Interprofessional Education: Effects On Professional Practice and Healthcare Outcomes (Update) (Review)

Interprofessional education: effects on professional practice
and healthcare outcomes (update) (Review)
Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2013, Issue 3
http://www.thecochranelibrary.com
Interprofessional education: effects on professional practice and healthcare outcomes (update) (Review)
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . . 3
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Figure 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
FEEDBACK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
WHAT’S NEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
HISTORY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Interprofessional education: effects on professional practice and healthcare outcomes (update) (Review) i
[Intervention Review]
Interprofessional education: effects on professional practice

and healthcare outcomes (update)
Scott Reeves1 , Laure Perrier2 , Joanne Goldman2 , Della Freeth3 , Merrick Zwarenstein4
1 Center of Innovation in Inteprofessional Education, University of California, San Francisco, San Francisco, California, USA.
2 Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, Li Ka Shing Knowledge Institute
of St. Michael’s Hospital, Toronto, Canada. 3 Centre for Medical Education, Institute of Health Sciences Education, Barts and The
London School of Medicine and Dentistry, Queen Mary University of London, London, UK. 4 Department of Family Medicine,
University of Western Ontario, London, Canada
Contact address: Scott Reeves, Center of Innovation in Inteprofessional Education, University of California, San Francisco, 521
Parnassus Avenue, CL112, San Francisco, California, 94143, USA. [email protected].
Editorial group: Cochrane Effective Practice and Organisation of Care Group.

Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 3, 2013.
Review content assessed as up-to-date: 3 August 2011.
Citation: Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional prac-
tice and healthcare outcomes (update). Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD002213. DOI:
10.1002/14651858.CD002213.pub3.
ABSTRACT
Background
The delivery of effective, high-quality patient care is a complex activity. It demands health and social care professionals collaborate in
an effective manner. Research continues to suggest that collaboration between these professionals can be problematic. Interprofessional
education (IPE) offers a possible way to improve interprofessional collaboration and patient care.
Objectives
To assess the effectiveness of IPE interventions compared to separate, profession-specific education interventions; and to assess the
effectiveness of IPE interventions compared to no education intervention.
Search methods
For this update we searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and
CINAHL, for the years 2006 to 2011. We also handsearched the Journal of Interprofessional Care (2006 to 2011), reference lists of all
included studies, the proceedings of leading IPE conferences, 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 or healthcare process outcomes.
Data collection and analysis
At least two review authors independently assessed the eligibility of potentially relevant studies. For included studies, at least two review
authors extracted data and assessed study quality. A meta-analysis of study outcomes was not possible due to heterogeneity in study
designs and outcome measures. Consequently, the results are presented in a narrative format.
Interprofessional education: effects on professional practice and healthcare outcomes (update) (Review) 1
Main results
This update located nine new studies, which were added to the six studies from our last update in 2008. This review now includes
15 studies (eight RCTs, five CBA and two ITS studies). All of these studies measured the effectiveness of IPE interventions compared
to no educational intervention. Seven studies indicated that IPE produced positive outcomes in the following areas: diabetes care,
emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency
department teams; collaborative team behaviour in operating rooms; management of care delivered in cases of domestic violence; and
mental health practitioner competencies related to the delivery of patient care. In addition, four of the studies reported mixed outcomes
(positive and neutral) and four studies reported that the IPE interventions had no impact on either professional practice or patient care.
Authors’ conclusions
This updated review reports on 15 studies that met the inclusion criteria (nine studies from this update and six studies from the
2008 update). Although these studies reported some positive outcomes, due to the small number of studies and the heterogeneity
of interventions and outcome measures, it is not possible to draw generalisable inferences about the key elements of IPE and its
effectiveness. To improve the quality of evidence relating to IPE and patient outcomes or healthcare process outcomes, the following
three gaps will need to be filled: first, studies that assess the effectiveness of IPE interventions compared to separate, profession-specific
interventions; second, RCT, CBA or ITS studies with qualitative strands examining processes relating to the IPE and practice changes;
third, cost-benefit analyses.
PLAIN LANGUAGE SUMMARY

Training health and social care professionals to work together effectively
Interprofessional education (IPE) is defined as an intervention where the members of more than one health or social care profession,
or both, learn interactively together, for the explicit purpose of improving interprofessional collaboration or the health/well being
of patients/clients, or both. This review evaluated the effectiveness of IPE compared to educational interventions in which different
professional groups were learning separately from one another and IPE compared with interventions in which no IPE was offered
to a comparison group. This review was restricted to studies that measured patient outcomes or healthcare processes. This excluded
qualitative studies and quantitative studies that reported on the impact that IPE can have on participants’ attitudes, knowledge and
skills of collaboration. This does not imply that qualitative studies and those focused on attitudes, knowledge and skills do not offer
useful insights for certain purposes; simply that they are not the focus of this review.
Nine studies met the inclusion criteria for the review. These studies were added to the six that we found the last time we updated the
review, bringing the total to 15 studies. Seven of these studies reported positive outcomes for healthcare processes or patient outcomes,
or both, four studies reported mixed outcomes (positive and neutral) and four reported no effects of IPE. The studies differed in many
respects. They were conducted in different areas of clinical practice and included different IPE interventions. The study designs and
outcome measures were also different. All 15 studies compared outcomes following an IPE intervention to outcomes, either in similar
clinical settings that did not receive the IPE intervention, or in the same clinical setting before the intervention was made. Because
no studies compared an interprofessional intervention to a profession-specific intervention, our understanding of interprofessional
interventions is limited. The small number of studies included in this review, and their varied nature, limit our understanding of the
key components of IPE and its effectiveness. More studies are needed to allow sound conclusions to be reached about the effectiveness
of IPE, as well as to inform IPE policy development. In particular, these should include: first, studies that assess the effectiveness of
IPE interventions compared to separate, profession-specific interventions; second, RCT, CBA or ITS studies with qualitative strands
examining processes relating to the IPE and practice changes; third, cost-benefit analyses.
S U M M A R Y O F F I N D I N G S F O R T H E M A I N C O M P A R I S O N [Explanation]
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

(GRADE)*
Patient outcomes The care provided by use of 6 ⊕⊕

interprofessional education may Low
lead to improved outcomes for
patients
Adherence rates The use of interprofessional ed- 3 ⊕⊕

ucation may lead to changes in Low
the use of guidelines or stan-
dards (e.g. adherence to clinical
guidelines) among different pro-
fessions
Patient satisfaction Patients may be more satisfied 2 ⊕⊕

with care provided by profes- Low
sionals who have participated
in an interprofessional education
intervention
Clinical process outcomes Changes in clinical processes (e. 1 ⊕⊕

g. shared decisions on surgical Low
incisions) may be linked to the
use of interprofessional educa-
tion
Collaborative behaviour We are unable to assess ade- 3 ⊕

quately the extent to which differ- Very low
ent professions behave collabo-
ratively in the delivery of care to
patients
Error rates We are unable to assess ad- 1 ⊕

equately the reduction of er- Very low
ror due to improved interprofes-
sional education
Practitioner competencies We are unable to assess ade- 1 ⊕
quately the competencies (e.g. Very low
skills, knowledge) of profession-
als to work together in the deliv-
ery of care
*GRADE Working Group grades of evidence

High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change
the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to
change the estimate.
Very low quality: We are very uncertain about the estimate.
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BACKGROUND Professional and academic leaders from diverse countries have de-
veloped a shared vision and strategy for postsecondary education
This review is an update to a previous Cochrane interprofessional
in medicine, nursing and public health. This commission called
education (IPE) review wherein four of the six included studies
for, among other recommendations, IPE that breaks down pro-
reported a range of positive outcomes (Reeves 2008). While that
fessional silos while promoting collaborative relationships (Frenk
review was an improvement from the original Cochrane IPE re-
2010). Similarly, the World Health Organization (WHO) pub-
view that identified no studies for inclusion (Zwarenstein 2000), it
lished a report that outlined the role of IPE in preparing healthcare
marked only a small step forward in establishing the evidence base
providers to enter the workplace as a member of the collaborative
for IPE due to the small number of studies, methodological limi-
practice team (WHO 2010). National organisations have created
tations, and the heterogeneity of IPE interventions. This updated
core competencies for interprofessional collaborative practice, po-
review is timely not only due to the passage of time but also given
sitioning IPE as fundamental to practice improvement (CIHC
the continued interest and investment in IPE by policymakers,
2010; Interprofessional Educ Collab Expert Panel 2011).
educators, healthcare professionals and researchers worldwide.
IPE occurs when members of more than one health or social Ideally, IPE should begin in the early training period and extend
care profession (or both) learn interactively together, for the ex- throughout a person’s professional career (Barr 2005). Many ex-
plicit purpose of improving interprofessional collaboration or the amples of IPE at different stages of professional development con-
health/well being of patients/clients (or both). The widespread ad- tinue to be published. From this work, it is possible to see that IPE
vocacy and implementation of IPE reflects the premise that IPE can have an impact on learners’ attitudes, knowledge and skills
will contribute to developing healthcare providers with the skills of collaboration (e.g. Charles Campion-Smith 2011; Makowsky
and knowledge needed to work in a collaborative manner (CIHC 2009; Sargeant 2011). These are important educational outcomes,
2010; Interprofessional Educ Collab Expert Panel 2011; WHO but not the focus of the current review.
2010). Interprofessional collaboration, in turn, is identified as crit- Given the ongoing emphasis on the importance of IPE to collab-
ical to the provision of effective and efficient health care, given the orative practice and ultimately to healthcare processes and out-
complexity of patients’ healthcare needs and the range of health- comes, ongoing attention is needed to advancing the research ev-
care providers and organisations. Interprofessional collaboration idence related to IPE. It is timely to undertake this updating re-
has been linked to a range of outcomes, including improvements view to identify whether there are additional studies with research
in patient safety and case management, the optimal use of the skills designs that meet the criteria of this Cochrane review, which can
of each healthcare team member and the provision of better health further inform the evidence of IPE.
services (Berridge 2010; Reeves 2010; Suter 2012; Zwarenstein
2000). The definition of an IPE intervention used in this review is the
following: nurses, pharmacists, physiotherapists, occupational therapists, ra-
diographers, speech therapists and social workers).
• An IPE intervention occurs when members of more than
one health or social care (or both) profession learn interactively
Types of interventions
together, for the explicit purpose of improving interprofessional
collaboration or the health/well being (or both) of patients/ All types of educational, training, learning or teaching initiatives,
clients. Interactive learning requires active learner participation, involving more than one profession in joint, interactive learning,
and active exchange between learners from different professions. as described in the IPE definition above.
Types of outcome measures

