Interprofessional Education in Diabetes Care—Findings from an Integrated Review
Abstract
:1. Introduction
2. Methods
2.1. Objective
2.2. Research Design
2.3. Searching the Literature
3. Results
3.1. Study Characteristics
Citation | Title | Setting | Study Aim | Study Design | Study Participants | Data Collection Method | Sample Size | Study Results |
---|---|---|---|---|---|---|---|---|
Study 1 Nurchis et al. (2022) [15] | Interprofessional Collaboration and Diabetes Management in Primary Care: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes | Primary Care | Evaluate the impact of IPC interventions for the management of type 2 diabetes in primary care settings via patient-reported outcomes. | Systematic review and meta-analysis | Patients with type 2 diabetes mellitus in primary care | Literature Search | 19 RCTs, each with different sample size | IPC is significantly associated with an increase in both patient satisfaction and mental well-being. There was also promising evidence supporting the association between an interprofessional approach and an increase in self-care and in generic and specific quality of life. |
Study 2 Kangas et al. (2021) [17] | Students’ perceptions of interprofessional collaboration on the care of diabetes: A qualitative study | University, a course was given to med and pharmacy students | Explore changes in medical and nursing students’ perceptions of IPC on diabetes management after an experimental, voluntary course of IPE with practical content. | Qualitative study | Pharmacy and medical students | Focus-group interviews before and after a novel IPE course | 30 15 medical students 15 nursing students | The course improved the students’ self-perceived competence and confidence in IPC in the care of patients with diabetes, and their understanding of IPC changed towards a more patient-centred and holistic perspective. |
Study 3 Pascucci et al. (2021) [18] | Impact of interprofessional collaboration on chronic disease management: Findings from a systematic review of clinical trial and meta-analysis | Pre-dominantly outpatient clinics. A few studies were conducted in hospitals or pharmacies. | Study the impact of IPC vs. usual care on clinical outcomes, clinical process measures and patient-reported outcomes for patients with chronic diseases. | Systematic review and meta-analysis | Patients with at least one chronic disease | Literature search: data extraction and synthesis from selected studies | 23 RCTs, each with different sample size | Significant reduction in the levels of systolic blood pressure, diastolic blood pressure, HbA1c and LDL. |
Study 4 Lee et al. (2021) [19] | Assessment of Interprofessional Collaborative Practices and Outcomes in Adults with Diabetes and Hypertension in Primary Care A Systematic Review and Meta-analysis | Primary care | Study the association of interprofessional collaborative practice (3+ health professions) with HbA1c, systolic and diastolic blood pressure levels. | Systematic review and meta-analysis | Adults with diabetes and/or hypertension receiving primary care | Literature search: data extraction and synthesis from selected studies | 50 studies for the SR 39 studies in the meta-analyses, each with different sample size | ICP was associated with: Improved HbA1c, systolic and diastolic blood pressure levels. Reductions in HbA1c were irrespective of baseline value. |
Study 5 Pisano et al. (2020) [20] | An interprofessional experience in diabetes management for pharmacy and medical students | University, a course was given to med and pharmacy students | Examine attitudes towards interprofessional learning before and after an IPE experience | Quasi-experimental | Pharmacy and medical students | Surveys comparing pre- and post-IPE experience | 168 participants 138 med students 30 pharmacy students | Learner attitudes were positive overall and improved from pre-test to post-test, suggesting more favourable attitudes to IPE after completing the class. Pharmacy students had more positive attitudes to IP learning before and after. Their understanding of the roles and responsibilities of the other learner groups was enhanced. |
Study 6 Atsalos et al. (2019) [21] | Meeting the challenges posed by an escalating diabetes healthcare burden: A mixed methods study | Hospital | Identify new strategies to maintain optimal care for patients with diabetes while in hospital | Mixed methods | Nurses and midwives Recently discharged hospital patients | Surveys Focus group interviews Individual interviews | 173 surveys 40 focus group interviews 6 individual interviews | Knowledge and confidence in diabetes management among HCPs should be enhanced via the introduction of focused education strategies, improved communication and teamwork to avoid delays in treatment requirements. |
