. The certainty of this evidence is low.

It is uncertain whether interprofessional education improves collaborative behaviours among professionals, the competencies of professionals to work together in delivering care or clinical processes. The certainty of this evidence is very low.

It is uncertain whether interprofessional education reduces errors in medical practice. The certainty of this evidence is very low.

 

Interprofessional education to improve professional practice and healthcare outcomes

People:  Health and social care professionals involved in interprofessional education interventions
Settings
:  Mexico, UK and the USA
Intervention
: Use of interprofessional education to improve collaboration and patient care
Comparison
: No education intervention*
Outcomes Impact Number of studies

Certainty of the evidence

(GRADE)

Patiet outcomes Interprofessional education may improve care outcomes for patients 6

   

Low

Adherence rates Interprofessional education may improve the adherence of different professionals to clinical guidelines or standards 3

   

Low

Patiet satisfaction Patients may be more satisfied with the care provided by professionals who have participated in an interprofessional education intervention 2

   

Low

Clinical process outcomes It is uncertain whether interprofessional education improves clinical processes (e.g. shared decision on clinical procedures among professionals) because the certainty of this evidence is very low 1 Very Low
Collaborative behaviur It is uncertain whether interprofessional education improves the extent to which different professions behave collaboratively in the delivery of patient care be-cause the certainty of this evidence is very low 3 Very Low
Medical error rates
It is uncertain whether interprofessional education decrease errors in medical practice because the certainty of this evidence is very low

1

Very Low
Professional competencies It is uncertain whether interprofessional education changes the competencies (e.g. skills, knowledge) of professionals to work together in the delivery of care because the certainty of this evidence is very low
1 Very Low

*Although the review searched for studies comparing interprofessional education to both separate, profession specific interventions and to no education interventions, all of the included studies compared interprofessional education with no education intervention.

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

 

 

 

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY
The included studies were conducted in the USA, UK and Mexico in varied settings (hospital emergency departments, health maintenance organisations, community mental health provider organisations, primary care practices). None of the studies were conducted in low income countries.

The impact of interprofessional education interventions in low-income settings is uncertain.

  •  
    • Differences in health system resources and functioning, clinical and organizational contexts, the resources available for health professional education, the range of professionals involved, gender relationships, the social status of different health professions and the extent to which health profession leaders are supportive of interprofessional working may influence the effectiveness of interprofessional education across different settings.
  •  

     

     

EQUITY
No information was reported on the differential effects of the intervention on different population groups. The additional resource requirements, as well as the need for the reorientation and reorganisation of professional development systems and work processes, may be a barrier to effective implementation in poorly resourced settings. Such settings may therefore not benefit from these interventions, including in terms of improvements in patient satisfaction, the way that care is delivered and care outcomes.
ECONOMIC CONSIDERATIONS
None of the included studies reported information on costs or cost-effectiveness.

The cost of interprofessional education is likely to be highly variable and needs to be estimated in the settings in which these interventions are being considered

 

  • Costs may include developing interprofessional training programmes, bringing together different professionals during their education and reinforcing such training once professionals are in service. Future studies of interprofessional education should include economic evaluations.

 

MONITORING & EVALUATION

Evidence on the impacts of interprofessional education interventions in low-income settings is lacking.

 

  • Few studies have evaluated the effects of interprofessional education interventions on clinical process outcomes (such as interprofessional decision-making), errors in medical practice and the competencies of professionals.

Further studies are needed of the effectiveness of interprofessional education interventions compared to both separate, profession-specific interventions and no education intervention.These studies should assess measures of collaborative behaviour or teamworking, clinical process outcomes, patient outcomes, errors in medical practice, the competencies of professionals and professionals’ satisfaction with interprofessional working.

 

  • Future studies should incorporate qualitative evaluations of how interprofessional education is implemented and received, and its impacts on working relations between professionals and on their professional practices, and should explore causal pathways for change.

 


*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

Rodger S, Hoffman S (on behalf of the World Health Organization Study Group On Interprofessional Education And Collaborative Practice). Where in the world is interprofessional education? A global environmental scan. Journal of Interprofessional Care 2010; 24: 479–491.

 

Sunguya BF, Hinthong W, Jimba M, Yasuoka J. Interprofessional Education for Whom? — Challenges and Lessons Learned from Its Implementation in Developed Countries and Their Application to Developing Countries: A Systematic Review. PLoS ONE 2014; 9(5): e96724.

 

World Health Organization. Framework for action on interprofessional education and collaborative practice, 2010. Available at: whqlibdoc.who.int/hq/2010/WHO_HRH_HPN_10.3_eng.pdf

 

Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practicebased interventions on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD000072.

 
This summary was prepared by

Newton Opiyo, Cochrane Central Editorial Unit (the previous summary was prepared by Lilian Dudley, University of Stellenbosch, South Africa & Charles Wiysonge, Cochrane South Africa)

 

Conflict of interest

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

 

Acknowledgements

This summary has been peer reviewed by: Natalie Leon and Scott Reeves.

This review should be cited as

Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional

practice and healthcare outcomes. Cochrane Database Syst Rev. 2013 Mar 28; 3:CD002213

 

The summary should be cited as

Opiyo N, Dudley L, Wiysonge CS. What are the effects of interprofessional education on professional

practice and healthcare outcomes? A SUPPORT Summary of a systematic review. April 2017.

www.supportsummaries.org

 

Keywords

Evidence informed health policy, evidence based, systematic review, health systems research,

interprofessional education, health care, low an middle income countries, developing countries,

primary health care

 

This summary was prepared with additional support from:

 

The South African Medical Research Council aims to improve South Africa’s health and quality of life through promoting and conducting relevant and responsive health research. www.mrc.ac.za/

 

 

Cochrane South Africa, the only centre of the global, independent Cochrane network in Africa, aims to ensure that health care decision making within Africa is informed by high quality, timely and relevant research evidence. www.mrc.ac.za/cochrane/cochrane.htm

 

 

 

 

w The impact of interprofessional education interventions in low-income settings is uncertain.

w Differences in health system resources and functioning, clinical and organizational contexts, the resources available for health professional education, the range of professionals involved, gender relationships, the social status of different health professions and the extent to which health profession leaders are supportive of interprofessional working may influence the effectiveness of interprofessional education across different settings.


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