Educación interprofesional: efectos en la práctica profesional y en los resultados de la atención sanitaria
Referencias
References to studies included in this review
References to studies excluded from this review
Additional references
References to other published versions of this review
Characteristics of studies
Characteristics of included studies [ordered by study ID]
Ir a:
| Methods | RCT where teams based in 10 public health centers were randomised to intervention project to improve the quality of diabetes care (n = 5) or control group (n = 5) | |
| Participants | Physicians, nurses, patients, nutritionists and psychologists | |
| Interventions | The intervention group received learning sessions focused on the implementation of strategies to improve quality of diabetes care | |
| Outcomes | Clinical outcomes, healthcare process quality improvement goals | |
| Notes | None | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Describes that health centres were " randomly selected" (p. 146) but random component in the sequence generation process is not described |
| Allocation concealment (selection bias) | Unclear risk | Not specified |
| Baseline outcome measurements similar | Low risk | Reported in Table 5 (p. 150) |
| Baseline characteristics similar | Low risk | Reported in Table 1 (p. 148) |
| Incomplete outcome data (attrition bias) | Unclear risk | Not reported |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not reported |
| Contamination | High risk | Quote "…avoiding the contamination' of centers that acted as controls…was not possible" (p. 151) |
| Selective reporting (reporting bias) | High risk | Quote "…did not collect data on intermediate process variables" (p. 151) |
| Other bias | High risk | Short follow‐up (p. 151) |
| Methods | RCT where clinicians were randomly assigned to attend immediate (intervention) or later sessions of the programme (control group) | |
| Participants | Physicians, nurse practitioners, physician assistants, optometrists | |
| Interventions | 2 physicians gave a communication skills training programme consisting of a 4‐hour interactive workshop and a 4‐hour follow‐up workshop 1 month later. Between workshops participants were asked to audio record and review at least 2 consultations, and an instructor made an encouraging telephone call to each participant | |
| Outcomes | Routinely collected patient satisfaction scores, self reported ratings of communication skills | |
| Notes | Reported increases in patient satisfaction were not significant. However baseline scores were high in both groups, leaving little room for increase. The study authors state that longer and more intensive training, performance incentives, ongoing feedback and possibly practice restructuring may be needed to improve general patient satisfaction. They also note that the content of the routinely conducted patient satisfaction survey was not well‐aligned to the particular focus of the communication skills training. The Art of Medicine survey used in this study is not a validated instrument | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote "…we used a random‐number table" (p. 823)
|
| Allocation concealment (selection bias) | Low risk | Quote "we used a random‐number table to assign persons to the intervention or control group" (p. 823) |
| Baseline outcome measurements similar | Low risk | Reported in Table 2 (p. 826) |
| Baseline characteristics similar | Low risk | Quote "Table 1 compares the characteristics of the intervention and control groups at study entry. No statistically significant differences were seen…" (p. 825) |
| Incomplete outcome data (attrition bias) | Low risk | Reported and intention‐to‐treat analysis was modified (p. 825) |
| Blinding of outcome assessment (detection bias) | Low risk | Outcomes were obtained from quote "an anonymous questionnaire that was mailed to patients by a contractor to the HMO" (p. 823) |
| Contamination | Unclear risk | Not specified if control group could have received similar training through other educational opportunities |
| Selective reporting (reporting bias) | Unclear risk | Insufficient information to make an assessment |
| Other bias | High risk | Survey not validated (p. 824) |
| Methods | RCT with baseline (pre‐test), immediate (9‐12 months), and long‐term (18‐24 months) post assessments. Hospitals randomly assigned to experimental and control groups | |
| Participants | Emergency department teams (physicians, nurses, social workers, administrators) and local domestic violence advocates | |
| Interventions | 2‐day information and team planning intervention | |
| Outcomes | Rates of reported domestic violence, patient satisfaction, audit of clinical documentation | |