Study 7 Levengood et al. (2019) [22] | Team-Based Care to Improve Diabetes Management: A Community Guide Meta-analysis | Mostly clinics or hospitals in an urban setting | Study the effectiveness of team-based care (TBC) in improving health outcomes of people with diabetes. Does TBC work? How should it be implemented to be effective? | Meta-analysis | Mostly patients with type 2 diabetes | Literature search: data extraction and synthesis from selected studies | 35 RCTs, each with different sample size | Team-based care improves blood glucose, blood pressure and lipid levels for patients with type 2 diabetes. |
Study 8 Kangas et al. (2018) [9] | An integrative systematic review of interprofessional education on diabetes | University, online courses or the clinical workplace. | Assess the outcomes of IPE on diabetes management. | Integrative systematic review | Groups of healthcare or social care students or professionals. | Literature search: data extraction and synthesis from selected studies | 14 studies, each with different sample size | Diabetes-specific IPE results in benefits for the learners and potentially contributes to better care provision for patients with diabetes. |
Study 9 Riskiyana et al. (2018) [23] | Objectively measured interprofessional education outcome and factors that enhance program effectiveness: A systematic review | University or clinical or community practices. | Generalise IPE learning outcomes in a global context. | Systematic Review | Healthcare professionals or students who experienced IPE or training. | Literature search: data extraction and synthesis from selected studies | 16 studies, each with different sample size | IPE improved interprofessional collaborative knowledge, skills, behaviour and quality of care. |
Study 10 Nagelkerk et al. (2018) [7] | Improving outcomes in adults with diabetes via an interprofessional collaborative practice program | Universities, family practice clinics. | Assess the effectiveness of interprofessional collaborative practice (IPCP) intervention on HCPs efficiencies, student learning and clinical outcomes of patients with diabetes. | Sequential mixed methods design | HCPs and students and patients with diabetes. | Staff and student teams received core modules on IPCP, implemented IPCP practices and completed pre and post knowledge tests and evaluation surveys. Forms, questionnaires, assessment tools and surveys were used. Focus group discussions were also held periodically. | HCPs practice team (n = 20), an interprofessional team of students (n = 22) and patients (n = 250) | IPCP interventions improved communication, team care, provider productivity and improved diabetes outcomes (A1c, triglyceride, lipid ratio, blood glucose) for a subgroup of higher-risk patients with diabetes. |
Study 11 Račić et al. (2017) [24] | The effects of interprofessional diabetes education on the knowledge of medical, dentistry and nursing students | University. | Assess the effects of interprofessional learning on diabetes knowledge. | Cross-sectional Study | Students of medicine, dentistry and nursing. | Group 1 received an interprofessional diabetes course. Group 2 received a diabetes course within groups of single professions. Both groups completed pre- and post-intervention knowledge assessments | 66 students. Medicine students (n = 29) Dentistry students (n = 21) Nursing students (n = 16). | IPE activities may improve health profession students’ specific clinical knowledge, skills, confidence and attitude toward IPC. |
Study 12 Khan et al. (2017) [25] | Diabetes foot complication: assessing primary and secondary outcomes of multidisciplinary team versus standard care (a systematic review) | Healthcare setting (podiatry clinics, general hospitals and general practice) | Evaluate the effectiveness of multidisciplinary teamwork compared to standard care in reducing diabetes-related foot complications and cost and improving quality of life. | Systematic Review | Patients of 25 years of age or older with type 1 or type 2 diabetes with risk for foot ulceration or amputation. | Literature search: data extraction and synthesis from selected studies | 9 studies | Multidisciplinary team approaches to diabetic foot care cause a significant reduction in complications compared to the standard approach. |
