1. Collaboration and its outcomes in primary care compared internationally Sanneke Schepman Johan Hansen Ronald Batenburg Dinny de Bakker Netherlands Institute for Health Services Research (NIVEL) 4 September 2012 A systematic literature review

2. Background What is already known? Lots of articles describe collaboration in primary care and its outcomes, but the “black box” is not open yet Therefore we conducted a systematic literature review to see if we could find out how certain elements of multidisciplinary collaboration in primary health care relate to outcomes for patients and professionals 2

3. Search strategy We searched Pubmed, CINAHL, Cochrane Library and EMBASE for relevant studies. Search terms: Inclusion criteria: Middle or high income countries Studies with quantitative data or literature reviews 3 Aspect 1 Subject Aspect 2 Subject Aspect 3 Sector Aspect 4 Outcomes Multidisciplinary OR …. (Synonyms) Collaboration OR …. Primary care OR …. Outcomes OR …. OR AND

4. Methods Selection process Studies identified (n=2760) MEDLINE (Pubmed): n= 2172 CINAHL: n= 326 Embase: n= 115 Cochrane: n= 147 Duplicate studies excluded: n= 243 Potentially relevant studies screened for retrieval: n= 2507 Studies retrieved for more detailed information: n= 113 Studies excluded based on title (n=1742) and abstract (n=652) Reasons abstract exclusion: - Sector n= 154 - Subject n= 218 - Countries n= 3 - Methods n= 205 Studies ultimately included in the review: Included= 25 Waiting for second opinion= 18 Pending= 34 Studies excluded based on full text (n= 29) Reasons: - Subject n= 17 - No outcomes n= 7 - Methods (quality) n= 5 *SLRs are not displayed in this presentation Numbers will change while study is still in progress 4 Literature reviews: n= 2*

5. Year of publication and origin of the studies (n= 25) 5 No studies before 2000 on this topic? Europe lagging behind?

6. Study designs Designs of the studiesN studies Randomised Controlled Trial6 Cluster Randomised Controlled Trial5 Interrupted time series4 Before-and-after study3 Controlled Trial3 Cross sectional study2 Cohort study1 Retrospective study1 Total25 6

7. Collaboration (n= 25 studies) Activities done in collaborationN TotalN with significant effect Development of individualized care plan 137 Multidisciplinary meetings 116 Organization and communication 71 Treatment (patient involved) 4 2 Training 2 2* Total 3718 * There was 1 study where outcomes were significant but negatively associated with the activity.

8. Outcomes N totalN with significant effect Patients’ health status (SF)92 Patients’ activities of daily living63 Patients’ quality of life51 Patients’ psychological well being /mental well being 21 Patients’ HbA1c (objective)53 Patients’ systolic blood pressure (objective) 52 Patients’ use of emergency services (objective) 32 Health professionals’ satisfaction32 Direct costs / provider visit costs31 Medication changes21 Total 4318 The outcomes of the collaboration (top 10):

9. Describe structural characteristics of the collaboration Linking collaborative activities with outcomes What’s next? 9

10. Key messages Development of care plans and multidisciplinary meetings is popular and seems to be successful in more than half of the cases. Objective outcomes for patients seem to improve more often Few research on outcomes of collaboration for professionals Inconclusive evidence for (positive) effects of multidisciplinary collaboration 10