| Notes | Only 1 hospital sent a complete team as requested; 2 hospitals did not send a physician; social worker sent from 5 of 6 hospitals. Limited institutional support for IPE noted as a possibility for poor outcomes in this study. The components of the culture of emergency department system‐change indicator instrument used in this study is not a validated tool | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified |
| Allocation concealment (selection bias) | Unclear risk | Not specified |
| Baseline outcome measurements similar | Low risk | Quote "This evaluation used an experimental design with baseline (pretest), immediate (9–12 months), and long‐term (18–24 months) post‐assessments…" (p. 132) |
| Baseline characteristics similar | High risk | Not specified |
| Incomplete outcome data (attrition bias) | Low risk | Response rates reported (p. 134) |
| Blinding of outcome assessment (detection bias) | Low risk | Reviewers had "no knowledge of an individual woman's responses to acute abuse" (p. 136) |
| Contamination | Low risk | Sites geographically spread across California and Pennsylvania (p. 132) |
| Selective reporting (reporting bias) | Low risk | All relevant outcomes in the methods section are reported in results |
| Other bias | High risk | Only 1 intervention hospital sent a complete team for training (p. 134); insufficient sample size (p. 136); external events may have impacted treatment of battered women at California hospitals (OJ Simpson trial) (p. 136) |
| Methods | ITS study to test the effectiveness of an intervention to increase adherence to a national suicide prevention guideline at a single trust hospital | |
| Participants | Community mental health professionals (individual professions not specified) | |
| Interventions | A didactic presentation, an interprofessional group discussion stressing positive normative beliefs, interactive group work based on 2 real‐life vignettes | |
| Outcomes | Adherence rates to guideline use | |
| Notes | Needs assessment data (interviews and questionnaires) were gathered in 2 earlier phases of the study to inform the design of the intervention. The impact of 2 extraneous events was also included – the national introduction of the guideline, and a local change in the system for monitoring service‐user discharges | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Incomplete outcome data (attrition bias) | High risk | Quote "...discontinuity occurred between those who returned the questionnaire and those who attended the intervention" (p. 516) |
| Blinding of outcome assessment (detection bias) | Low risk | Routinely collected audit adherence data used (p. 505) |
| Selective reporting (reporting bias) | Low risk | Routinely collected audit adherence data used (p. 505) |
| Other bias | High risk | High staff turnover at intervention site (p. 516). Discontinuities in the samples |
| Intervention independent of other changes | Low risk | 2 events were identified and 6 separate analyses were done in order to accommodate the events (p. 509) |
| Shape of intervention effect pre‐specified | Low risk | Point of analysis is the point of intervention |
| Intervention unlikely to affect data collection | Low risk | Routinely collected audit adherence data used (p. 505) |
| Methods | An RCT of an IPE intervention aimed to improve patient‐centred care with follow‐up data gathered at 6 and 18 months. Individual professionals were randomised to receive the intervention (n = 13) or act as a control group (n = 14) | |
| Participants | Physicians, physician assistants and nurse practitioners | |
| Interventions | A full‐day interprofessional training, individualised feedback on video‐taped interactions with simulated patients, and optional workshops to reinforce strategies for engaging the patient | |
| Outcomes | Observations of patient‐centred communication | |
| Notes | Data were also gathered on simulated professional‐patient interactions to detect the efficacy of the intervention | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not reported |
| Allocation concealment (selection bias) | Unclear risk | Not reported |
| Baseline outcome measurements similar | Low risk | Patient‐centredness summary score reported for training and medical visits (Tables 4 and 5) |
| Baseline characteristics similar | Low risk | Quote "…no significant differences between the groups in terms of sex or practice type, either at baseline or at the final medical visit" |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs indicated in Figure 1. Adjusted for in analysis |
| Blinding of outcome assessment (detection bias) | Unclear risk | Quote "The simulated patients were blind to the provider group assignment", however no statement is made about whether coders were blinded |