Study 13 Ching et al. (2015) [26] | Is an inter-professional education programme effective in promoting collaboration and improving diabetes care? | General practice setting (n = 26) | Assess the impact of an IPE program on the knowledge, attitudes and behaviours of HCPs and how it may relate to disease outcomes. | Mixed-method Study | General practitioners and practice nurses Patients with diabetes | Interviews and data extraction from diabetes registers. Comparison between pre- and post-IPE program data. (24 months) | 26 primary care practices 4167 people with diabetes | the IPE program resulted in improving the quality of care, patient outcomes (cholesterol and blood pressure levels), professional behaviours and clinical practices (lower referrals and more patients receiving foot care and being screened for microalbuminuria). |
Study 14 Yamani et al. (2014) [27] | The effect of interprofessional education on interprofessional performance and diabetes care knowledge of health care teams at level one of health service provision | Educational. | Study the effect of IPE on diabetes care knowledge and performance of healthcare teams. | Quasi-experimental Study | Healthcare teams | Pre- and post-intervention (IPE workshop) team performance evaluations and knowledge assessments (3 months) | 6 teams (n = 34) 12 physicians 10 healthcare associates 12 Behvarz (rural healthcare providers) | IPE can increase diabetes care knowledge and collaborative performance of teams of HCPs |
Study 15 Pittenger et al. (2013) [28] | An Interprofessional Diabetes Experience to Improve Pharmacy and Nursing Students’ Competency in Collaborative Practice | University campuses. | Improve pharmacy and nursing students’ competency in collaborative practice via an interprofessional diabetes experience. | Mixed-method Study | Pharmacy and nursing students. | An IPE diabetes course was given. Pre- and post-intervention surveys. | 9 groups. Pharmacy students (n = 34) Nursing students (n = 17) | Interprofessional approaches increase students’ knowledge of the roles of other professions and understanding of communication strategies. |
Study 16 Reeves et al. (2013) [29] | Interprofessional education: effects on professional practice and healthcare outcomes | Different areas of clinical practice | Evaluate the effectiveness of IPE interventions as opposed to profession-specific or no-education interventions. | Narrative Review | Professionals or patients involved in IPE intervention | Comparison between outcomes following an IPE intervention, outcomes with a non-IPE intervention and outcomes with no intervention. | 15 studies (RCTs, controlled before and after studies and interrupted time series studies). | A range of positive results on diabetes clinical outcomes and improving diabetes care was reported. |
Study 17 Pimouguet et al. (2011) [30] | Effectiveness of disease-management programs for improving diabetes care: a meta-analysis | Different healthcare settings. | Study the effectiveness of disease-management programs for improving glycemic control in adults with diabetes. | Meta-analysis | Adults with type 1 or 2 diabetes whose HbA1c levels were measured to evaluate the effects of disease management programs. | Literature search: data extraction and synthesis from selected studies | 41 RCTs | Disease management programs significantly impact HbA1c in adults with diabetes, |
Study 18 Hammick et al. (2009) [31] | A best evidence systematic review of interprofessional education: BEME Guide no. 9 | Educational settings | Review best evidence on IPE evaluations, classify outcomes and identify mechanisms guiding IPE outcomes. | Systematic Review | Professional groups from health and social care. | Literature search: data extraction and synthesis from selected studies | 21 studies | IPE is used as a mechanism to develop clinical practice and improve services |
Study 19 Janson et al. (2009) [32] | Improving Chronic Care of Type 2 Diabetes Using Teams of Interprofessional Learners | Internal medicine clinics. | Enhance the care and outcomes of patients with type 2 diabetes by introducing a care model to interprofessional teams. | Non-randomised parallel-group clinical trial (18 months) | Adults with type 2 diabetes | Interprofessional team care was provided by groups of HCPs and compared with usual care by internal medicine residents only. Pre- and post-intervention data collection. | Team care professionals: Primary care internal medicine residents, nurse practitioner students and pharmacy students. 384 adult patients with type 2 diabetes | The quality of care provided to adult patients with type 2 diabetes improved with interprofessional team care. |
3.2. Study Participants
- Healthcare professionals (general practitioners, practice nurses and healthcare associates, n = 8);
- Students of healthcare professions (medicine, pharmacy, nursing, midwifery, dentistry, podiatry, dietetics and social care, n = 7);
- Adult patients with type 1 or type 2 diabetes (n = 11).
