Interventions to promote effective interprofessional collaboration that improves care outcomes for older people: a realist synthesis of evidence.
Dr Carmel Davies is a Lecturer/Assistant Professor School of Nursing, Midwifery and Health Systems, University College Dublin. Dr Davies’s research interest is multidisciplinary applied health and social research. Her research focuses broadly on quality improvement and clinical effectiveness and promoting the implementation of best research evidence into healthcare policy and practice. Her research expertise is in Implementation Science methods, particularly in process/formative evaluation, realist review, clinical practice guideline adaptation and implementation. Her research is strongly participatory, engaging the public, patients, healthcare professionals and policymakers. She has a keen interest in reciprocal knowledge translation and how patient and public involvement can enhance and influence shaping health service policy and applied health research agendas. She is a member of the European Implementation Collaborative European and Implementation Network Ireland and Northern Ireland.
Interprofessional Collaboration (IPC) in healthcare integration is promoted in research evidence and health policy as central to the design and delivery of quality healthcare for older people. Health system reform and national policy in Ireland have identified interdisciplinary team-based approaches as critical for enabling care integration for older people. The National Integrated Care Programme for Older Persons are currently implementing Community Specialist Teams for Older People (CST-OP) to support care integration through interprofessional collaborative practice. IPC involves new ways of working conceptualised by the ECLECTIC competency framework under three domains: Knowledge of the Team, Communication and Shared Decision-making.
The new ways of working to support interprofessional collaboration in contexts of healthcare integration are challenging to implement, and evidence to guide implementation is underdeveloped. There is a lack of evidence to explain how to support IPC within care integration for older people. This emphasises the need to ask the research question: what works, for whom, in what context and why?
Based on a synthesis of research evidence, identify interventions and mechanisms that enable interprofessional collaboration for improving care for older people.
Realist synthesis is a theory-driven approach based on scientific realism. It is context-driven, explores beyond when an intervention is effective and embraces complexity recognising healthcare as a dynamic social system. It is relevant to synthesise relevant implementation literature systematically. It develops Programme Theory through causal explanations linking Context, Mechanism & Outcome configurations (CMOcs)
The study design is guided by a five steps process involving an exploratory scoping phase (steps 1-2), systematic search, appraisal and synthesis phase (steps 3-5), which is then synthesised and developed into initial programme theories.
The relative importance of understanding mechanisms is often understated. We follow Sonia Dalkin and colleagues’ operationalisation using the formula: M (Resources) + C → M (Reasoning) = O
Mechanisms are a combination of resources offered by the intervention under study (ICP) and stakeholders’ reasoning in response. The context is the conditions to activate mechanisms which induce an individual’s reasoning in collaboration, leading to an outcome. Initial programme theory results are presented in tables in the poster.
This work is ongoing as part of a multiphase realist evaluation. The finalised IPTS will be tested and further refined through empirical exploration using case study analysis with CST-OPs implemented recently in Ireland to support scale-up efforts across the Irish health system.
The emerging findings contribute to others adopting similar work; some contextually relevant evidence will inform a roadmap for implementation planning to support workforce planning, capacity building and competency development to improve older people’s health services.