| Contamination | Unclear risk | Sample size is small and recruited from departments of General Internal Medicine and Family Practice of 1 university medical system |
| Selective reporting (reporting bias) | Low risk | See Tables 4 and 5 |
| Other bias | High risk | Sampling bias |
| Methods | A CBA study that aimed to evaluate interprofessional team‐based diabetes care. 120 clinical students received the intervention, while 28 medical residents acted as the control group | |
| Participants | Medicine residents, nurse practitioner students, pharmacy students | |
| Interventions | Weekly intervention consisting of didactic presentations, clinical discussions and clinic visits with patients. Quality improvement projects were also developed and implemented. Quarterly patient panel reports also received | |
| Outcomes | Clinical outcomes, planned visits | |
| Notes | As intervention team members were clinical learners enrolled in different training programmes, they had different rotational schedules, which resulted in a changing team membership | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Quote "This study was designed as a nonrandomized, parallel‐group clinical trial" (p. 1541) |
| Allocation concealment (selection bias) | High risk | EPOC indicates: CBA studies should be scored ‘high risk’ |
| Baseline outcome measurements similar | Low risk | Reported in Tables 3 and 4 (p. 1544‐1545) |
| Baseline characteristics similar | Low risk | Quote "Table 2 shows the demographic characteristics of the two cohorts; there were no significant differences between them" (p. 1543) |
| Incomplete outcome data (attrition bias) | Unclear risk | Table 2 has data missing for 1 participant |
| Blinding of outcome assessment (detection bias) | Low risk | Data came in from clinical info system directly and loaded into SPSS (p. 1543). Aggregate data stripped of identifiers was analysed (p. 1541) |
| Contamination | High risk | 1 institution, team members from intervention group could readily interact with control group |
| Selective reporting (reporting bias) | Low risk | All relevant outcomes in the methods section are reported in results |
| Other bias | Low risk | Study patients were pre‐assigned to the medicine residents in both groups and were not randomised (p. 1546) |
| Methods | CBA study with data gathered 8 months after the intervention. 6 emergency departments received the intervention, while 3 emergency departments acted as the control group | |
| Participants | Physicians, nurses, technicians, and clerks based in 9 teaching and community hospital emergency departments | |
| Interventions | An 8‐hour intervention delivered to groups of physicians, nurses, technicians and clerks involving lectures, discussion of video‐taped segments of teamwork and clinical vignettes and interactive teamwork exercises | |
| Outcomes | Collaborative behaviour, clinical error rates | |
| Notes | Also gathered survey data which indicated no change in attitudes for participants following the delivery of the IPE intervention | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote "A prospective investigation using a quasi‐experimental, untreated control group design" (p. 1556) |
| Allocation concealment (selection bias) | High risk | EPOC indicates: CBA studies should be scored ‘high risk’ |
| Baseline outcome measurements similar | Low risk | Reported in Tables 3 and 4 (pp. 1569‐1570) |
| Baseline characteristics similar | Low risk | Quote "The control and experimental group patients who participated in the study were similar in both Period 1 and Period 2…" (p. 1563) |
| Incomplete outcome data (attrition bias) | Low risk | Missing data was minimal, amounting to 8.1% or less for each of the outcome measures (p. 1563) |
| Blinding of outcome assessment (detection bias) | Low risk | Reported use of "blinded raters…" (p. 1566) |
| Contamination | Low risk | 9 separate teaching and community hospital sites (p. 1553) |
| Selective reporting (reporting bias) | Low risk | Reported in Table 2 (pp. 1555‐1556) |
| Other bias | Low risk | Quote "91 percent agreement rate of observed errors that was significantly above chance, we feel that the lack of blinding was unlikely to introduce appreciable bias into the observed error results" (p. 1575) |
| Methods | A cluster RCT to evaluate the effectiveness of an interprofessional intervention aimed at reducing adverse outcomes and improving processes of care in labour and delivery units. Fifteen hospitals were randomised to either receive the intervention (n = 7) or act as the control (n = 8) | |
| Participants | Obstetricians, anaesthesiologists and nurses | |
