Interprofessional collaboration and chronicity management: a systematic review of clinical trials

The increasing prevalence of chronic disease generates significant financial, social and psychosocial burden for patients, families and healthcare system. Interprofessional collaboration (IPC) is becoming recognized as a discipline among health and social care professionals and medical training institutions worldwide. Literature research suggests that following interventions could be particularly useful in the management of chronic patients. The objective of this systematic review was to assess the impact of IPC on chronic patients compared to standard health-care practice. The PICO model was adopted and three electronic databases (Medline, EMBASE, Web of Science) were searched using appropriate keywords. Selected trials were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment of Controlled Intervention Studies. Data were analyzed using descriptive statistic, and comparison of outcomes among teams with or without pharmacist was performed using t-Student test (p < 0,05). Out of 11.128, 24 studies met the inclusion criteria and 58 indicators were identified: 62% improved significantly, 38% did not show any variation, no indicator worsened after intervention. In particular, systolic blood pressure (SBP) showed a statistically significant improvement in 70.0 % of trials in which was considered while did not show any difference in the rest. The presence of a pharmacist in the team show a statistically significant improvement on SBP (p = 0,002) in patients with hypertension while no statistically significant effect is observed on glycated hemoglobin (p = 0,193) in diabetics. The results support that IPC contributes to positive patient, provider and institutional level outcomes, in particular for chronic conditions. Future research should focus on the inclusion of patient/caregivers in the collaborative team, and on the role of interprofessional education (IPE) on collaborative practice in the management of the patient with chronicity. Key messages IPC is an innovative strategy to address the complex health needs of chronic populations. Further studies are needed to evaluate the role of IPE in achieving better IPC and improving chronic patients’ outcomes.