OBJECTIVES 1. Objectively measured or self reported (validated instrument)
The two objectives of this review are: patient/client outcomes in the following areas: health status mea-
sures; disease incidence, duration or cure rates; mortality; compli-
1. to assess the effectiveness of IPE interventions compared to cation rates; readmission rates; adherence rates; satisfaction; con-
separate, profession-specific education interventions in which the tinuity of care; use of resources (e.g. cost-benefit analyses).
same professions were learning separately from one another;
2. Objectively measured or self reported (validated instrument)
2. to assess the effectiveness of IPE interventions compared healthcare process measures (e.g. skills development, changes in
with control groups which received no education intervention. practice style, interprofessional collaboration, teamwork).
In the first objective we are seeking to understand the effects of
IPE better in relation to the current dominant uniprofessional
education model, where ideally the control group should receive Search methods for identification of studies
the same education in a uniprofessional manner. We included the See:
second objective as there was a lack of studies addressing the first Cochrane Effective Practice and Organisation of Care Group
objective. Our rationale for doing so was that while studies that do methods used in reviews.
not meet the first objective are not as rigorous as those that do, such Effective Practice and Organisation of Care Group (EPOC)
studies do nevertheless have value in providing some indication of specialized register (epoc.cochrane.org/epoc-register-studies), July
the effects of IPE. 2006 to 2 August 2011.
The search strategy from the previous IPE Cochrane review was
adapted for each of the following databases searched:
METHODS • MEDLINE August week 4 2006 to July week 3 2011;
• CINAHL, July 2006 to 2 August 2011.
See Appendix 1 and Appendix 2 for the search strategies
Criteria for considering studies for this review No language restrictions were placed on the search strategy.
We also handsearched the Journal of Interprofessional Care (2006 to