| Interventions | A 3‐day intervention consisting of 4 hours of didactic lessons, video scenarios, and interactive training covering team structure and processes, planning and problem solving, communication, workload management and team skills, assistance with creation of interprofessional teams by use of onsite training sessions, and an on‐call contingency team to respond to obstetric emergencies | |
| Outcomes | Adverse maternal/neonatal outcomes, clinical process outcomes | |
| Notes | Explanations for lack of significant impact include training not effective, teamwork that results in a detectable impact may require more than a 4‐hour training session and more than 4 months to practice behaviours regularly | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote "…a table of random numbers was used to simulate the toss of a coin" (p. 49) |
| Allocation concealment (selection bias) | Low risk | Quote "A balanced, masked randomization scheme at the hospital (cluster) level was implemented by the project biostatistician" (p. 49) |
| Baseline outcome measurements similar | Low risk | Reported in Table 3 (p. 52) |
| Baseline characteristics similar | Low risk | Reported in Table 3 (p. 52) |
| Incomplete outcome data (attrition bias) | Low risk | Quote "All analyses were by intention to treat" (p. 51) |
| Blinding of outcome assessment (detection bias) | High risk | Quote "The trial was not blinded, with personnel at each site aware of their assignment to either the intervention or control arm" (p. 49) |
| Contamination | Unclear risk | Hospitals are in different US states but unclear if some personnel may be in contact (e.g. if they are in the military) |
| Selective reporting (reporting bias) | Low risk | See Table 4 (p. 53) |
| Other bias | Unclear risk | Unclear if data were collected independently by co‐ordinators that were not hospital personnel |
| Methods | A CBA study aimed to evaluate an interprofessional fall management quality improvement project in nursing homes 19 nursing homes received the intervention while 23 acted as the control | |
| Participants | Nurses, physiotherapists, occupational therapists, nursing assistants, maintenance staff | |
| Interventions | A full‐day interprofessional workshop and a second follow‐up workshop approximately 1 month later to address arising challenges, organisational leadership buy‐in and support , a facility‐based falls coordinator, ongoing consultation by advanced practice nurses with expertise in falls management | |
| Outcomes | Care documentation, fall rates, restraint use | |
| Notes | None | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Convenience sample of 19 nursing homes (p. 342) |
| Allocation concealment (selection bias) | High risk | EPOC indicates: CBA studies should be scored ‘high risk’ |
| Baseline outcome measurements similar | Low risk | Reported in Table 2 (p. 347) |
| Baseline characteristics similar | Low risk | Table 1 indicates no statistically significant differences (p. 346) |
| Incomplete outcome data (attrition bias) | Unclear risk | Table 2 reports results of care processes for 14 of 19 nursing homes – no explanation of missing data on 5 nursing homes |
| Blinding of outcome assessment (detection bias) | High risk | Chart audits done by individuals who quote "were not blind to the intervention status of the facilities" (p. 345) |
| Contamination | High risk | Nursing homes owned and operated by a single non‐profit organisation (p. 342) |
| Selective reporting (reporting bias) | High risk | Chart audits only done on 14 out of 19 intervention nursing homes |
| Other bias | High risk | Not randomised, chart audit incomplete |
| Methods | Cluster RCT involving 31 stroke rehabilitation clinics that were randomised to either receive an IPE intervention designed to improve the care of people who had had a stroke (n = 15) or act as a control group (n = 16) | |
| Participants | Physicians, nurses, occupational therapists, speech‐language pathologists, physiotherapists and social workers | |
| Interventions | A 6‐month intervention consisting of an interactive workshop emphasising team dynamics, problem solving, and the use of performance feedback data and action plans for process improvement. Follow‐up telephone and video‐conference consultations were also offered | |
| Outcomes | Functional gains, length of stay, rates of community discharge | |
| Notes | None | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote "…randomized sites to either intervention or control group using a computer…" (pp. 11‐12) |
| Allocation concealment (selection bias) | Low risk | Quote "…randomized sites to either intervention or control group using a computer…" (pp. 11‐12) |
| Baseline outcome measurements similar | Low risk | Reported in Table 2 |
