According to a new systematic review and meta-analysis, the collaboration between health care providers in primary care leads to significantly better patient outcomes in patients with high blood pressure and diabetes.
The study focused on the concept of interprofessional collaborative practice (ICP), which the World Health Organization defines as “multiple health workers with different professional backgrounds” work together with patients, families, caregivers and communities to ensure the highest quality of care. “
Corresponding author Jeannie K. Lee, PharmD of the College of Pharmacy, University of Arizona, and colleagues noted that while ICP is philosophically consistent with many goals of modern health care, there is little thorough evidence to support its effects when on patient results at all.
To change this, Lee and colleagues searched a number of databases for studies published between 2013 and 2018 evaluating ICP in primary care and involving adults Diabetes and / or high blood pressure and rated HbA1c and systolic and diastolic blood pressures. In the study, ICP was defined as using three or more health care professionals, including doctors, nurses, dietitians, pharmacists, and other providers.
Of more than 6,000 items identified through the search, the team reviewed 3,543 studies and identified 50 items that met their criteria for systematic review. Of these, 39 were included in the meta-analysis; The remaining 11 did not have sufficient data. Fifteen of the 39 studies in the meta-analysis were randomized controlled trials (RCTs).
The team used standardized mean difference (SMD) as a metric to determine the impact of ICP. In the case of HbA1c, the researchers found suitable data in 34 studies involving 12,599 people. They found that collaborative practices in primary care in all settings had a positive effect on HbA1c, but that effect was greatest in patients with the highest HBA1c at baseline.
The SMDs in patients with baseline HbA1c less than 8 had an SMD of -0.13 in ICP settings; those with HbA1c between 8 and 9 had an SMD of -0.24; those with HbA1c of 9 or higher had an SMD of -0.60 in the studies.
Meanwhile, systolic (SBP) and diastolic (DBP) blood pressures in an ICP environment had SMDs of -0.31 (based on 25 studies) and -0.28 (based on 24 studies), respectively. The observed blood pressure effects were not related to the baseline values.
Lee and colleagues believe their study provides the most complete and up-to-date picture of the effects of ICP in these patients. One of the strengths of their study is that they included both RCTs and real-world studies.
“RCTs are performed in controlled settings with specific patient populations and using precise interventions, and have a superior study design with a lower risk of bias,” the researchers say. “However, the results from RCTs may lack real-world scenarios and patient behavior in response to clinical interventions that better reflect everyday experience.”
The authors said the data makes a strong case for ICP helping to improve patient outcomes for diabetes and high blood pressure. However, they also said that there is a practical reason why practices should consider using ICP. They said the global rise in chronic diseases like diabetes and the growing elderly population could overwhelm primary care practitioners, especially in areas with limited health resources.
“ICP appears to be a plausible option for areas with limited access to care and for patients with poorer diabetes control,” wrote Lee and colleagues. “Based on what we have learned, GPs may want to consider providing ICP with at least three occupations to improve outcomes in diabetes and high blood pressure.”
The study, Assessing Interprofessional Collaborative Practices and Outcomes in Adults with Diabetes and Hypertension in Primary Care, was published online on the JAMA Network Open.