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

Health workers attending a meeting.
UNICEF/C. Nesbitt

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

RHL summary

Interventions to overcome challenges in inter-professional collaboration can potentially improve professional practice and health-care outcomes. This review assessed the impact of practice-based interventions designed to improve collaboration. Of the five included studies, two had examined inter-professional rounds in inpatient medical wards, another two had examined inter-professional meetings, and one study had examined externally facilitated inter-professional audit. While the results of interdisciplinary rounds were mixed, monthly multidisciplinary team meetings appeared to improve prescribing of psychotropic drugs in nursing homes. In multidisciplinary case conferences, results were also mixed with respect to video conferences versus audio conferences. However, multidisciplinary meetings conducted with an external facilitator were associated with increased audit activity and improved patient care. The limited data available suggest that practice-based inter-professional collaboration interventions can improve health-care processes and outcomes, but more, better designed, studies are needed.


Cochrane review

Citation: Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professionalpractice and healthcare outcomes.Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD000072. DOI:10.1002/14651858.CD000072.pub2.10.1002/14651858.CD007017

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.