2011), proceedings from key interprofessional conferences - ’All
Types of studies
Together Better Health’ (Sydney, April 2010) and ’Collaborating
Randomised controlled trials (RCTs), controlled before and after Across Borders’ (Minneapolis, October 2007 and Halifax, May
(CBA) studies and interrupted time series (ITS) studies. 2008) and the grey literature contained on the websites of the UK
Centre for the Advancement of Interprofessional Education (date
accessed: 15 September 2011) and the Canadian Interprofessional
Types of participants Health Collaborative (date accessed 16 September 2011). In ad-
Health and social care professionals (e.g. chiropodists/podia- dition, we drew on our international networks to ensure that all
trists, complementary therapists, dentists, dieticians, doctors/ relevant published and unpublished work in the field would be
physicians, hygienists, psychologists, psychotherapists, midwives, identified. These searches generated 76 abstracts. See Figure 1.
Figure 1. Flow diagram.(*Total refers to sum of 1999 review and updates in 2008 and 2012).
A total of 3069 abstracts were found: 1248 from CINAHL, 285
from EPOC, 1460 from MEDLINE, 76 from handsearching and 4. the intervention was evaluated using an RCT, CBA or ITS
conference abstracts. After duplicates were removed, 2733 ab- design.
stracts remained. While the abstract search was sensitive to iden- Twenty-eight studies were identified from this abstract search as
tifying a high proportion of relevant IPE intervention studies, it potentially meeting these criteria. The full text of these articles was
exhibited low specificity in relation to differentiating between IPE obtained. These three review authors independently assessed each
interventions and other interprofessional teamwork interventions full-text article to examine whether it met all of the criteria further.
without IPE components, such as continuous quality improve- Any disagreements and uncertainties were resolved by discussion,
ment and total quality improvement initiatives. See Figure 1 for and the input of a fourth review author (MZ), who reviewed all
further information. of the final papers as a further quality check for inclusion in the
review. Nine studies met the outlined criteria; these nine studies
Data collection and analysis were added to the six studies from the previous review for a total
Three review authors (SR, LP and JG) independently reviewed of 15 studies.
the 2733 abstracts retrieved by the searches to identify all those
that suggested that:
1. there was an intervention where interprofessional exchange Assessment of the risk of bias in included studies
occurred; Two review authors (SR and LP) assessed the risk of bias for each
2. education took place; study using a form with the standard criteria described in EPOC
3. professional practice, patient care processes or health or (2002). The ’Risk of bias’ assessments are displayed in Figure 2
patient satisfaction outcomes were reported; and Figure 3. The ’Risk of bias’ summary is in Figure 4.
Figure 2.
Figure 3.
Figure 4. Risk of bias summary: review authors’ judgements about each risk of bias item for each included
study.
We did not exclude studies on the grounds of risk of bias, but
sources of bias are reported when presenting the results of studies. nutritionists and psychologists also participating in some teams.
All 10 health centres implemented a clinical information system
Data extraction and provided the opportunity for patients to participate in peer
support groups. Beyond this, five health centres were randomly
Three review authors (SR, LP and JG) extracted the following assigned to receive the intervention, and five received no inter-
information from included studies: vention. The intervention consisted of a multifaceted quality im-
1. type of study (RCT, CBA, ITS); provement initiative during which teams and patients participated
2. study setting (country, healthcare setting); in three interprofessional learning sessions within a period of 18
3. types of study participants; months. These included a structured patient diabetes education
4. description of education programme; programme, training in foot care and in-service training. In each
5. description of any other interventions in addition to the of the three learning sessions, the teams selected specific objectives
education; for ’plan-do-study-act’ (PDSA) improvement cycles. The objec-
6. main outcome measures; tives were based on problems identified in the practice of each
7. results for the main outcome measures; health centre (e.g. organisation of care, decision support, informa-
8. any additional information that potentially affected the tion sharing). Other aspects of the multifaceted quality improve-
results. ment programme included support from hospital specialists and a
case management advisor. Reported outcome measures included
Analysis clinical observations (e.g. metabolic control and cholesterol) and
adherence to clinical protocols (e.g. conducting periodic foot and
Ideally, a meta-analysis of study outcomes would have been con-
eye examinations). The authors reported that multilevel logistic
ducted for this review. However, this was not possible due to het-
regression models were adjusted for the clustering of participants
erogeneity of study designs, interventions and outcome measures
within health centres.
among the small number of included studies (n = 15). Conse-
Brown 1999 undertook an RCT that aimed to examine whether
quently, the results are presented in a narrative format.
an interprofessional communication skills training programme
for physicians, physician assistants, nurse practitioners and op-
tometrists increased participants’ ratings of clinicians’ communi-
cation skills. The healthcare professionals worked for a ’not for
RESULTS profit’ group-model health maintenance organisation (HMO) in
the US. The IPE intervention, led by two physicians, consisted
Description of studies of two four-hour workshops delivered one month apart with two
hours of homework and a telephone call from an instructor inbe-
See: Characteristics of included studies; Characteristics of excluded
tween. The intervention involved didactic components, role play-
studies.
ing and interactive dialogue. Of the 69 participants (75% of whom
All 15 studies addressed objective number two - to assess the effec-
were physicians), 37 were randomly assigned to receive the inter-
tiveness of IPE interventions compared with control groups that
vention and 32 were assigned to the control group (which received
received no education intervention. Given the major differences
the IPE intervention after the study). Pre- and post-intervention
between the included studies, a description of each is provided
patient satisfaction scores were drawn from routine data collec-
below. A formal calculation of the evidence, including the creation
tion, which yielded clinician-specific patient satisfaction ratings
of a ’Summary of findings’ table, was not feasible given the lack of
every six months. The HMO contracted out the routine data col-
overlap among the outcomes reported. The included studies are
lection. The contractor randomly sampled clinical consultations
presented in three sections according to the type of research design
and mailed a questionnaire to the relevant participants within 10
they employed.
days of each consultation in the sample.
Campbell 2001 described an RCT that evaluated an interprofes-
Randomised controlled trials sional training programme for emergency department (ED) physi-
cians, nurses, social workers, hospital administrators and repre-
Barcelo 2010 described an RCT that aimed to improve the quality
sentatives from local domestic violence service organisations. The
of diabetes care in primary healthcare centres using the chronic
intervention aimed to increase the identification of acutely abused
care model. Forty-three primary care teams based in 10 public
women in EDs, and improve staff and institutional responses.
health centres participated in this study. Teams were made up
The two-day programme, developed and implemented by violence
mainly of physicians and nurses with other professionals, such as
prevention organisations, involved didactic instruction, role play, study. All teams had representatives from medicine, nursing, occu-
team planning and team work to develop a written action plan. pational therapy, speech-language pathology, physiotherapy and
Participants from each ED were asked to meet before and after the social work. The team training intervention consisted of a multi-
training. The programme addressed systems change and coalition phase IPE programme delivered over six months, including: an in-
building as well as provider attitudes and skill building. The atten- teractive workshop emphasising team dynamics, problem solving,
dees were expected to collaborate in order to implement system the use of performance feedback data and the creation of action
changes in their respective EDs, including implementing training plans for process improvement. The intervention also included
for ED staff. The instructors were available for telephone assis- follow-up telephone and video-conference consultations. Patient
tance during the implementation phase. Six EDs were randomly outcomes data (functional improvement, community discharge,
assigned to receive either the IPE intervention (three hospitals) or length of stay) were gathered from 579 stroke patients treated by
to be in a control group that received no intervention (three hos- these teams before and after the intervention.
pitals). Follow-up data were collected at nine to 12 months and Thompson 2000a described a group RCT aimed at evaluating the
18 to 24 months. effectiveness of IPE and a clinical practice guideline aimed at im-
Helitzer 2011 reported an RCT that evaluated the effects of an proving the recognition and improvement of depression in pri-
intervention aimed at improving patient-centred communication mary care practices. A primary care physician, practice nurse and
skills and proficiency in discussing patients’ health risks. Twenty- community mental health nurse delivered the four-hour IPE sem-
six primary care professionals (physicians, physician assistants and inars to general practitioners and practice nurses in groups of two
nurse practitioners) based in a single academic setting participated or three practices when convenient. Teaching was supplemented
in the intervention. A total of 12 professionals were allocated to by video-tape recordings, small-group discussion of cases and role
the intervention group and 14 to the control group. The inter- play. The educators were available for nine months after the sem-
vention consisted of training focused on patient-centred commu- inars to facilitate guideline implementation and promote use of
nication about behavioural risk factors and included a full day teamwork. Fifty-nine primary care practices were assigned to the
of IPE, individualised feedback on video-taped interactions with intervention group (29 practices) or control group (30 practices).
simulated patients, and optional workshops to reinforce strategies Practices in the control group received the IPE intervention after
for engaging the patient. Data were gathered from patients on the study had been completed. Data were collected six weeks and
professionals’ patient-centred communication behaviour during six months after patient visits.
two clinic visits that were held at six and 18 months following the Thompson 2000b undertook a cluster RCT to examine the ef-
intervention. fectiveness of a one-year intervention linked to improving identi-
Nielsen 2007 described a cluster RCT study to evaluate the effec- fication of domestic violence and the collaborative management
tiveness of a teamwork training intervention in reducing adverse of primary care clinics. The intervention for teams of physicians,
outcomes and improving the process of care in hospital labour and nurse practitioners, physician assistants, registered nurses, practi-
delivery units. Fifteen hospitals took part in this study, seven as cal nurses and medical assistants, consisted of two half-day IPE
intervention sites and eight as control sites. Participants included sessions, a bimonthly newsletter, clinic educational rounds, sys-
labour and delivery room personnel from obstetrics, anaesthesiol- tem support (posters, cue cards, questionnaires) and feedback of
ogy and nursing (n = 1307). The intervention consisted of a three- results. Five primary care clinics were randomly assigned to receive
day instructor training session comprising four hours of didac- the intervention (two clinics) or to the control group (three clin-
tic lessons, video scenarios and interactive training covering team ics). Data were collected at baseline, nine to 10 months, and 21
structure and processes, planning and problem solving, communi- to 23 months.
cation, workload management and team skills. The intervention
also included assistance with creation and structure of interpro-
fessional teams at each intervention site, which entailed facilita- Controlled before and after studies
tors conducting onsite training sessions to structure each unit into
Janson 2009 reported a CBA study aimed at improving the care
core interprofessional teams. In addition, a contingency team, a
and outcomes of people with type 2 diabetes by improving the
group of physicians and nurses drawn from practitioners that were
care delivered by interprofessional teams. Participants consisted
on call during a 24-hour period, were trained to respond in a co-
of interprofessional teams of 120 learners (56 second/third-year
ordinated way to obstetric emergencies. Data were gathered on
medicine residents, 29 second-year nurse practitioner students and
adverse maternal or neonatal outcomes as well as clinical process
35 fourth-year pharmacy students) who delivered team-based dia-
data from 28,536 deliveries.
betes care to 221 people. The control group consisted of 28 tradi-
Strasser 2008 described a cluster RCT aimed at evaluating the
tional-track internal medicine residents who provided usual care
effects of an IPE intervention on team functioning in stroke re-
to 163 people. The study was undertaken in two general medicine
habilitation units. A total of 227 staff on 14 intervention teams
clinics. The intervention involved weekly didactic presentations,
and 237 clinical staff on 15 control teams participated in this
clinical discussions and clinic visits with participants. A quality
improvement approach was offered by planning and implement- Young 2005 presented a CBA study that evaluated effects of a
ing projects using the plan-do-study-act model. The intervention consumer-led innovation aimed at improving the competence of
group also received quarterly patient panel reports on process of mental health practitioners working in community mental health
care benchmarks and clinical status markers. provider organisations. The practitioner intervention for psychi-
Morey 2002 presented a CBA study to evaluate the effectiveness of atrists, nurses, therapists, case managers, residential staff, mental
a programme aimed at improving collaborative behaviour of hospi- health workers, and administrative support involved six educa-
tal ED staff (physicians, nurses, technicians and clerks). The inter- tional components held over a one-year period that included pre-
vention consisted of an emergency team co-ordination education sentations, discussions, small groups and role-playing techniques,
course as well as implementation of formal teamwork structures as well as three or four full-day follow-up visits to sites. An addi-
and processes. A physician-nurse pair from each ED was involved tional 16 hours was also spent with staff at the sites. The interven-
in developing and implementing the curriculum. The course con- tion was developed and delivered by two people who were con-
sisted of eight hours of instruction in one day. The format was lec- sumers of mental health services. The innovation also involved a
tures, discussion of behaviours, practical exercises and discussion consumer-focused intervention. The study was conducted at five
of video-segments. Teamwork implementation involved forming organisations in two states; one organisation in each state received
teams by shift and delivering care in a team structure. Each staff the intervention (total of 269 mental health practitioners, 151 in
member completed a four-hour practicum in which teamwork intervention groups and 118 in control groups). Data were col-
behaviours were practised and critiqued by an instructor. Staff lected at baseline and one year.
supported the adoption of collaborative behaviour during normal
shifts. This teamwork implementation phase lasted six months.
Nine hospital EDs self selected to receive either the IPE interven- Time interrupted series studies
tion (six EDs, 684 clinicians) or act as a control (three EDs, 374
Hanbury 2009 described an ITS study that aimed to test the ef-
clinicians). Control group departments received the intervention
fectiveness of a theory of planned behaviour intervention to in-
at a later date. Data were collected at two four-month intervals
crease community mental health professionals’ adherence to a na-
following the training.
tional suicide prevention guideline. The intervention was deliv-
Rask 2007 presented a CBA study that aimed to evaluate an in-
ered to 49 participants. The intervention comprised three com-
terprofessional fall management quality improvement project in
ponents designed to target normative beliefs. First, a presenta-
nursing homes. Participants consisted of 19 interprofessional falls
tion that contained factual statements, statistics and graphs taken
teams (made up of a nurse, physiotherapist or occupational thera-
from key government publications highlighting and supporting
pist, certified nursing assistants, a member of maintenance staff ).
the guideline evidence base. Second, an interprofessional group
The control group comprised 23 falls teams. The intervention
discussion was facilitated to ensure that positive normative beliefs
consisted of a full-day interprofessional workshop and a second
were emphasised and any negative normative beliefs challenged.
workshop approximately one month later to address arising chal-
Third, interprofessional group work based on two real life vignettes
lenges. Organisational interventions were also provided in the
was undertaken by participants. Data in the form of aggregated,
form of seeking leadership buy-in and support, providing a desig-
monthly audit adherence data were collected for nearly four years
nated facility-based falls co-ordinator, and ongoing consultation
(28 months before the intervention and 18 months afterwards) to
and oversight by advanced practice nurses with expertise in falls
evaluate patterns of adherence to using the national suicide pre-
management. Data were gathered on process of care documenta-
vention guideline. Data from a control site was also included to
tion, trends in fall rates and changes in physical restraint use.
evaluate the level of adherence.
Weaver 2010 described a CBA study that evaluated an interven-
Taylor 2007 presented an ITS study that assessed the effects an
tion aimed at improving teamwork for operating room staff based
intervention designed to improve the delivery of standard diabetes
at two community-based hospitals. In total, 55 professionals par-
services and patient care. Professionals based in a single primary
ticipated in the intervention: 29 in the intervention group (three
care clinic participated in the study. An eight-hour intervention
surgeons, nine nurses, three surgical technicians, 12 anaesthesiol-
was delivered to participants. The intervention consisted of a range
ogists, two physician assistants); and 26 in the control group (two
of interactive activities (task redistribution, standardised commu-
surgeons, 18 nurses, three surgical technicians, three anaesthesiol-
nication methods and decision-support tool development) that
ogists). The intervention consisted of one four-hour session that
aimed to improve interprofessional communication, teamwork,