| Baseline characteristics similar | Low risk | Reported in Table 1. Description of adjustments in analyses (pp. 12‐13) |
| Incomplete outcome data (attrition bias) | Unclear risk | Acknowledge sites dropped out but do not discuss if necessary to adjust analyses (p. 12) |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not reported if data collectors and assessors were blinded |
| Contamination | Low risk | Sites randomised across US |
| Selective reporting (reporting bias) | Unclear risk | Lack of reporting on sites that dropped out of study |
| Other bias | Unclear risk | Lack of reporting on sites that dropped out of study |
| Methods | An ITS study to assess the effects of an IPE intervention on the delivery of standard diabetes services and clinical outcomes for patients based at 1 site | |
| Participants | Healthcare professionals based in a single primary care clinic | |
| Interventions | An education intervention that aimed to improve communication, teamwork, workflow to improve diabetes care and patient outcomes. The intervention included task redistribution, standardised communication and decision‐support tool development | |
| Outcomes | Rates of diabetes testing, clinical outcomes | |
| Notes | Participants are reported as a "team" but different professional groups are not described. Clinicians and staff revised existing diabetes care protocols and processes using the American Diabetes Association clinical guidelines. The new process and diabetes checklist were implemented | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Incomplete outcome data (attrition bias) | Low risk | Pre‐intervention visit and post‐intervention visit reported for 277 individuals (p. 246) |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not reported |
| Selective reporting (reporting bias) | High risk | Table 2 analyses reported inconsistently for 3 months or 12 months (p. 246) |
| Other bias | High risk | Lack of a control group (p. 247) |
| Intervention independent of other changes | Unclear risk | Lack of a comparator as no control group in the study |
| Shape of intervention effect pre‐specified | Low risk | Point of analysis is the point of intervention |
| Intervention unlikely to affect data collection | Unclear risk | Not reported |
| Methods | RCT involving 59 primary care practices which were randomly assigned to an intervention group (29 practices) or a control group (30 practices) | |
| Participants | Physician and nursing teams from the participating primary care practices | |
| Interventions | 4‐hour seminar delivered to the primary healthcare teams. The seminars included video‐tapes, small group discussion of cases, and role play | |
| Outcomes | Recognition and treatment of patient depression | |
| Notes | While actual number of physicians is reported (n = 152), actual number of nurses is not recorded. Qualitative data relating to participants' views of the intervention were also gathered | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote "Practices were randomly assigned by computer" (p. 186) |
| Allocation concealment (selection bias) | Low risk | Quote "Practices were randomly assigned by computer" (p. 186) |
| Baseline outcome measurements similar | Low risk | Quote "Analyses controlled for ... baseline differences in outcome measures between groups" (p. 187) |
| Baseline characteristics similar | Low risk | Quote "Randomisation produced adequate matching between the intervention and control groups" (p. 188). Also reported in Table 2 |
| Incomplete outcome data (attrition bias) | High risk | An intention‐to‐treat analysis was reported (p. 187) |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not reported |
| Contamination | Low risk | Sites were geographically spread across county of Hampshire |
| Selective reporting (reporting bias) | Low risk | Reported in Tables 4 and 5 |
| Other bias | High risk | Large drop‐out rates reported in the control group |
| Methods | RCT involving 5 clinics which were randomly assigned to 2 intervention groups and 3 control groups. Follow‐up data were gathered at 9‐10 months and 21‐23 months | |
| Participants | Primary care practice teams of physicians, nurse practitioners, physician assistants, registered nurses, licensed practical nurses, medical assistants | |
| Interventions | 2 half‐day training sessions based on Precede/Proceed model for behaviour change; 3 extra training sessions for opinion leaders, newsletter, 4 additional educational sessions to teams, system support (e.g. posters in waiting areas, cue cards for providers) | |
| Outcomes | Provider knowledge, attitudes and beliefs, rates of asking, case finding, quality of assistance | |