3.3. IPE Interventions and Settings
3.4. Findings from Content Analysis
3.5. Impact on Provider/Student Approaches and Enhancement of Care Provision
Reported Parameter | Selected Studies |
---|---|
Impact on health provider/student | |
Better self-perceived competence in diabetes care | [17] |
Improved confidence | [17,21,24] |
Improved knowledge | [21,23,24,27] |
Improved skills | [23,24] |
Improved behaviour | [23,26] |
Improved attitudes toward IPE and IPC | [35] |
Impact on aspects of healthcare provision | |
Improved clinical practice | [9,17,26,31] |
Improved quality of care | [23,26,29,32] |
Improved understanding of roles and responsibilities of other HCPs or students | [20,28] |
Improved communication | [7,21,28] |
Improved IPC and team care | [7,21,27] |
Improved provider productivity | [7] |
3.6. Effect on Diabetes Self-Management and Disease Outcomes
Reported Parameter | Selected Studies |
---|---|
Indicators of Diabetes Management | |
Increased patient satisfaction | [15] |
Improved patient wellbeing | [15] |
Improved DSM skills | [15] |
Improved generic and diabetes-specific quality of life | [15] |
Disease outcomes | |
Reduced HbA1c | [7,18,19,29,30] |
Reduced blood glucose | [7,22] |
Reduced SBP | [18,19,22,26] |
Reduced DBP | [18,19,22,26] |
Reduced Cholesterol | [26] |
Reduced LDL | [18,19] |
Reduced Triglyceride | [7] |
Reduced Lipid Ratio | [7] |
Reduced diabetic foot complications | [25] |
3.7. Inhibitors and Enablers of IPE and IPC in Practice
General Barriers | ||
---|---|---|
General barriers | Barriers | Possible approaches to overcome barriers |
Changes in existing state of affairs are often met with resistance due to the need for redefining the roles of individual stakeholders [37] | Identify the causes of resistance. Allow HCPs to influence the change, feel prepared for the change and recognise its value [38]. | |
Novelty- resource-intensive programme with uncertain outcomes [9] | Awareness raising of the impact of IPE/IPC on patient outcomes [39]. | |
Inadequate evaluation and research [40] | Develop standardised IPE assessment tools, establish research priorities and promote rigorous evaluation for IPE initiatives [40]. | |
Stakeholder-Specific Barriers | ||
Stakeholder | Barriers | Possible approaches to overcome barriers |
Government and Professional | Scarce resources [37] | Allocating resources to support IPE research and initiatives, develop sustainable funding models, apply for grants and advocate for IPE at institutional and policy levels [39,41]. |
Strained stakeholder relationships due to the change in the organisation following IPE implementation in higher education [37] | Having open communication, mutual respect and increasing awareness of the value of interprofessional initiatives on disease management [41]. | |
Institution | Hierarchical culture [41] | Ensuring equal representation of the relevant disciplines and fostering a culture of respect to navigating professional hierarchy and empowering collaborative decision making [41]. |
Time constraints [37] | Being flexible in scheduling and incorporating an online aspect to facilitate self-paced learning [41]. | |
Limited resources [37] | Empowering clinical teams to advocate to obtain resources that can advance practice and improve care [42]. | |
Ability to develop and deliver IPE within pre-existing curricula considering the different assessment criteria for individual healthcare programmes [37] | Creating clear, specific and measurable objectives and using adult learning theories to incorporate interprofessional knowledge and competencies in problem-based learning opportunities, most of which being pre-existing learning tools and opportunities in different health professions’ curricula [41]. | |
Individual | Professional silos | Ensuring equal representation of the relevant disciplines and empowering collaborative decision making [41]. |
Communication challenges | Fostering a culture of respect, advising on lines of communication providers can resort to for support and highlighting ongoing practice challenges to the appropriate channels [42]. | |
Lack of adequate faculty support and understanding of the need for IPE [37] | Offering educational programmes to collaborating teams, highlighting the expected standards of care and publicising professional and technical support [42]. | |
Limited professional development opportunities [37] | Providing interprofessional faculty-led training sessions and learning materials [41]. | |
Lack of reward for staff involved in interprofessional activities [37] | Establish a reward system, such as a percentage increase in basic salary, and assign interprofessional service heroes to advocate for and represent interprofessional initiatives [43]. |
4. Discussion
Interprofessional Education and Diabetes Management: The Impact
5. Limitations and Future Research Potential
6. IPE and Diabetes Care–Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
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Sidani, S.; Patel, K.D. Interprofessional Education in Diabetes Care—Findings from an Integrated Review. Diabetology 2023, 4, 356-375. https://doi.org/10.3390/diabetology4030030
Sidani S, Patel KD. Interprofessional Education in Diabetes Care—Findings from an Integrated Review. Diabetology. 2023; 4(3):356-375. https://doi.org/10.3390/diabetology4030030
Chicago/Turabian StyleSidani, Samira, and Kunal D. Patel. 2023. "Interprofessional Education in Diabetes Care—Findings from an Integrated Review" Diabetology 4, no. 3: 356-375. https://doi.org/10.3390/diabetology4030030
APA StyleSidani, S., & Patel, K. D. (2023). Interprofessional Education in Diabetes Care—Findings from an Integrated Review. Diabetology, 4(3), 356-375. https://doi.org/10.3390/diabetology4030030