included didactic presentations and interactive role-playing activ-
workflow organisation and information exchange in order to en-
ities between participants aimed at improving their knowledge
hance the care of 619 people with diabetes. Data were collected
and skills of teamwork and collaboration. Data were gathered by
from medical records. Using 1805 clinic visits completed during
observed changes in collaborative behaviour (frequency of team
the study period (160 pre-intervention clinic days and 122 post-
briefings in which information was shared among team members
intervention clinic days), diabetic services and associated patient
and patient care was planned).
outcomes were evaluated for adherence to the American Diabetes
Association periodicity recommendations and treatment targets: 2010). Only two studies were free of other bias (Janson 2009;
quarterly blood sugar; quarterly blood pressure; annual low-den- Morey 2002) (see Figure 2).
sity lipoprotein; annual urine microalbumin; and annual lower
extremity amputation prevention check.
Interrupted time series studies
Both ITS studies were adequate for pre-specifying the shape of
Risk of bias in included studies the intervention effect and for the intervention to be unlikely to
affect data collection. Taylor 2007 was unclear in their reporting
The risk of bias in studies was variable. Data are presented for of whether the intervention was independent of other changes,
RCTs and CBA studies (Figure 2), and separately for ITS studies and were inadequate with regards to selective outcome reporting.
(Figure 3). Hanbury 2009 did not address all incomplete outcome data. Both
ITS studies were not free of other bias (see Figure 3).
All studies
For the eight studies that were RCTs, four met five of the
nine EPOC ’Risk of bias’ criteria (Brown 1999; Nielsen 2007;
Effects of interventions
Thompson 2000a; Thompson 2000b). Three of the five CBA See: Summary of findings for the main comparison
studies met five of the nine EPOC ’Risk of bias’ criteria (Janson Effects of IPE interventions reported in each of the studies are
2009; Morey 2002; Young 2005). The EPOC ’Risk of bias’ criteria presented by the research design each employed.
have seven elements for ITS studies and one of the two studies met
four of the seven EPOC ’Risk of bias’ criteria (Hanbury 2009).
Randomised controlled trials
The results of the study by Barcelo 2010 indicated that the pro-
Randomised controlled trials portion of people with good glycaemic control (glycosylated hae-
Four of the eight RCTs reported adequately protecting against moglobin (HbA1c) < 7% (53 mmol/mol)) among those in the
contamination (Campbell 2001; Strasser 2008; Thompson 2000a; intervention group increased from 28% to 39% after the interven-
Thompson 2000b). All of the RCTS demonstrated adequate sim- tion (p value < 0.05). The proportion of people achieving three or
ilar baseline outcome measurements. Only one study was in- more quality improvement goals increased from 16.6% to 69.7%
adequate with regards to baseline characteristics being similar (p value < 0.001) among the intervention group while the control
(Campbell 2001). Inadequate allocation concealment was an issue group experienced a non-significant decrease from 12.4% to 5.9%
in four of the RCTs, with studies either failing to conceal allocation (p value = 0.118).
or not making this clear (Barcelo 2010; Campbell 2001; Helitzer In the study by Brown 1999, the communication skills training
2011; Thompson 2000b). The same four RCTs were unclear or programme did not improve patient satisfaction scores. Based on
failed in their reporting of adequate sequence generation (Barcelo an average of 81 responses for each of the 69 participating clini-
2010; Campbell 2001; Helitzer 2011; Thompson 2000b). Four cians, there was no significant difference in the mean satisfaction
RCTs were unclear or inadequate with regards to the adequacy of scores for the intervention and control groups: each group showed
blinding in the assessment of outcomes (Barcelo 2010; Helitzer a very small increase in mean scores on 9-point scales (intervention
2011; Nielsen 2007; Strasser 2008). Three RCTs were unclear or group 0.03 points and control group 0.05).
had evidence of selective outcome reporting (Barcelo 2010; Brown The results in Campbell 2001 study indicated that the EDs
1999; Thompson 2000a). All RCTs had evidence of other bias. that received the intervention to improve responses to acutely
abused women recorded significantly higher levels on all compo-
nents of the “culture of the emergency department” system-change
Controlled before and after studies indicator (e.g. appropriate protocols; materials such as posters,
Allocation concealment was an issue for all CBA studies. Four brochures, medical record intervention checklists and referral in-
of the CBA studies did not address incomplete outcome data ( formation available to staff; and staff training) (F = 5.72, p value =
Janson 2009; Rask 2007; Weaver 2010; Young 2005). Two of the 0.04) and higher levels of patient satisfaction (F = 15.43, p value
studies did not demonstrate adequate sequence generation (Janson < 0.001) than the EDs in the control group.
2009; Weaver 2010); or selective outcome reporting and adequate Helitzer 2011 reported that the intervention generated signifi-
blinding (Rask 2007; Weaver 2010). All CBA studies ensured cant and persistent changes in patient-centred communication in
baseline outcome measurements were similar with the exception the intervention group. After six months, a significant difference
of one (Weaver 2010). Two studies did not report similar baseline was found in scores for patient-centredness, which favoured the
characteristics (Weaver 2010; Young 2005); or that the study was intervention group (F(1, 20.59) = 8.43, p value < 0.01). After
adequately protected against contamination (Rask 2007; Weaver 18 months, the intervention group’s significantly higher patient-
centredness scores were sustained (F(1, 17.16) = 5.48, p value = behaviour in EDs, showed a statistically significant improvement
0..032). in quality of observed team behaviours between the intervention
Nielsen 2007 found overall no statistically significant differences and control groups following training (p value = 0.012). The clin-
between the intervention and control groups. Data on adverse ical error rate significantly decreased from 30.9% to 4.4% in the
outcome prevalence were similar in the control and intervention intervention group (p value = 0.039).
groups, both at baseline and after implementation of teamwork Rask 2007 reported that several key areas of documentation re-
training (9.4% versus 9.0% and 7.2% versus 8.3%, respectively). garding assessment and management of fall risk factors improved.
However, the time from the decision to the incision for an im- All except two were statistically significant for the intervention
mediate caesarean delivery was significantly shorter in the inter- teams. Fall rates were not significantly different for the interven-
vention group (p value = 0.03). In addition, one process measure, tion nursing homes (p value = 0.92) and were significantly posi-
the time from the decision to perform an immediate caesarean tive (p value = 0.008) for the control sites. Restraint use decreased
delivery to the incision, differed significantly after team training substantially during the project period, from 7.9% to 4.4% in
(33.3 minutes versus 21.2 minutes, p value = 0.03). the intervention nursing homes (a relative reduction of 44%) and
Strasser 2008 reported a significant difference in improvement from 7.0% to 4.9% at the control sites (a relative reduction of
in motor score between the intervention group and the control 30%).
group (13.6% of people in the intervention gained more than 23 Weaver 2010 reported that intervention participants engaged in
points, p value = 0.038). There was no significant difference for significantly more team pre-case briefings after attending training
the other two outcome measures (p value = 0.1) for both. The (F [1, 147] = 35.01, p value < 0.001). There was also a significant
proportion of people who had had a stroke making greater than increase in the proportion of information sharing (e.g. interven-
the median functional gain increased by 4.4% in the intervention tion team members were more willing to speak up and participate
group, whereas it decreased by 9.2% in the control group, lending during briefings) (F [1,128] = 11.47, p value < 0.001). This pat-
further support to the effect of the intervention. At the same time, tern was also present in the frequency of care plan discussions (F
the intervention had no measurable effect on participants’ length [1,145] = 5.00, p value < 0.05).
of stay. Young 2005 reported that in comparison to mental health prac-
Thompson 2000a reported no differences between the interven- titioners in the control group, practitioners in the intervention
tion and control groups in relation to the recognition of depres- group reported significantly higher scores in relation to the follow-
sive symptoms in their evaluation of the effectiveness of an IPE ing competencies: teamwork (r = 0.28, p value = 0.003); holistic
and clinical practice guideline intervention. The outcome for peo- approaches (r = 0.17, p value = 0.06); education about care (r =
ple diagnosed with depression did not significantly improve at six 0.22, p value = 0.03); rehabilitation methods (r = 0.25, p value =
weeks or six months after the intervention. 0.007) and overall competency (r = 0.21, p value = 0.02).
Thompson 2000b reported that following the intervention, doc-
umentation of domestic violence incidents increased by 14.3%.
Time interrupted series studies
It is also stated that there was a 3.9-fold relative increase of docu-
mentation at nine months in intervention clinics compared to the Hanbury 2009 reported that the intervention did not significantly
control sites. Overall case finding increased by 30%, but this was increase adherence to the national guideline. Multiple regression
not statistically significant. Recorded quality of domestic violence was used to calculate the proportion of variance in intention ac-
patient assistance did not change. counted for by the predictors, and identify the most significant
predictor. The intervention was found to account for 58% of the
variance (adjusted R2 = 0.58) in intention to adhere to the guide-
line, a statistically significant finding (F = 23.586, 3 degrees of
Controlled before and after studies
freedom (df ), p value = 0.0001).
Janson 2009 reported that, at study completion, intervention Taylor 2007 found that the intervention achieved improvements
group participants more frequently received assessments of HbA1c in microalbumin testing (+7.40%, p value = 0.001) and HbA1c
(79% versus 67%; p value = 0.01), low-density-lipoprotein choles- testing (+3.80%, p value = 0.029). A significant increase in mi-
terol (69% versus 55%; p value = 0..009), blood pressure (86% croalbumin levels that were at target (+3.87%, p value = 0.018),
versus 79%; p value = 0.08), microalbuminuria (40% versus 30%; and a significant decrease in HbA1c levels that were also at target
p value = 0.05), smoking status (43% versus 31%; p value = 0.02), (-3.81%, p value = 0.011). It is unclear in the reporting if the in-
and foot examinations (38% versus 20%; p value = 0.0005). It tervention is independent of other changes. In addition, outcomes
was also reported that intervention group participants had more were not assessed blindly.
planned general medicine visits (7.9 = 6.2 versus 6.2 = 5.7; p value
= 0.006) than did control group participants.
The results of Morey 2002 evaluation of the effectiveness of an
interprofessional teamwork training programme on collaborative DISCUSSION
In total, this review included 15 studies, locating nine new stud- the education, and the clinical areas and settings. The IPE compo-
ies, which were added to the six studies from the previous update nent in these studies ranged from a few hours, to a few days, to lon-
(Reeves 2008). This small growth of eligible studies marks con- gitudinal programmes that were delivered over one year or more.
tinued development of the IPE field, as the first IPE review found The professional mix of participants also varied from surgeons,
no eligible studies (Zwarenstein 2000). nurses, surgical technicians, anaesthesiologists and physician as-
sistants (Weaver 2010), to nurses, physiotherapists, occupational
Seven of the studies reported positive outcomes in the following therapists, nursing assistants and maintenance staff (Rask 2007).
areas: improvements in diabetes clinical outcomes and healthcare The aims of the interventions also varied. For example in studies
quality improvement goals (Barcelo 2010); improvements in pa- by Brown 1999 and Helitzer 2011, the emphasis was on commu-
tient-centred communication (Helitzer 2011); improved clinical nication between clinicians and participants, whereas other stud-
outcomes for people with diabetes (Janson 2009); collaborative ies explicitly focused on interprofessional team work in the con-
team behaviour and reduction of clinical error rates for ED teams text of particular settings (ED, operation room) (e.g. Morey 2002;
(Morey 2002); increased rates of diabetes testing and improved Weaver 2010).
patient outcomes (Taylor 2007); improved mental health practi-
tioner competencies related to the delivery of patient care (Young Despite three studies sharing a focus on improving diabetes care
2005); and improved team behaviours and information sharing (Barcelo 2010; Janson 2009; Taylor 2007), each employed a dif-
for operating room teams (Weaver 2010). Three of the studies ferent research design: an RCT (Barcelo 2010), a CBA (Janson
also reported that the gains attributed to IPE were sustained over 2009) and an ITS (Taylor 2007). The interventions were differ-
time: eight months (Morey 2002) and 18 months (Barcelo 2010; ent: from a single eight-hour IPE session (Barcelo 2010), to three
Helitzer 2011). workshops (Taylor 2007), to weekly seminars (Janson 2009). The
participants also varied, from physicians, nurses, nutritionists and
In addition, four studies (Campbell 2001; Rask 2007; Strasser psychologists based at 10 public health centres (Barcelo 2010),
2008; Thompson 2000b) reported a mixed set of outcomes. As to 120 students (medical residents, senior nurse practitioner and
well as reporting positive outcomes in relation to changes in pro- pharmacy students) (Janson 2009), to an existing team of profes-
fessional practice and patient satisfaction, Campbell 2001 found sionals (who were not identified) based in a single clinic (Taylor
no differences in the identification rates of victims of domestic vi- 2007). These few examples are some indication of the degrees of
olence between their intervention and control groups. While Rask heterogeneity and why it is difficult to summarise and identify key
2007 reported improvements in care documentation and decreases elements of successful IPE.
in the use of restraint for people in nursing homes, they found no
change in fall rates. Despite reporting functional gains for patients, Eight of the studies (Barcelo 2010; Campbell 2001; Janson 2009;
Strasser 2008 also reported no significant difference in length of Morey 2002; Nielsen 2007; Rask 2007; Thompson 2000b; Young
stay or rates of community discharge for stroke rehabilitation pa- 2005) contained multi-faceted interventions, of which the IPE was
tients. Thompson 2000b found that documented asking about only one component. The other interventions included team re-
domestic violence significantly increased, yet the increase in case structuring, tools such as posters and questionnaires, measurement
finding was not significant. and feedback, and consumer-directed interventions. In these stud-
ies, the authors commented on the importance of system change
Four studies reported that the IPE interventions had no impact and the time and resources required to facilitate it (Campbell
on either healthcare processes or patient health care or outcomes: 2001), the need for leaders who support teamwork within organi-
Brown 1999 found no significant difference in the improvement sations (Morey 2002; Rask 2007) and the use of quality improve-
of routinely collected patient satisfaction scores between interven- ment projects (Barcelo 2010; Janson 2009).
tion and control groups; Hanbury 2009 reported that the interven-
tion did not significantly increase adherence among participants; Methodologically, the studies shared a common key limitation.
Nielsen 2007 reported no statistically significant differences be- All comparative studies (RCTs and CBAs, n = 13) compared the
tween the intervention and control groups; and Thompson 2000a effects of the IPE interventions with control groups that received
reported that there were no differences between the intervention no educational intervention. As a result, it is difficult to assess
and control groups in relation to the recognition or treatment of the effects of the IPE. Furthermore, most of the included studies
patients with depression. involved small samples (defined as fewer than 100 individually
randomised practitioners or fewer than 20 randomised clusters),
Although overall the results indicate some positive outcomes re- which limited their ability to provide a convincing level of gener-
lated to IPE, its effectiveness remains unclear at this time due to alisable evidence for the effects of the IPE interventions.
the heterogeneity among the 15 studies as well as their method-
ological limitations, as outlined above. The studies were heteroge- It is also worth noting that there was little evidence of preliminary
neous in relation to the objectives and format of the educational studies to optimise the IPE interventions and evaluation strate-
intervention, the existence of other interventions in addition to gies. IPE interventions are complex, multifaceted interventions in
which the components may act both independently and interde- AUTHORS’ CONCLUSIONS
pendently. Guidance on the development and testing of complex
interventions stresses the importance of stepwise work to under- Implications for practice
stand the context for the intervention fully, and optimise the de-
Our first IPE review published in 1999 found no eligible stud-
sign and implementation of the intervention and evaluation be-
ies, our 2008 update located six studies, and this update located a
fore proceeding to a trial (Craig 2008).
further nine studies. At 15 eligible studies, this demonstrates that
When planning future trials of IPE, thought should be given to the IPE field is growing steadily in terms of publishing rigorous
the following dimensions: better randomisation procedures, al- IPE research (those employing RCTs, CBA or ITS designs). Al-
location concealment, larger sample sizes and more appropriate though these studies reported a range of positive outcomes, the
control groups. Importantly, studies should include at least one heterogeneity of IPE interventions means it is not possible to draw
common outcome for measurement of teamwork to enable a for- generalisable inferences for the effects of IPE. Despite marking a
mal weighing up of the evidence; in addition, the remainder of step forward in beginning to establish an evidence base for IPE,
the outcomes should include a clear patient health outcome rather more rigorous IPE research (those employing RCTs, CBA or ITS
than only process measures. Given that IPE is delivered by two designs) is needed to demonstrate evidence of the impact of this
or more providers, future trials should have cluster randomised type of intervention on professional practice or healthcare out-
designs, and researchers are advised to be thoughtful about their comes, or both.
unit of analysis. In addition, given a lack of evidence on the impact
of IPE on resources (e.g. costs and benefits), attention is needed Implications for research
in this area. Despite a growth of IPE studies in the past few years, most of this
research does not employ rigorous designs. Future RCTs explic-
