Multidisciplinary team, working with elderly persons living in the community: a systematic literature review

What is known about the topic• There is policy commitment to closer working between professionals to improve health and social care but the benefits of this are poorly understood at the user ⁄ patient level.• Language and terminology used to capture the process of interprofessional working are imprecise.• There is little evidence linking interprofessional working to explicit outcomes for older people.• It is not clear how different contexts, systems, professionals, agencies, roles and services influence the effectiveness of inter-professional working. What this paper adds• There are different ways to document the process of interprofessional working.• Studies should measure effectiveness and cost effectiveness of interprofessional working.• Integrated models of inter-professional working have the potential to improve processes of care and to reduce hospital use or long-term care moves. AbstractHealth and social care policy in the UK advocates inter-professional working (IPW) to support older people with complex and multiple needs. Whilst there is a growing understanding of what supports IPW, there is a lack of evidence linking IPW to explicit outcomes for older people living in the community. This review aimed to identify the models of IPW that provide the strongest evidence base for practice with community dwelling older people. We searched electronic databases from 1 January 1990-31 March 2008. In December 2010 we updated the findings from relevant systematic reviews identified since 2008. We selected papers describing interventions that involved IPW for community dwelling older people and randomised controlled trials (RCT) reporting user-relevant outcomes. Included studies were classified by IPW models (Case Management, Collaboration and Integrated Team) and assessed for risk of bias. We conducted a narrative synthesis of the evidence according to the type of care (interventions delivering acute, chronic, palliative and preventive care) identified within each model of IPW. We retrieved 3211 records and included 37 RCTs which were mapped onto the IPW models: Overall, there is weak evidence of effectiveness and cost-effectiveness for IPW, although well-integrated and shared care models improved processes of care and have the potential to reduce hospital or nursing ⁄ care home use. Study quality varied considerably and high quality evaluations as well as observational studies are needed to identify the key components of effective IPW in relation to user-defined outcomes. Differences in local contexts raise questions about the applicability of the findings and their implications for practice. We need more information on the outcomes of the process of IPW and evaluations of the effectiveness of different configurations of health and social care professionals for the care of community dwelling older people.

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“…As in our review, teams in different contexts, with various definitions and compositions, were described by Johansson et al. (2010).…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of inter-professional working for older people living in the community: a systematic review

Trivedi

Goodman

Gage

et al. 2012

Health &Amp; Social Care in the Community

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“…Mainly two directions may be identified: one, quantitative analysis, focuses on outcomes of teamwork, in terms of efficiency, improved care and team climate (e.g. Batorowicz & Shepherd, 2008;Johansson, Eklund, & Gosman-Hedström, 2010); the other, qualitative research, studies professionals' perceptions of teamwork and professional boundaries (Kvarnström, 2008;Sousa & Costa, 2010) and is based mainly on interview data. Some studies of interprofessional teamwork of hospital professionals combine observation and interview data (e.g.…”

Section: Introductionmentioning

confidence: 99%

Care planning and decision-making in teams in Swedish elderly care: A study of interprofessional collaboration and professional boundaries

Dunér

2013

Journal of Interprofessional Care

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In front-line practice, joint working between different professionals in health/social care and rehabilitation is regarded as a means to reach a comprehensive assessment of the needs of the older care recipients, leading to decisions on appropriate care and services. The aim of this study was to examine professional collaboration and professional boundaries in interprofessional care planning teams. Two different care planning teams were studied, one performing care planning in the homes of older individuals and the other performing care planning for older people in hospital wards. The empirical data consisted of audio-recorded care planning meetings and interviews with the professionals in the teams. The integration between the professionals involved was most noticeable in the investigation and assessment phase, while it was lower in the planning phase and almost non-existent in decision-making. The home care planning team tended to work in a more integrated manner than the discharge planning team. The importance of clarifying the roles of all professions concerned with needs assessment and care planning for older people became evident in this study.

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“…There does not seem to be a generic term or model for interprofessional collaboration, but the most frequent terms are multidisciplinary (synonymous with multiprofessional), interdisciplinary (synonymous with interprofessional or integrative) or transdisciplinary team or collaboration (synonymous with transprofessional) 14,19. The term “multidisciplinary” often refers to a process where different disciplines work independently, but share information with each other.…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary collaboration in reablement – a qualitative study

Birkeland¹,

Tuntland²,

Førland³

et al. 2017

JMDH

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BackgroundIn-depth knowledge regarding interdisciplinary collaboration, a key feature in reablement, is scarce.ObjectiveTo elucidate how the interdisciplinary collaboration in reablement worked in a Norwegian context.Sample and methodsSeven focus group interviews were conducted with 33 health care providers working in interdisciplinary reablement teams in seven municipalities across the country. The focus group interviews were transcribed and an hermeneutical analysis was conducted.ResultsThe analysis resulted in four main themes: “participant’s own goals as a common interdisciplinary platform”, “a positive professional community”, “learning from each other’s skills and competencies” and “new roles and joint efforts but specific competencies”. The results show that interdisciplinary collaboration in reablement depends on participants defining their own rehabilitation goals, which function as a professional unifying platform for the interdisciplinary collaboration. The challenges for participants in reablement are often complex and include assessments, effort and a need for close collaboration between several different professionals. A tight interdisciplinary collaboration causes major changes in roles, often from a particular role to a more general role with broader job tasks. Although different professionals perform the same rehabilitation tasks, it is important that each professional contributes their unique competence and thus together they complete each other’s competencies.ConclusionFactors that have a positive impact on interdisciplinary collaboration in reablement are participants’ definitions of their goals, number and variety of professionals involved, how closely these professionals collaborate, the amount of time for communication and shared planning and decision making.

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Multidisciplinary team, working with elderly persons living in the community: a systematic literature review

Cited by 49 publications

References 46 publications

The effectiveness of inter-professional working for older people living in the community: a systematic review

The effectiveness of inter-professional working for older people living in the community: a systematic review

Care planning and decision-making in teams in Swedish elderly care: A study of interprofessional collaboration and professional boundaries

Interdisciplinary collaboration in reablement – a qualitative study

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Multidisciplinary team, working with elderly persons living in the community: a systematic literature review

Cited by 49 publications

References 46 publications

The effectiveness of inter-professional working for older people living in the community: a systematic review

The effectiveness of inter-professional working for older people living in the community: a systematic review

Care planning and decision-making in teams in Swedish elderly care: A study of interprofessional collaboration and professional boundaries

Interdisciplinary collaboration in reablement &ndash; a qualitative study

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Interdisciplinary collaboration in reablement – a qualitative study