Interprofessional education: effects on professional practice and health care outcomes

 

Abstract

Background

Patient care is a complex activity which demands that health and social care professionals work together in an effective manner. The evidence suggests, however, that these professionals do not collaborate well together. Interprofessional education (IPE) offers a possible way to improve collaboration and patient care.

Objectives

To assess the effectiveness of IPE interventions compared to education interventions in which the same health and social care professionals learn separately from one another; and to assess the effectiveness of IPE interventions compared to no education intervention.

Search methods

We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 1999 to 2006. We also handsearched the Journal of Interprofessional Care (1999 to 2006), reference lists of the six included studies and leading IPE books, IPE conference proceedings, and websites of IPE organisations.

Selection criteria

Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client and/or healthcare process outcomes.

Data collection and analysis

Two reviewers independently assessed the eligibility of potentially relevant studies, and extracted data from, and assessed study quality of, included studies. A meta-analysis of study outcomes was not possible given the small number of included studies and the heterogeneity in methodological designs and outcome measures. Consequently, the results are presented in a narrative format.

Main results

We included six studies (four RCTs and two CBA studies). Four of these studies indicated that IPE produced positive outcomes in the following areas: emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; management of care delivered to domestic violence victims; and mental health practitioner competencies related to the delivery of patient care. In addition, two of the six studies reported mixed outcomes (positive and neutral) and two studies reported that the IPE interventions had no impact on either professional practice or patient care.

Authors' conclusions

This updated review found six studies that met the inclusion criteria, in contrast to our first review that found no eligible studies. Although these studies reported some positive outcomes, due to the small number of studies, the heterogeneity of interventions, and the methodological limitations, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. More rigorous IPE studies (i.e. those employing RCTs, CBA or ITS designs with rigorous randomisation procedures, better allocation concealment, larger sample sizes, and more appropriate control groups) are needed to provide better evidence of the impact of IPE on professional practice and healthcare outcomes. These studies should also include data collection strategies that provide insight into how IPE affects changes in health care processes and patient outcomes.

 

Plain language summary

Training health and social care professionals to work together effectively

Health and social care professionals, such as doctors, nurses, physiotherapists and social workers, need to work together effectively to take care of patients effectively. Unfortunately, professionals may not always work well together. Training and educational programmes have been developed as a possible way to improve how professionals work together to take care of patients. Interprofessional education (IPE) is any type of educational, training, teaching or learning session in which two or more health and social care professions are learning interactively.

This review found six studies that evaluated the effects of IPE. Four of these studies found that IPE improved some ways in how professionals worked together and the care they provided. It improved the working culture in an emergency department and patient satisfaction; decreased errors in an emergency department; improved the management of the care delivered to domestic violence victims; and improved the knowledge and skills of professionals providing care to mental health patients. But two of those four studies also found that IPE had little to no effect on other areas. Two other studies found that IPE had little to no effect at all.

The studies evaluated different types of IPE and were not of high quality. It is, therefore, difficult to be certain about the effect of IPE and to understand the key features of IPE to train health and social care professionals to work together effectively.

 

摘要

背景

專業間教育:專家作法與健康照護結果的效果

病患照護是一種複雜的活動，其需要健康與社會照護專家以有效的方式一同工作。然而，證據認為這些專家無法很好地協同合作。專業間教育Interprofessional education (IPE))提供一種可能的方式用以改善合作及病患照護。

目標

評估IPE介入措施相較於教育介入措施對於相同健康及社會照護專家彼此分開學習的效果並評估IPE介入措施對照無教育介入措施的效果。

搜尋策略

我們檢索1996年至2006年the Cochrane Effective Practice及Organisation of Care Group specialised register, MEDLINE 及CINAHL。我們也人工檢索the Journal of Interprofessional Care (1999年至2006年)，納入回顧之六篇研究其參考文獻及主要的IPE書籍，IPE會議記錄及IPE組織的網站。

選擇標準

IPE介入措施報告客觀地測量或自我報告(有效的工具)病患/顧客及/或健康照護過程結果之隨機對照試驗(Randomised controlled trials (RCTs))，前後對照試驗(controlled before and after (CBA) studies)及間段時間序列(interrupted time series (ITS) studies)。

資料收集與分析

兩位回顧作者分別獨立評估可能相關研究的合格性並自納入研究中摘錄資料，及評估研究的品質。由於少量的納入研究及方法學設計與結果測量的異質性，因此不可能進行研究結果的統合分析。所以，結果以敘述性的方式呈現。

主要結論

我們納入六篇研究(四篇RCTs及兩篇CBA研究)。其中四篇指出IPE對下列範圍具有正向的結果:急診的文化與病患滿意度合作的團隊行為與減少急診的臨床錯誤率提供照護管理予家暴被害人及心理健康醫師提供病患照護的能力。再者，六篇研究中的兩篇研究報告混合的結果(正向的或中立的)，且有兩篇研究報告IPE介入措施不論對於專家做法或病患照護皆不具有影響。

作者結論

這篇更新的回顧發現六篇研究符合納入標準，相較於我們的第一篇回顧發現沒有合格的研究。雖然這些研究報告有相同的正向結果，但由於少量的研究，介入措施的異質性，及方法學的限制，因此有關IPE的主要因素及效果不可能具有廣泛的推論。需要更嚴謹的IPE研究(例那些RCTs, CBA或ITS其具有嚴謹的隨機分配過程，較佳的保密分派方式，較大的樣本數及較合適的對照組)以提供IPE對於專家做法及健康照護結果影響之較佳的證據。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

訓練健康及社會照護專家以有效率地一同工作。健康及社會專家，如醫師，護士，物理治療師及社會工作者，需要有效率地一同工作以有效率地照護病患。不幸地，專家也許並不總是很好地協同工作。訓練及教育計畫已被發展為可能的方式用來改善如何使專家一同工作以照護病患。專業間教育(Interprofessional education (IPE))是任何一種教育，訓練，教學或學習課程，其間兩位或更多的健康及社會照護專家學習互動。這篇回顧發現六篇研究評估IPE的效果。其中四篇研究發現IPE可以改善一些方法有關如何使專家一同工作及他們所提供的照護。它可以改善急診的工作文化及病患滿意度降低急診的錯誤改善提供予家暴被害人之照護管理並改善專家提供照護予心理健康患者之知識及技巧。但這四篇研究中的兩篇研究也發現IPE對於其他範圍也具有些微效果。其餘兩篇研究則發現IPE對於全部範圍皆無效果。這些研究評估不同類型的IPE且不具高品質。因此，確定IPE的效果及了解IPE的主要特點以訓練健康及社會照護專家有效率地一同工作是很困難的。