While uniprofessional education remains the dominant model
itly focused on IPE with rigorous randomisation procedures and
for delivering education for health and social care profession-
allocation concealment, larger sample sizes and more appropriate
als, IPE is increasingly becoming common. Advocacy and imple-
control groups would improve the evidence base of IPE. A focus
mentation of IPE reflects the premise that IPE will contribute
on understanding the use of IPE in relation to resources is also
to developing healthcare providers with the skills and knowledge
needed. These studies should also include data collection strate-
needed to work in a collaborative manner (Barr 2005; CIHC 2010;
gies that provide insight into how IPE affects changes in health-
Interprofessional Educ Collab Expert Panel 2011; WHO 2010).
care processes and patient outcomes as research to date has not
Interprofessional collaboration, in turn, is identified as critical to
sufficiently addressed this critical issue.
the provision of effective and efficient health care, given the com-
plexity of patients’ healthcare needs and the range of healthcare To improve the quality of evidence relating to IPE and patient
providers and organisations. In relation to implementing IPE at outcomes or healthcare process outcomes, the following three gaps
differing stages of the professional development continuum, it is will need to be filled: studies that assess the effectiveness of IPE
worth remembering that pre-qualification IPE can be regarded as interventions compared to separate, profession-specific interven-
an investment in the future and, in general, studies with short tions; RCT, CBA or ITS studies with qualitative strands examin-
periods of follow-up would not be expected to detect effects on ing processes relating to the IPE and practice changes; and cost-
patient outcomes or healthcare processes, which would be diffi- benefit analyses.
cult to pinpoint, due to a wide variety of potentially confounding
variables. Measuring patient outcomes or care process outcomes
arising from IPE after qualification (e.g. during continuing profes- What’s new
sional development and quality improvement initiatives) is more We completed a substantive update of review from 2008 to 2011.
feasible. But it still presents methodological challenges, particu- Nine new studies were found and added to the six studies located
larly identifying the influence of IPE within multifaceted inter- from the previous update.
ventions and, further, identifying key attributes of effective IPE.
Although this review located nine new IPE studies (which were
added to the six studies from the last update) their heterogeneity
ACKNOWLEDGEMENTS
limits the conclusions we can draw from this work. Nevertheless, a
continued increase in eligible studies represents a further positive Amber Fitzsimmons, doctoral student at University of California,
step forward in establishing a robust evidence base for the effects San Francisco, for her help with preliminary abstraction notes of
of IPE on professional practice and healthcare outcomes. some of the included studies.
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Bauer 2009 {published data only} 34(2):60–70.
Bauer G, Bossi L, Santoalla M, Rodriguez S, Farina D, Bradshaw 2011 {published data only}
Speranza AM. [Impact of a respiratory disease prevention Bradshaw LM, Gergar ME, Holko GA. Collaboration in
program in high-risk preterm infants: a prospective, wound photography competency development: a unique
multicentric study]. Archivos Argentinos de Pediatria 2009; approach. Advances in Skin & Wound Care 2011;24(2):
107(2):111–8. 85–92.
Beal 2006 {published data only} Buck 1999 {published data only}
Beal T, Kemper K J, Gardiner P, Woods C. Long-term Buck MM, Tilson ER, Andersen JC. Implementation and
impact of four different strategies for delivering an on-line evaluation of an interdisciplinary health professions core
curriculum about herbs and other dietary supplements. curriculum. Journal of Allied Health 1999;28(3):174–8.
BMC Medical Education 2006;6:39. Burns 2003 {published data only}
Belardi 2004 {published data only} Burns JP, Mello MM, Studdert DM, Puopolo AL, Truog
Belardi FG, Weir S, Craig FW. A controlled trial of an RD, Brennan TA. Results of a clinical trial on care
advanced access appointment system in a residency family improvement for the critically ill. Critical Care Medicine
medicine center. Family Medicine 2004;36(5):341–5. 2003;31(8):2107–17.
Bell 2000 {published data only} Buxton 2004 {published data only}
Bell CM, Ma M, Campbell S, Basnett I, Pollock A, Taylor Buxton L, Pidduck D, Marston G, Perry D. Development
I. Methodological issues in the use of guidelines and audit of a multidisciplinary care pathway for a specialist learning
to improve clinical effectiveness in breast cancer in one disability inpatient treatment and assessment unit. Journal
United Kingdom health region. European Journal of Surgical of Integrated Care Pathways 2004;8(3):119–26.
Oncology 2000;26(2):130–6. Cameron 2009 {published data only}
Cameron TS, McKinstry A, Burt SK, Howard ME, Bellomo
Bellamy 2006 {published data only}
R, Brown DJ, et al.Outcomes of patients with spinal cord
Bellamy A, Fiddian M, Nixon J. Case reviews: promoting
injury before and after introduction of an interdisciplinary
shared learning and collaborative practice. International
tracheostomy team. Critical Care & Resuscitation 2009;11
Journal of Palliative Nursing 2006;12(4):158–62.
(1):14–9.
Benjamin 1999 {published data only} Carew 2001 {published data only}
Benjamin EM, Schneider MS, Hinchey KT. Implementing Carew LB, Chamberlain VM. Interdisciplinary update
practice guidelines for diabetes care using problem-based nutrition course offered to educators through interactive
learning: a prospective controlled trial using firm systems. television. Journal of Nutrition Education 2001;33(6):
Diabetes Care 1999;22(1019):1672–8. 352–3.
Berg 2009 {published data only} Cobia 1995 {published data only}
Berg BW, Sampaga A, Garshnek V, Hara KM, Phrampus Cobia DC, Center H, Buckhalt JA, Meadows ME. An
PA. Simulation crisis team training effect on rural hospital interprofessional model for serving youth at risk for
safety climate (SimCritter). Hawaii Medical Journal 2009; substance abuse: the team case study. Journal of Drug
68(10):253–5. Education 1995;25(2):99–109. [MEDLINE: 95387218]
Coggrave 2001 {published data only} Fields 2005 {published data only}
Coggrave M. Care of the ventilator dependent spinal cord- Fields M, Peterman J. Intravenous medication safety system
injured patient. British Journal of Therapy & Rehabilitation averts high-risk medication errors and provides actionable
2001;8(4):146–9. data. Nursing Administration Quarterly 2005;29(1):78–87.
Connolly 1995 {published data only} Gandara 2010 {published data only}
Connolly PM. Transdisciplinary collaboration of academia Gandara E, Ungar J, Lee J, Chan-Macrae M, O’Malley
and practice in the area of serious mental illness. Australian T, Schnipper JL. Discharge documentation of patients
& New Zealand Journal of Mental Health Nursing 1995;4 discharged to subacute facilities: a three-year quality
(4):168–80. [MEDLINE: 97241876] improvement process across an integrated health care
Cooper 2005 {published data only} system. Joint Commission Journal on Quality & Patient Safety
Cooper H, Spencer-Dawe E, McLean E. Beginning 2010;36(6):243–51.
the process of teamwork: design, implementation and Hanson 2005 {published data only}
evaluation of an inter-professional education intervention Hanson LC, Reynolds KS, Henderson M, Pickard CG. A
for first year undergraduate students. Journal of quality improvement intervention to increase palliative care
Interprofessional Care 2005;19(5):492–508. in nursing homes. Journal of Palliative Medicine 2005;8(3):
Corso 2006 {published data only} 576–84.
Corso R, Brekken L, Ducey C, KnappPhilo J. Professional Harmon 1998 {published data only}
development strategies to support the inclusion of infants Harmon RL, Sheehy LM, Davis DM. The utility of external
and toddlers with disabilities in infant-family programs. performance measurement tools in program evaluation.
Zero to Three 2006;26(3):36–42. Rahabilitation Nursing 1998;23(1):8–11. [MEDLINE:
Crutcher 2004 {published data only} 98121755]
Crutcher RA, Then K, Edwards A, Taylor K, Norton P. Hayward 1996 {published data only}
Multi-professional education in diabetes. Medical Teacher Hayward KS, Powell LT, McRoberts J. Changes in student
2004;26(5):435–43. perceptions of interdisciplinary practice in the rural setting.
Dacey 2010 {published data only} Journal of Allied Health 1996;25(4):315–27. [MEDLINE:
Dacey M, Murphy JI, Anderson DC, McCloskey WW. An 97137480]
interprofessional service-learning course: uniting students Hien 2008 {published data only}
across educational levels and promoting patient-centered Hien le TT, Takano T, Seino K, Ohnishi M, Nakamura K.
care. Journal of Nursing Education 2010;49(12):696–9. Effectiveness of a capacity-building program for community
Dalton 1999 {published data only} leaders in a healthy living environment: a randomized
Dalton JA, Blau W, Lindley C, Carlson J, Youngblood R, community-based intervention in rural Vietnam. Health
Greer SM. Changing acute pain management to improve Promotion International 2008;23(4):354–64.
patient outcomes: an educational approach. Journal of Pain Hook 2003 {published data only}
and Symptom Management 1999;17(4):277–87. Hook AD, Lawson-Porter A. The development and
DeVita 2005 {published data only} evaluation of a fieldwork educator’s training programme for
DeVita, Schaefer J, Lutz J, Wang H, Dongilli T. Improving allied health professionals. Medical Teacher 2003;25(5):
medical emergency team (MET) performance using a novel 527–36.
curriculum and a computerized human patient stimulator. Hope 2005 {published data only}
Quality & Safety in Health Care 2005;14(5):326–31. Hope JM, Lugassy D, Meyer R, Jeanty F, Myers S, Jones
S, et al.Bringing interdisciplinary and multicultural team
Dienst 1981 {published data only}
building to health care education: the downstate team-
Dienst ER, Byl N. Evaluation of an educational program in
building initiative. Academic Medicine 2005;80(1):74–83.
health care teams. Journal of Community Health 1981;6(4):
282–98. [MEDLINE: 82120622] Horbar 2001 {published data only}
Dobson 2002 {published data only} Horbar JD, Rogowski J, Plsek PE, Delmore P, Edwards
Dobson S, Upadhyaya S, Stanley B. Using an WH, Hocker J, et al.Collaborative quality improvement for
interdisciplinary approach to training to develop the quality neonatal intensive care. NIC/Q project investigators of
of communication with adults with profound learning the Vermont Oxford Network. Pediatrics 2001;107(1383):
disabilities by care staff. International Journal of Language & 14–22.
Communication Disorders 2002;37(1):41–57. Hughes 2000 {published data only}
Falconer 1993 {published data only} Hughes TL, Medina Walpole AM. Implementation of an
Falconer JA, Roth EJ, Sutin JA, Strasser DC, Chang RW. interdisciplinary behavior management program. Journal of
The critical path method in stroke rehabilitation: lessons the American Geriatrics Society 2000;48(5):581–7.
from an experiment in cost containment and outcome James 2005 {published data only}
improvement. Quality Review Bulletin 1993;19(1):8–16. James R, Barker J. Evaluation of a model of interprofessional
[MEDLINE: 93205371] education. Nursing Times 2005;101(40):34–6.
Jones 2006 {published data only} Monette 2008 {published data only}
Jones D, Bates S, Warrillow S, Goldsmith D, Kattula A, Monette J, Champoux N, Monette M, Fournier L,
Way M, et al.Effect of an education programme on the Wolfson C, du Fort GG, et al.Effect of an interdisciplinary
utilization of a medical emergency team in a teaching educational program on antipsychotic prescribing among
hospital. Internal Medicine Journal 2006;36(4):231–6. nursing home residents with dementia. International Journal
of Geriatric Psychiatry 2008;23(6):574–9.
Jordan-Marsh 2004 {published data only}
Jordan-Marsh M, Hubbard J, Watson R, Deon Hall R, Nash 1993 {published data only}
Miller P, Mohan O. The social ecology of changing pain Nash A, Hoy A. Terminal care in the community - an
management: do I have to cry?. Journal of Pediatric Nursing evaluation of residential workshops for general practitioner/
2004;19(3):193–203. district nurse teams. Palliative Medicine 1993;7(1):5–17.
[MEDLINE: 94115720]
Kenward 2009 {published data only}
O’Boyle 1995 {published data only}
Kenward L, Stiles M. Intermediate care: an interprofessional
O’Boyle M, Paniagua FA, Wassef A, Hoizer C. Training
education opportunity in primary care. Journal of
health professionals in the recognition and treatment
Interprofessional Care 2009;23(6):668–71.
of depression. Psychiatric Services 1995;46(6):616–8.
Ketola 2000 {published data only} [MEDLINE: 95368428]
Ketola E, Sipil R, M’kel M, Klockars M. Quality Olivecrona 2010 {published data only}
improvement programme for cardiovascular disease risk Olivecrona C, Karrlander S, Hylin U, Tornkvist H, Jonsson
factor recording in primary care. Quality in Health Care C, Svensen C. [A successful educational program for
2000;9(3257):175–80. medical and nursing students. Interprofessional learning
Kwan 2006 {published data only} gives insights and strengthens team work]. Lakartidningen
Kwan D, Barker KK, Austin Z, Chatalalsingh C, Grdisa 2010;107(3):113–5.
V, Langlois S, et al.Effectiveness of a faculty development Ouslander 2001 {published data only}
program on interprofessional education: a randomized Ouslander JG, Maloney C, Grasela TH, Rogers L,
controlled trial. Journal of Interprofessional Care 2006;20(3): Walawander CA. Implementation of a nursing home
314–6. urinary incontinence management program with and
without tolterodine. Journal of the American Medical
Landon 2004 {published data only}
Directors Association 2001;2(5):207–14.
Landon BE, Wilson IB, McInnes K, Landrum MB,
Phillips 2002 {published data only}
Hirschhorn L, Marsden PV, et al.Improving patient
Phillips M, Givens C, Schreiner B. Put into practice: impact
care: effects of a quality improvement collaborative on
of a multidisciplinary education program for children and
the outcome of care of patients with HIV infection: the
adolescents with type 2 diabetes. Diabetes Educator 2002;
EQHIV study. Annals of Internal Medicine 2004;140(11):
28(3):400–2.
887–96.
Price 2005 {published data only}
Lawrence 2002 {published data only}
Price D, Howard M, Shaw E, Zazulak J, Waters H, Chan D.
Lawrence SJ, Shadel BN, Leet TL, Hall JB, Mundy LM.
Family medicine obstetrics: collaborative interdisciplinary
An intervention to improve antibiotic delivery and sputum
program for a declining resource. Canadian Family
procurement in patients hospitalized with community-
Physician 2005;51:68–74.
acquired pneumonia. Chest 2002;122(3):913–9.
Rogowski 2001 {published data only}
Lia-Hoagberg 1997 {published data only} Rogowski JA, Horbar JD, Plsek PE, Baker LS, Deterding
Lia-Hoagberg B, Nelson P, Chase RA. An interdisciplinary J, Edwards WH, et al.Economic implications of neonatal
health team training program for school staff in Minnesota. intensive care unit collaborative quality improvement.
Journal of School Health 1997;67(3):94–7. [MEDLINE: Pediatrics 2001;107(1384):23–9.
97225297] Rubenstein 1999 {published data only}
Llewellyn-Jones 1999 {published data only} Rubenstein LV, Jackson-Triche M, Unutzer J, Miranda
Llewellyn-Jones RH, Baikie KA, Smithers H, Cohen J, Minnium K, Pearson ML, et al.Evidence-based care
J, Snowdon J, Tennant CC. Multifaceted shared care for depression in managed primary care practices. Health
intervention for late life depression in residential care: Affairs 1999;18(5439):89–105.
randomised controlled trial. BMJ 1999;319(7211174): Ryan 2002 {published data only}
676–82. Ryan A, Carter J, Lucas J, Berger J. You need not make
McBride 2000 {published data only} the journey alone: overcoming impediments to providing
McBride P, Underbakke G, Plane MB, Massoth K, Brown palliative care in a public urban teaching hospital. American
R, Solberg LI, et al.Improving prevention systems in Journal of Hospice and Palliative Care 2002;19(3):171–80.
primary care practices: the health education and research Sauer 2010 {published data only}
trial (HEART). Journal of Family Practice 2000;49(2707): Sauer J, Darioly A, Mast MS, Schmid PC, Bischof
115–25. N. A multi-level approach of evaluating crew resource
management training: a laboratory-based study examining Wells 2000 {published data only}
communication skills as a function of team congruence. Wells K, Sherbourne C, Schoenbaum M, Duan N,
Ergonomics 2010;53(11):1311–24. Meredith L, Unutzer J, et al.Impact of disseminating quality
Smarr 2003 {published data only} improvement programs for depression in managed primary
Smarr KL. The effects of arthritis professional continuing care: a randomized controlled trial. JAMA 2000;283
education in vocational rehabilitation [unpublished Ph.D.]. (2176):212–20.
University of Missouri, Columbia 2003. Westfelt 2010 {published data only}
Westfelt P, Hedskold M, Pukk-Harenstam K, Svensson R
Smith 2005 {published data only}
M, Wallin C J. [Efficient training in cooperation within
Smith C, Rebeck S, Schaag H, Kleinbeck S, Moore JM,
your own emergency department. With patient simulation
Bleich MR. A model for evaluating systemic change:
and skilled trainers]. Lakartidningen 2010;107(10):685–9.
measuring outcomes of hospital discharge education
redesign. Journal of Nursing Administration 2005;35(2): Wisborg 2009 {published data only}
67–73. Wisborg T, Brattebo G, Brinchmann-Hansen A, Hansen
Stewart 2010 {published data only} K S. Mannequin or standardized patient: participants’
Stewart EE, Nutting PA, Crabtree BF, Stange KC, Miller assessment of two training modalities in trauma team
WL, Jaen CR. Implementing the patient-centered medical simulation. Scandinavian Journal of Trauma, Resuscitation
home: observation and description of the national & Emergency Medicine 2009;17:59.
demonstration project. Annals of Family Medicine 2010;8
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Thomas EJ, Taggart B, Crandell S, Lasky RE, Williams Berridge EJ, Mackintosh N, Freeth D. Supporting
AL, Love LJ, et al.Teaching teamwork during the Neonatal patient safety: examining communication within delivery
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Trummer UF, Mueller UO, Nowak P, Stidl T, Pelikan Campion-Smith C, Austin H, Criswick S, Dowling B,
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299–306. CIHC 2010
Tschopp 2005 {published data only} Canadian Interprofessional Health Collaboration. A
Tschopp JM, Frey JG, Janssens JP, Burrus C, Garrone S, national interprofessional competency framework, 2010.
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practitioners. Journal of Public Health Management and guidance. BMJ 2008;337:a1655.
Practice 2003;9(2):123–35. Frenk 2010
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Ward C, Wright M. Fast-track palliative care training to Panel. Core competencies for interprofessional
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10-242IPECFullReportfinal.pdf. Washington, D.C.: Suter 2012
Interprofessional Education Collaborative, (accessed 18 Suter E, Deutschlander S, Mickelson G, Nurani Z, Lait
February 2013). J, Harrison L, et al.Can interprofessional collaboration
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∗
265–7. [DOI: 10.1002/chp.20139] Indicates the major publication for the study
CHARACTERISTICS OF STUDIES
Characteristics of included studies [ordered by study ID]
Barcelo 2010
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 Unclear risk Describes that health centres were “
bias) randomly selected” (p. 146) but random
component in the sequence generation pro-
cess is not described
Allocation concealment (selection bias) Unclear risk Not specified
Baseline outcome measurements similar Low risk Reported in Table 5 (p. 150)
All outcomes
Baseline characteristics similar Low risk Reported in Table 1 (p. 148)
Incomplete outcome data (attrition bias) Unclear risk Not reported

