Poor interprofessional collaboration (IPC) can adversely 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 improve interprofessional collaboration (IPC)
amongst health and social care professionals, compared to usual care or to an alternative
intervention, on at least one of the following primary outcomes: patient health outcomes,
clinical process or efficiency outcomes or secondary outcomes (collaborative behaviour).
We searched CENTRAL (2015, issue 11), MEDLINE, CINAHL, ClinicalTrials.gov and WHO
International Clinical Trials Registry Platform to November 2015. We handsearched
relevant interprofessional journals to November 2015, and reviewed the reference lists
of the included studies. We included randomised trials of practice‐based IPC interventions
involving health and social care professionals compared to usual care or to an alternative
intervention. Two review authors independently assessed the eligibility of each potentially
relevant study. We extracted data from the included studies and assessed the risk
of bias of each study. We were unable to perform a meta‐analysis of study outcomes,
given the small number of included studies and their heterogeneity in clinical settings,
interventions and outcomes. Consequently, we summarised the study data and presented
the results in a narrative format to report study methods, outcomes, impact and certainty
of the evidence. We included nine studies in total (6540 participants); six cluster‐randomised
trials and three individual randomised trials (1 study randomised clinicians, 1 randomised
patients, and 1 randomised clinicians and patients). All studies were conducted in
high‐income countries (Australia, Belgium, Sweden, UK and USA) across primary, secondary,
tertiary and community care settings and had a follow‐up of up to 12 months. Eight
studies compared an IPC intervention with usual care and evaluated the effects of
different practice‐based IPC interventions: externally facilitated interprofessional
activities (e.g. team action planning; 4 studies), interprofessional rounds (2 studies),
interprofessional meetings (1 study), and interprofessional checklists (1 study).
One study compared one type of interprofessional meeting with another type of interprofessional
meeting. We assessed four studies to be at high risk of attrition bias and an equal
number of studies to be at high risk of detection bias. For studies comparing an IPC
intervention with usual care, functional status in stroke patients may be slightly
improved by externally facilitated interprofessional activities (1 study, 464 participants,
low‐certainty evidence). We are uncertain whether patient‐assessed quality of care
(1 study, 1185 participants), continuity of care (1 study, 464 participants) or collaborative
working (4 studies, 1936 participants) are improved by externally facilitated interprofessional
activities, as we graded the evidence as very low‐certainty for these outcomes. Healthcare
professionals' adherence to recommended practices may be slightly improved with externally
facilitated interprofessional activities or interprofessional meetings (3 studies,
2576 participants, low certainty evidence). The use of healthcare resources may be
slightly improved by externally facilitated interprofessional activities, interprofessional
checklists and rounds (4 studies, 1679 participants, low‐certainty evidence). None
of the included studies reported on patient mortality, morbidity or complication rates.
Compared to multidisciplinary audio conferencing, multidisciplinary video conferencing
may reduce the average length of treatment and may reduce the number of multidisciplinary
conferences needed per patient and the patient length of stay. There was little or
no difference between these interventions in the number of communications between
health professionals (1 study, 100 participants; low‐certainty evidence). Given that
the certainty of evidence from the included studies was judged to be low to very low,
there is not sufficient evidence to draw clear conclusions on the effects of IPC interventions.
Neverthess, due to the difficulties health professionals encounter when collaborating
in clinical practice, it is encouraging that research on the number of interventions
to improve IPC has increased since this review was last updated. While this field
is developing, further rigorous, mixed‐method studies are required. Future studies
should focus on longer acclimatisation periods before evaluating newly implemented
IPC interventions, and use longer follow‐up to generate a more informed understanding
of the effects of IPC on clinical practice. How effective are strategies to improve
the way health and social care professional groups work together? What is the aim
of this review? The aim of this Cochrane Review was to find out whether strategies
to improve interprofessional collaboration (the process by which different health
and social care professional groups work together), can positively impact the delivery
of care to patients. Cochrane researchers collected and analysed all relevant studies
to answer this question, and found nine studies with 5540 participants. Key messages
Strategies to improve interprofessional collaboration between health and social care
professionals may slightly improve patient functional status, professionals' adherence
to recommended practices, and the use of healthcare resources. Due to the lack of
clear evidence, we are uncertain whether the strategies improved patient‐assessed
quality of care, continuity of care, or collaborative working. What was studied in
this review? The extent to which different health and social care professionals work
well together affects the quality of the care that they provide. If there are problems
in how these professionals communicate and interact with each other, this can lead
to problems in patient care. Interprofessional collaboration practice‐based interventions
are strategies that are put into place in healthcare settings to improve interactions
and work processes between two or more types of healthcare professionals. This review
studied different interprofessional collaboration interventions, compared to usual
care or an alternative intervention, to see if they improved patient care or collaboration.
What are the main results of the review? The review authors found nine relevant studies
across primary, secondary, tertiary and community care settings. All studies were
conducted in high‐income countries (Australia, Belgium, Sweden, UK and USA) and lasted
for up to 12 months. Most of the studies were well conducted, although some studies
reported that many participants dropped out. The studies evaluated different methods
of interprofessional collaboration, namely externally facilitated interprofessional
activities (e.g. collaborative planning/reflection activities led by an individual
who is not part of the group/team), interprofessional rounds, interprofessional meetings,
and interprofessional checklists. Externally facilitated interprofessional activities
may slightly improve patient functional status and health care professionals' adherence
to recommended practices, and may slightly improve use of healthcare resources. We
are uncertain whether externally facilitated interprofessional activities improve
patient‐assessed quality of care, continuity of care, or collaborative working behaviours.
The use of interprofessional rounds and interprofessional checklists may slightly
improve the use of healthcare resources. Interprofessional meetings may slightly improve
adherence to recommended practices, and may slightly improve use of healthcare resources.
Further research is needed, including studies testing the interventions at scale to
develop a better understanding of the range of possible interventions and their effectiveness,
how they affect interprofessional collaboration and lead to changes in care and patient
health outcomes, and in what circumstances such interventions may be most useful.
How up to date is this review? The review authors searched for studies that had been
published to November 2015.