Reeves S, Zwarenstein M, Goldman J, Barr H, Freeth D, Hammick M, Koppel I
Wilson Centre for Research in Education, Department of Psychiatry, Li Ka Shing Knowledge Institute & Centre for Faculty Development, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8.
Cochrane Database Syst Rev. 2008 Jan 23(1):CD002213. doi: 10.1002/14651858.CD002213.pub2.
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.
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.
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.
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.
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.
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.
患者护理是一项复杂的活动,要求卫生和社会护理专业人员有效协作。然而,证据表明这些专业人员之间的协作并不理想。跨专业教育(IPE)为改善协作和患者护理提供了一种可能的途径。
评估与卫生和社会护理专业人员分别进行学习的教育干预相比,IPE干预措施的有效性;并评估与无教育干预相比,IPE干预措施的有效性。
我们检索了Cochrane有效实践与护理组织小组专门注册库、MEDLINE和CINAHL在1999年至2006年期间的数据。我们还手工检索了《跨专业护理杂志》(1999年至2006年)、六项纳入研究的参考文献列表以及主要的IPE书籍、IPE会议论文集和IPE组织的网站。
对IPE干预措施进行随机对照试验(RCT)、前后对照(CBA)研究和中断时间序列(ITS)研究,这些研究报告了客观测量或自我报告(经过验证的工具)的患者/服务对象和/或医疗保健过程结果。
两名综述作者独立评估潜在相关研究的合格性,并从纳入研究中提取数据并评估研究质量。鉴于纳入研究数量较少以及方法设计和结果测量的异质性,无法对研究结果进行荟萃分析。因此,结果以叙述形式呈现。
我们纳入了六项研究(四项RCT和两项CBA研究)。其中四项研究表明,IPE在以下方面产生了积极结果:急诊科文化和患者满意度;协作团队行为以及急诊科团队临床错误率的降低;对家庭暴力受害者的护理管理;以及与患者护理提供相关的心理健康从业者能力。此外,六项研究中的两项报告了混合结果(积极和中性),两项研究报告称IPE干预对专业实践或患者护理均无影响。
本次更新综述发现六项研究符合纳入标准,而我们的首次综述未发现符合条件的研究。尽管这些研究报告了一些积极结果,但由于研究数量少、干预措施的异质性以及方法学局限性,无法就IPE的关键要素及其有效性得出可推广的推论。需要更严格的IPE研究(即采用RCT、CBA或ITS设计且随机化程序严格、分配隐藏更好、样本量更大且对照组更合适的研究),以提供更好的证据证明IPE对专业实践和医疗保健结果的影响。这些研究还应包括数据收集策略,以深入了解IPE如何影响医疗保健过程和患者结果的变化。