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
April, 2017 - SUPPORT Summary of a systematic review | print this article | download PDF
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.
People making decisions about education of health professionals
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
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.
| 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
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.
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 |
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| 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* |
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| 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) |
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| 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.
|
| 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
|
| MONITORING & EVALUATION | |
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Evidence on the impacts of interprofessional education interventions in low-income settings is lacking.
|
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.
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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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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.
Newton Opiyo, Cochrane Central Editorial Unit (the previous summary was prepared by Lilian Dudley, University of Stellenbosch, South Africa & Charles Wiysonge, Cochrane South Africa)
None declared. For details, see: www.supportsummaries.org/coi
This summary has been peer reviewed by: Natalie Leon and Scott Reeves.
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
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
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
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 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.w The impact of interprofessional education interventions in low-income settings is uncertain.