| Notes | Unvalidated survey and qualitative data on provider views of the intervention were gathered | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Not specified |
| Allocation concealment (selection bias) | Unclear risk | Not specified |
| Baseline outcome measurements similar | Low risk | Reported in Table 2 (p. 258) |
| Baseline characteristics similar | Low risk | "Intervention and control groups at baseline did not differ…" (p. 256) |
| Incomplete outcome data (attrition bias) | Low risk | Adjustments in analysis made for this (p. 256) |
| Blinding of outcome assessment (detection bias) | Low risk | Quote "Chart abstractors, blinded to intervention status, ascertained any mention of possible DV in the records" (p. 256) |
| Contamination | Low risk | Clinics spread across large metropolitan area (p 254) |
| Selective reporting (reporting bias) | Low risk | Reported in Table 2 (p. 258) |
| Other bias | High risk | Small number of clinics (p. 260) |
| Methods | A CBA study to evaluate an interprofessional intervention designed to improve team‐based collaboration for operating room clinicians. Staff at 1 hospital site received the intervention, while staff based at 1 other site acted as a control | |
| Participants | Surgeons, nurses, surgical technicians, anaesthesiologists, physician assistants | |
| Interventions | The intervention consisted of a 4‐hour session which included interactive role‐playing activities between participants | |
| Outcomes | Observed collaborative behaviour between participants | |
| Notes | Other outcomes reported included changes in perceptions and attitudes from the use of the Hospital Survey on Patient Safety Culture and Operating Room Management Attitudes Questionnaire | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Quote "teams...volunteered to participate in the training and evaluation efforts" (p. 135) |
| Allocation concealment (selection bias) | High risk | EPOC indicates: CBA studies should be scored ‘high risk’ |
| Baseline outcome measurements similar | High risk | Reported in Tables 3 and 4 (p. 136‐137) |
| Baseline characteristics similar | Unclear risk | Not reported (p. 135) |
| Incomplete outcome data (attrition bias) | Unclear risk | For example, analyses not conducted for initial observations with regards to debriefing (p. 139) |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not reported if observers were blinded (p. 137) |
| Contamination | Low risk | Groups located at separate campuses (p. 133) |
| Selective reporting (reporting bias) | Unclear risk | For example, analyses not conducted for initial observations with regards to debriefing (p. 139) |
| Other bias | Unclear risk | Observation tool not validated (p. 137). Small sample size of volunteers used in the study. Attrition of control group (p. 139) |
| Methods | CBA study involving 2 mental health provider organisations which received the intervention, while 3 acted as the control group | |
| Participants | Psychiatrists, mental health nurses, therapists, case managers | |
| Interventions | 6 educational components delivered over 1 year involving presentations, small group discussions, role play and 3‐ to 4‐day detailing visits 16 hours of follow‐up discussions to monitor progress | |
| Outcomes | Practitioner professional competencies | |
| Notes | Semi‐structured interviews were gathered to qualitatively explore the effects of the intervention in more detail | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote "This study used a quasi‐experimental design" (p. 968) |
| Allocation concealment (selection bias) | High risk | EPOC describes that CBAs should be scored high for first 2 items |
| Baseline outcome measurements similar | Low risk | Reported in Tables 4 and 5 |
| Baseline characteristics similar | High risk | Site selection based on clinics which "served a large population with severe and persistent mental illness, and provided similar types of services" (p. 986) |
| Incomplete outcome data (attrition bias) | Unclear risk | Analyses undertaken "using multiple imputation to replace missing data" (p. 970) |
| Blinding of outcome assessment (detection bias) | Unclear risk | Not reported |
| Contamination | Low risk | Sites based in 2 US states – Quote "each state included both intervention and control organizations, ensuring that external events would not be confounded with the intervention" (p. 986) |
| Selective reporting (reporting bias) | Low risk | See Tables 4 and 5 |
| Other bias | High risk | Small sample size, authors did not measure change in the appropriateness of care or client outcomes (p. 974) |
CBA: controlled before and after; EPOC: Effective Practice and Organisation of Care; IPE: interprofessional education; ITS: interrupted time series; RCT: randomised controlled trial.