All outcomes
Blinding of outcome assessment (detection Unclear risk Not reported

bias)
All outcomes
Contamination High risk Quote “…avoiding the contamination’ of

centers that acted as controls…was not pos-
sible” (p. 151)
Selective reporting (reporting bias) High risk Quote “…did not collect data on interme-
diate process variables” (p. 151)
Other bias High risk Short follow-up (p. 151)
Brown 1999
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 work-
shops 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
Random sequence generation (selection Low risk Quote “…we used a random-number ta-
bias) ble” (p. 823)
Allocation concealment (selection bias) Low risk Quote “we used a random-number table to
assign persons to the intervention or con-
trol group” (p. 823)
All outcomes
Baseline characteristics similar Low risk Quote “Table 1 compares the characteris-
tics 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
All outcomes was modified (p. 825)
Blinding of outcome assessment (detection Low risk Outcomes were obtained from quote “an
bias) anonymous questionnaire that was mailed
All outcomes to patients by a contractor to the HMO”
(p. 823)
Brown 1999 (Continued)
Contamination Unclear risk Not specified if control group could have

received similar training through other ed-
ucational opportunities
Selective reporting (reporting bias) Unclear risk Insufficient information to make an assess-
ment
Other bias High risk Survey not validated (p. 824)
Campbell 2001
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
Random sequence generation (selection Unclear risk Not specified

