SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
May, 2017 - SUPPORT Summary of a systematic review | print this article | download PDF
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.
People making decisions about the implementation of interventions to foster or improve interprofessional collaboration in healthcare.
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.
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
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).
| 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.
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
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.
Practice based interventions to improve collaboration between different health and social care professionals compared to usual care or no intervention |
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| 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 |
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| 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) |
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One study undertaken in hospital settings in Australia compared video and audio conferencing, both involving a wide range of health and social care professionals.
Practice-based interprofessional collaboration interventions compared with alternate IPC intervention |
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| 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 |
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| 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) |
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|
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 |
| 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.
|
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
|
| 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
|
| 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
|
| 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
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*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 |
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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.
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.
None declared. For details, see: www.supportsummaries.org/coi
This summary has been peer reviewed by: Merrick Zwarenstein, Ekwaro Obuku, and Scott Reeves.
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.
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
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
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.
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.
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.
None declared. For details, see: www.supportsummaries.org/coi
This summary has been peer reviewed by: Merrick Zwarenstein, Ekwaro Obuku, and Scott Reeves.
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.
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:
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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. |