Characteristics of excluded studies [ordered by study ID]
Ir a:
| Study | Reason for exclusion |
| Not an IPE intervention | |
| Not an RCT, CBA or ITS | |
| Post‐intervention study design | |
| Not an RCT, CBA or ITS | |
| Description of IPE intervention that reports no outcomes | |
| Not an IPE intervention. 1 group pre‐/post‐test study design | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| 1 group pre‐/post‐test study design | |
| Not an IPE intervention | |
| Not an RCT, CBA or ITS | |
| Not an IPE intervention | |
| Not an RCT, CBA or ITS | |
| 1 group pre‐/post‐test study design | |
| 1 group pre‐/post‐test study design | |
| Not an IPE intervention | |
| Post‐intervention study design | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Post‐intervention study design | |
| Before and after study with no controls | |
| Not an IPE intervention | |
| Post‐intervention study with no controls | |
| A CBA study that gathered self report data related to attitudes and knowledge change | |
| 1 group post‐intervention study design | |
| A clinical controlled trial of an IPE intervention. Reports outcomes related to self reported knowledge change | |
| Not an RCT, CBA or ITS | |
| Not an IPE intervention | |
| 1 group post‐intervention study design | |
| CBA study. Failed to meet comparison group criteria | |
| 1 group pre‐/post‐test study design | |
| Post‐intervention study with control group. Failed to meet comparison group criteria | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| 5‐year longitudinal study with no controls | |
| Before and after study with no controls | |
| Not an IPE intervention | |
| 1 group post‐intervention study design | |
| 1 group pre‐/post‐intervention study design | |
| Not an IPE intervention | |
| Descriptive study | |
| 1 group pre‐/post‐intervention study design | |
| Not an IPE intervention | |
| 1 group pre‐/post‐test study with follow‐up data collection points | |
| Not an RCT, CBA or ITS | |
| Not an IPE intervention | |
| Outcomes did not meet inclusion criteria | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Before and after study with no controls | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Before and after study with no controls | |
| Before and after study with no controls | |
| Not an RCT, CBA or ITS | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| 1 group pre‐/post‐intervention study design | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| No control group | |
| 1 group pre‐/post‐intervention study design | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an IPE intervention | |
| Not an RCT, CBA or ITS | |
| Not an RCT, CBA or ITS |
CBA: controlled before and after; IPE: interprofessional education; ITS: interrupted time series; RCT: randomised controlled trial.
Flow diagram.
(*Total refers to sum of 1999 review and updates in 2008 and 2012).
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
| Interprofessional education to improve professional practices | |||
| Patient or population: professionals or patients involved in interprofessional education intervention Settings: primarily USA and the UK Intervention: use of interprofessional education to improve collaboration and patient care Comparison: separate, profession‐specific education interventions; or no education intervention | |||
| Outcomes | Impacts | No of studies | Quality of the evidence |
| Patient outcomes | The care provided by use of interprofessional education may lead to improved outcomes for patients | 6 | ⊕⊕⊖⊖ Low |
| Adherence rates | The use of interprofessional education may lead to changes in the use of guidelines or standards (e.g. adherence to clinical guidelines) among different professions | 3 | ⊕⊕⊖⊖ Low |
| Patient satisfaction | Patients may be more satisfied with care provided by professionals who have participated in an interprofessional education intervention | 2 | ⊕⊕⊖⊖ Low |
| Clinical process outcomes | Changes in clinical processes (e.g. shared decisions on surgical incisions) may be linked to the use of interprofessional education | 1 | ⊕⊕⊖⊖ Low |
| Collaborative behaviour | We are unable to assess adequately the extent to which different professions behave collaboratively in the delivery of care to patients | 3 | ⊕⊖⊖⊖ Very low |
| Error rates | We are unable to assess adequately the reduction of error due to improved interprofessional education | 1 | ⊕⊖⊖⊖ Very low |
| Practitioner competencies | We are unable to assess adequately the competencies (e.g. skills, knowledge) of professionals to work together in the delivery of care | 1 | ⊕⊖⊖⊖ Very low |
| *GRADE Working Group grades of evidence | |||