bias)
Baseline outcome measurements similar Low risk Quote “This evaluation used an experi-
All outcomes mental design with baseline (pretest), im-
mediate (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)
All outcomes
Campbell 2001 (Continued)
Blinding of outcome assessment (detection Low risk Reviewers had “no knowledge of an indi-
bias) vidual woman’s responses to acute abuse”
All outcomes (p. 136)
Contamination Low risk Sites geographically spread across Califor-

nia and Pennsylvania (p. 132)
Selective reporting (reporting bias) Low risk All relevant outcomes in the methods sec-
tion are reported in results
Other bias High risk Only 1 intervention hospital sent a com-

plete team for training (p. 134); insuffi-
cient sample size (p. 136); external events
may have impacted treatment of battered
women at California hospitals (OJ Simp-
son trial) (p. 136)
Hanbury 2009
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 norma-

tive 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
Incomplete outcome data (attrition bias) High risk Quote “...discontinuity occurred between
All outcomes those who returned the questionnaire and
those who attended the intervention” (p.
516)
Blinding of outcome assessment (detection Low risk Routinely collected audit adherence data
bias) used (p. 505)
All outcomes
Hanbury 2009 (Continued)
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 anal-
yses 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 collec- Low risk Routinely collected audit adherence data
tion used (p. 505)
Helitzer 2011
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
Random sequence generation (selection Unclear risk Not reported

bias)
Allocation concealment (selection bias) Unclear risk Not reported
Baseline outcome measurements similar Low risk Patient-centredness summary score re-
All outcomes ported for training and medical visits (Ta-
bles 4 and 5)
Helitzer 2011 (Continued)
Baseline characteristics similar Low risk Quote “…no significant differences be-
tween the groups in terms of sex or practice
type, either at baseline or at the final med-
ical visit”
Incomplete outcome data (attrition bias) Low risk Drop-outs indicated in Figure 1. Adjusted
All outcomes for in analysis
Blinding of outcome assessment (detection Unclear risk Quote “The simulated patients were blind
bias) to the provider group assignment”, how-
All outcomes ever 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
Janson 2009
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 pro-
grammes, they had different rotational schedules, which resulted in a changing team
membership
Risk of bias
Random sequence generation (selection High risk Quote “This study was designed as a
bias) nonrandomized, parallel-group clinical
trial” (p. 1541)
Janson 2009 (Continued)
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)
All outcomes
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
All outcomes
Blinding of outcome assessment (detection Low risk Data came in from clinical info system di-
bias) rectly and loaded into SPSS (p. 1543). Ag-
All outcomes gregate data stripped of identifiers was anal-
ysed (p. 1541)
Contamination High risk 1 institution, team members from inter-

vention group could readily interact with
control group
Selective reporting (reporting bias) Low risk All relevant outcomes in the methods sec-
tion 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)
Morey 2002
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 fol-
lowing the delivery of the IPE intervention
Morey 2002 (Continued)
Risk of bias
Random sequence generation (selection Low risk Quote “A prospective investigation us-
bias) ing a quasi-experimental, untreated control
group design” (p. 1556)
Baseline outcome measurements similar Low risk Reported in Tables 3 and 4 (pp. 1569-
All outcomes 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.
All outcomes 1% or less for each of the outcome measures
(p. 1563)
Blinding of outcome assessment (detection Low risk Reported use of “blinded raters…” (p.
bias) 1566)
All outcomes
Contamination Low risk 9 separate teaching and community hospi-

tal 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 ob-
served errors that was significantly above
chance,
we feel that the lack of blinding was un-
likely to introduce appreciable bias into the
observed error results” (p. 1575)
Nielsen 2007
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 in-
teractive training covering team structure and processes, planning and problem solving,
communication, workload management and team skills, assistance with creation of in-
terprofessional 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
Random sequence generation (selection Low risk Quote “…a table of random numbers
bias) 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)
All outcomes
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
All outcomes treat” (p. 51)
Blinding of outcome assessment (detection High risk Quote “The trial was not blinded, with per-
bias) sonnel at each site aware of their assign-
All outcomes ment to either the intervention or control
arm” (p. 49)
Contamination Unclear risk Hospitals are in different US states but un-

clear if some personnel may be in contact
(e.g. if they are in the military)
Nielsen 2007 (Continued)
Selective reporting (reporting bias) Low risk See Table 4 (p. 53)
Other bias Unclear risk Unclear if data were collected indepen-

dently by co-ordinators that were not hos-
pital personnel
Rask 2007
Methods A CBA study aimed to evaluate an interprofessional fall management quality improve-
ment 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
Random sequence generation (selection Low risk Convenience sample of 19 nursing homes
bias) (p. 342)
All outcomes
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
All outcomes 14 of 19 nursing homes - no explanation
of missing data on 5 nursing homes
Blinding of outcome assessment (detection High risk Chart audits done by individuals who
bias) quote “were not blind to the intervention
All outcomes status of the facilities” (p. 345)
Rask 2007 (Continued)
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
Strasser 2008
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, physiothera-

pists and social workers
Interventions A 6-month intervention consisting of an interactive workshop emphasising team dy-

namics, 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
Random sequence generation (selection Low risk Quote “…randomized sites to either in-
bias) tervention or control group using a com-
puter…” (pp. 11-12)
Allocation concealment (selection bias) Low risk Quote “…randomized sites to either in-
tervention or control group using a com-
puter…” (pp. 11-12)
Baseline outcome measurements similar Low risk Reported in Table 2

All outcomes
Baseline characteristics similar Low risk Reported in Table 1. Description of adjust-

ments in analyses (pp. 12-13)
Incomplete outcome data (attrition bias) Unclear risk Acknowledge sites dropped out but do not
All outcomes discuss if necessary to adjust analyses (p.
12)
Strasser 2008 (Continued)
Blinding of outcome assessment (detection Unclear risk Not reported if data collectors and assessors
bias) were blinded
All outcomes
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
Taylor 2007
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 redistri-
bution, 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 Amer-
ican Diabetes Association clinical guidelines. The new process and diabetes checklist
were implemented
Risk of bias
Incomplete outcome data (attrition bias) Low risk Pre-intervention visit and post-interven-
All outcomes tion visit reported for 277 individuals (p.
246)

bias)
All outcomes
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)
Taylor 2007 (Continued)
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 collec- Unclear risk Not reported

tion
Thompson 2000a
Methods RCT involving 59 primary care practices which were randomly assigned to an interven-
tion 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
Random sequence generation (selection Low risk Quote “Practices were randomly assigned
bias) 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
All outcomes 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
All outcomes (p. 187)
Thompson 2000a (Continued)

bias)
All outcomes
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
Thompson 2000b
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, reg-
istered 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 assis-
tance
Notes Unvalidated survey and qualitative data on provider views of the intervention were
gathered
Risk of bias
Random sequence generation (selection Unclear risk Not specified

bias)
All outcomes
Baseline characteristics similar Low risk “Intervention and control groups at base-
line did not differ…” (p. 256)
Incomplete outcome data (attrition bias) Low risk Adjustments in analysis made for this (p.
All outcomes 256)
Thompson 2000b (Continued)
Blinding of outcome assessment (detection Low risk Quote “Chart abstractors, blinded to inter-
bias) vention status, ascertained any mention of
All outcomes 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)
Weaver 2010
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
Random sequence generation (selection High risk Quote “teams...volunteered to participate

bias) in the training and evaluation efforts” (p.
135)
Baseline outcome measurements similar High risk Reported in Tables 3 and 4 (p. 136-137)
All outcomes
Baseline characteristics similar Unclear risk Not reported (p. 135)
Incomplete outcome data (attrition bias) Unclear risk For example, analyses not conducted for
All outcomes initial observations with regards to debrief-
ing (p. 139)
Weaver 2010 (Continued)
Blinding of outcome assessment (detection Unclear risk Not reported if observers were blinded (p.
bias) 137)
All outcomes
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 debrief-
ing (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)
Young 2005
Methods CBA study involving 2 mental health provider organisations which received the inter-
vention, 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 inter-
vention in more detail
Risk of bias
Random sequence generation (selection Low risk Quote “This study used a quasi-experimen-
bias) tal
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

All outcomes
Baseline characteristics similar High risk Site selection based on clinics which
“served a large population with severe and
Young 2005 (Continued)
persistent mental illness, and provided sim-

ilar types of services” (p. 986)
Incomplete outcome data (attrition bias) Unclear risk Analyses undertaken “using multiple im-
All outcomes putation to replace missing data” (p. 970)

bias)
All outcomes
Contamination Low risk Sites based in 2 US states - Quote “each

state included both intervention and con-
trol 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]
Study Reason for exclusion
Ammentorp 2007 Not an IPE intervention
Anderson 2009 Not an RCT, CBA or ITS
Antunez 2003 Post-intervention study design
Armitage 2009 Not an RCT, CBA or ITS
Barrett 2001 Description of IPE intervention that reports no outcomes
Barton 2006 Not an IPE intervention. 1 group pre-/post-test study design
Bashir 2000 Not an IPE intervention
Bauer 2009 Not an IPE intervention
(Continued)
Beal 2006 Not an IPE intervention
Belardi 2004 Not an IPE intervention
Bell 2000 Not an IPE intervention
Bellamy 2006 1 group pre-/post-test study design
Benjamin 1999 Not an IPE intervention
Berg 2009 Not an RCT, CBA or ITS
Berggren 2008 Not an IPE intervention
Birch 2007 Not an RCT, CBA or ITS
Bluespruce 2001 1 group pre-/post-test study design
Boyle 2004 1 group pre-/post-test study design
Bradshaw 2011 Not an IPE intervention
Buck 1999 Post-intervention study design
Burns 2003 Not an IPE intervention
Buxton 2004 Not an IPE intervention
Cameron 2009 Not an IPE intervention
Carew 2001 Post-intervention study design
Cobia 1995 Before and after study with no controls
Coggrave 2001 Not an IPE intervention
Connolly 1995 Post-intervention study with no controls
Cooper 2005 A CBA study that gathered self report data related to attitudes and knowledge change
Corso 2006 1 group post-intervention study design
Crutcher 2004 A clinical controlled trial of an IPE intervention. Reports outcomes related to self reported knowledge change
Dacey 2010 Not an RCT, CBA or ITS
Dalton 1999 Not an IPE intervention
(Continued)
DeVita 2005 1 group post-intervention study design
Dienst 1981 CBA study. Failed to meet comparison group criteria
Dobson 2002 1 group pre-/post-test study design
Falconer 1993 Post-intervention study with control group. Failed to meet comparison group criteria
Fields 2005 Not an IPE intervention
Gandara 2010 Not an IPE intervention
Hanson 2005 Not an IPE intervention
Harmon 1998 5-year longitudinal study with no controls
Hayward 1996 Before and after study with no controls
Hien 2008 Not an IPE intervention
Hook 2003 1 group post-intervention study design
Hope 2005 1 group pre-/post-intervention study design
Horbar 2001 Not an IPE intervention
Hughes 2000 Descriptive study
James 2005 1 group pre-/post-intervention study design
Jones 2006 Not an IPE intervention
Jordan-Marsh 2004 1 group pre-/post-test study with follow-up data collection points
Kenward 2009 Not an RCT, CBA or ITS
Ketola 2000 Not an IPE intervention
Kwan 2006 Outcomes did not meet inclusion criteria
Landon 2004 Not an IPE intervention
Lawrence 2002 Not an IPE intervention
Lia-Hoagberg 1997 Before and after study with no controls
Llewellyn-Jones 1999 Not an IPE intervention
(Continued)
McBride 2000 Not an IPE intervention
Monette 2008 Not an IPE intervention
Nash 1993 Before and after study with no controls
O’Boyle 1995 Before and after study with no controls
Olivecrona 2010 Not an RCT, CBA or ITS
Ouslander 2001 Not an IPE intervention
Phillips 2002 Not an IPE intervention
Price 2005 Not an IPE intervention
Rogowski 2001 Not an IPE intervention
Rubenstein 1999 Not an IPE intervention
Ryan 2002 Not an IPE intervention
Sauer 2010 Not an IPE intervention
Smarr 2003 Not an IPE intervention
Smith 2005 1 group pre-/post-intervention study design
Stewart 2010 Not an IPE intervention
Taylor 2002 Not an IPE intervention
Thomas 2007 Not an IPE intervention
Trummer 2006 No control group
Tschopp 2005 1 group pre-/post-intervention study design
Umble 2003 Not an IPE intervention
Unutzer 2001 Not an IPE intervention
Ward 2004 Not an IPE intervention
Wells 2000 Not an IPE intervention
Westfelt 2010 Not an RCT, CBA or ITS
(Continued)
Wisborg 2009 Not an RCT, CBA or ITS
CBA: controlled before and after; IPE: interprofessional education; ITS: interrupted time series; RCT: randomised controlled trial.
DATA AND ANALYSES
This review has no analyses.
APPENDICES
Appendix 1. MEDLINE search strategy

MEDLINE search strategy
1 (interprofession$ or inter-profession$).tw.
2 (interdisciplin$ or inter-disciplin$).tw.
3 (interoccupation$ or inter-occupation$).tw.
4 (interinstitut$ or inter-institut$).tw.
5 (interagen$ or inter-agen$).tw.
6 (intersector$ or inter-sector$).tw.
7 (interdepartment$ or inter-department$).tw.
8 (interorgani?ation$ or inter-organi?ation$).tw.
9 interprofessional relations/
10 team$.tw.
11 (multiprofession$ or multi-profession$).tw.
12 (multidisciplin$ or multi-disciplin$).tw.
13 (multiinstitution$ or multi-institution$).tw.
14 (multioccupation$ or multi-occupation$).tw.
15 (multiagenc$ or multi-agenc$).tw.
16 (multisector$ or multi-sector$).tw.
17 (multiorgani?ation$ or multi-organi?ation$).tw.
18 exp professional-patient relations/
19 (transprofession$ or trans-profession$).tw.
20 (transdisciplin$ or trans-disciplin$).tw
21 or/1-20
22 (education$ or train$ or learn$ or teach$ or course$).tw.
23 exp education, continuing/
24 exp education, graduate/
25 or/22-24
26 21 and 25
27 program evaluation/
28 “health care outcome?”.tw.
29 (education$ adj outcome?).tw.
30 or/27-29
31 26 and 30
Appendix 2. CINAHL search strategy
CINAHL search strategy
(TX interprofession*) or (TX inter-profession*) or (TX interdisciplin*) or (TX inter-disciplin*) or (TX interoccupation*) or (TX
inter-occupation*) or (TX interinstitut*) or (TX inter-institut*) or (TX interagen*) or (TX inter-agen*) or (TX intersector*) or
(TX inter-sector*) or (TX interdepartment*) or (TX inter-department*) or (TX interorgani?ation*) or (TX inter-organi?ation*) or
(MH interprofessional relations) or (TX team*) or (TX multiprofession*) or (TX multi-profession*) or (TX multidisciplin*) or (TX
multi-disciplin*) or (TX multiinstitution*) or (TX multi-institution*) or (TX multioccupation*) or (TX multi-occupation*) or (TX
multiagenc*) or (TX multi-agenc*) or (TX multisector*) or (TX multi-sector*) or (TX multiorgani?ation*) or (TX multi-organi?ation*)
or (MH “Professional-Patient Relations+”) or (TX transprofession*) or (TX trans-profession*) or (TX transdisciplin*) or (TX trans-
disciplin*) AND (TX education*) or (TX train*) or (TX learn*) or (TX teach*) or (TX course*) or (MH “education, continuing+”)
or (MH “education, graduate+”) AND (MH “student performance appraisal+”) or (MH “course evaluation”) or (MH “program
evaluation”) or (MH “evaluation research+”) or (MH “health care outcome*”) or (education* N1 outcome*)
FEEDBACK
Lack of Evidence
Summary
Received 20/04/2003 13:47:02
I am assuming this excellent work is a follow up from earlier published material from 1999 (J. Int. Care 13 (4)417-4). What I
cannot understand is why, therefore is IPE still ’flavour of the month’? We wouldn’t push ideas forward without adequate evidence
of effectiveness first! Isn’t anyone else out there brave enough to concur with the authors? I certify that I have no affiliations with or
involvement in any organisation or entity with a direct financial interest in the subject matter of my criticisms.
Reply
Thank you for your positive comment. The article to which you refer is indeed a print version of this Cochrane review, and we will note
that in the review. We would like to stress that the ’absence of evidence of effect is not evidence of absence of effect’ (Cochrane Reviewers’
Handbook 4.1.5, section 9.7). We therefore suggest that interprofessional education (IPE) interventions ought to be implemented
widely, but ONLY in the context of rigorous evaluations, ideally randomised controlled trials of their effects. This is not as difficult as
it might at first seem, and we would encourage those who are interested enough in IPE to want to subject it to reliable test to contact
us or other groups of researchers with randomised controlled trial experience for advice and help.
Merrick Zwarenstein [on behalf of the reviewers.]
The most recent update to this review is published in Issue 1, 2008. The update now has 6 studies. However, it still remains very
difficult to draw conclusions about the effectiveness of this intervention and we continue to require further research in the area.
Alain Mayhew [on behalf of the authors and the editorial staff and team]
Contributors
Jane Warner, Practice Nurse
WHAT’S NEW
Last assessed as up-to-date: 3 August 2011.
Date Event Description
28 February 2013 New search has been performed Substantive amendment, search up to Aug 2011, nine
additonal studies
28 February 2013 New citation required but conclusions have not Nine new studies, but no change in conclusions
changed
HISTORY
Protocol first published: Issue 3, 2000
Review first published: Issue 1, 2001
Date Event Description
29 July 2008 Amended Converted to new review format.
12 November 2007 New citation required and conclusions have changed Substantive amendment
CONTRIBUTIONS OF AUTHORS
SR, LP and JG searched and reviewed the literature and extracted data with input from MZ. SR interpreted the data and wrote the
main draft of the review with input from LP, JG, DF and MZ. MZ Is guarantor for the review.
DECLARATIONS OF INTEREST
None known.
SOURCES OF SUPPORT
Internal sources
• Center for Innovation in Interprofessional Education, University of California, San Francisco, USA.
• Li Ka Shing Knowledge Institute of St Michael’s Hospital, Canada.
• Continuing Education and Professional Development, Faculty of Medicine, University of Toronto, Canada.
• Institute of Health Sciences Education, Queen Mary University London, UK.
• Institute for Clinical Effectiveness, Toronto, Canada.
External sources
• No sources of support supplied
INDEX TERMS
Medical Subject Headings (MeSH)

∗ Interprofessional Relations; ∗ Patient Care; ∗ Patient Care Team; ∗ Professional Practice; Attitude of Health Personnel; Health Personnel
[∗ education]; Randomized Controlled Trials as Topic; Treatment Outcome
MeSH check words

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Interprofessional education: effects on professional practice

and healthcare outcomes (update) (Review)

Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M

Interprofessional education: effects on professional practice

Editorial group: Cochrane Effective Practice and Organisation of Care Group.

PLAIN LANGUAGE SUMMARY

Interprofessional education to improve professional practices

Patient or population: professionals or patients involved in interprofessional education intervention

Outcomes Impacts No of studies Quality of the evidence

Patient outcomes The care provided by use of 6 ⊕⊕

Adherence rates The use of interprofessional ed- 3 ⊕⊕

Patient satisfaction Patients may be more satisfied 2 ⊕⊕

Clinical process outcomes Changes in clinical processes (e. 1 ⊕⊕

Collaborative behaviour We are unable to assess ade- 3 ⊕

Error rates We are unable to assess ad- 1 ⊕

*GRADE Working Group grades of evidence

Types of outcome measures

We also handsearched the Journal of Interprofessional Care (2006 to

Thomas 2007 {published data only} Berridge 2010

Trummer 2006 {published data only} Charles Campion-Smith 2011

Characteristics of included studies [ordered by study ID]

Participants Physicians, nurses, patients, nutritionists and psychologists

Outcomes Clinical outcomes, healthcare process quality improvement goals

Bias Authors’ judgement Support for judgement

Allocation concealment (selection bias) Unclear risk Not specified

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 Unclear risk Not reported

Contamination High risk Quote “…avoiding the contamination’ of

Other bias High risk Short follow-up (p. 151)

Participants Physicians, nurse practitioners, physician assistants, optometrists

Interventions 2 physicians gave a communication skills training programme consisting of a 4-hour

Bias Authors’ judgement Support for judgement

Contamination Unclear risk Not specified if control group could have

Other bias High risk Survey not validated (p. 824)

Interventions 2-day information and team planning intervention

Bias Authors’ judgement Support for judgement

Random sequence generation (selection Unclear risk Not specified

Allocation concealment (selection bias) Unclear risk Not specified

Baseline characteristics similar High risk Not specified

Contamination Low risk Sites geographically spread across Califor-

Other bias High risk Only 1 intervention hospital sent a com-

Participants Community mental health professionals (individual professions not specified)

Interventions A didactic presentation, an interprofessional group discussion stressing positive norma-

Outcomes Adherence rates to guideline use

Bias Authors’ judgement Support for judgement

Participants Physicians, physician assistants and nurse practitioners

Interventions A full-day interprofessional training, individualised feedback on video-taped interactions

Outcomes Observations of patient-centred communication

Bias Authors’ judgement Support for judgement

Random sequence generation (selection Unclear risk Not reported

Allocation concealment (selection bias) Unclear risk Not reported

Contamination Unclear risk Sample size is small and recruited from

Selective reporting (reporting bias) Low risk See Tables 4 and 5

Other bias High risk Sampling bias

Participants Medicine residents, nurse practitioner students, pharmacy students

Outcomes Clinical outcomes, planned visits

Bias Authors’ judgement Support for judgement

Contamination High risk 1 institution, team members from inter-