Improved patient-reported outcomes after interprofessional training in mental health: a nonrandomized intervention study

Michael Marcussen, Birgitte Nørgaard, Karen Borgnakke, Sidse Arnfred, Michael Marcussen, Birgitte Nørgaard, Karen Borgnakke, Sidse Arnfred

Abstract

Background: Collaborative interprofessional practices are essential in caring for people with complex mental health problems. Despite the difficulties of demonstrating positive impacts of interprofessional education (IPE), it is believed to enhance interprofessional practices. We aimed to assess impacts on patient satisfaction, self-reported psychological distress and mental health status in a psychiatric ward.

Methods: We conducted a nonrandomized intervention study with patient satisfaction, psychological distress, and health status as outcomes. Mental health inpatients were referred to either an interprofessional training unit (intervention group) or to a conventionally organized ward (comparison group). Outcomes were assessed using the Short Form Health Survey (SF-36), the Kessler Psychological Distress Scale (K10), and the Client Satisfaction Questionnaire (CSQ-8).

Results: The intervention group included 129 patients, the comparison group 123. The former group reported better mental health status than the latter; the postintervention mean difference between them being 5.30 (95% CI 2.71-7.89; p = 0.001; SF-36), with an effect size of 0.24. The intervention group patients also scored higher on satisfaction (mean difference 1.01; 95% CI 0.06-1.96; p = 0.04), with an effect size of 0.31. The groups' mean scores of psychological distress were identical.

Conclusion: Our results support the hypothesized value of interprofessional training: intervention group patients reported higher scores regarding mental health status and satisfaction than did comparison group patients. As IPE interventions have rarely involved patients and fewer have taken place in practice settings, further research into both the processes and the long-term effects of IPE in mental healthcare is needed.

Trial registration: The study was registered in ClinicalTrials.gov: NCT03070977 on March 6, 2017.

Keywords: *IPE; *Inpatients; *Interprofessional training; *Mental health services; *PRO; *Patient-reported outcomes; *Team-based care.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart of study participants

References

    1. (WHO) WHO. Integrating mental health into primary care: A global perspective. WHO Libr. 2008. Available from: .
    1. Pauzé E, Reeves S. Examining the effects of interprofessional education on mental health providers: findings from an updated systematic review. J Ment Health. 2010;19(3):258–271. doi: 10.3109/09638230903469244.
    1. Tomizawa R, Shigeta M, Reeves S. Framework development for the assessment of interprofessional teamwork in mental health settings. J Interprof Care. 2017;31:43–50. doi: 10.1080/13561820.2016.1233098.
    1. Kinnair DJ, Anderson ES, Thorpe LN. Development of interprofessional education in mental health practice: adapting the Leicester model. J Interprof Care. 2012;26(3):189–197. doi: 10.3109/13561820.2011.647994.
    1. Reeves S, Freeth D. Re-examining the evaluation of interprofessional education for community mental health teams with a different lens: understanding presage, process and product factors. J Psychiatr Ment Health Nurs. 2006;13(6):765–770. doi: 10.1111/j.1365-2850.2006.01032.x.
    1. World Health Organization. Framework for Action on Interprofessional Education & Collaborative Practice. Practice. 2010:1–63 Available from: .
    1. Marcussen M, Norgaard B, Arnfred S. The effects of Interprofessional education in mental health practice: findings from a systematic review. Acad Psychiatry. 2018;43:200–208. doi: 10.1007/s40596-018-0951-1.
    1. Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2017;2017:1–38.
    1. Harris M, Greaves F, Gunn L, Patterson S, Greenfield G, Majeed A, et al. Multidisciplinary group performance—measuring integration intensity in the context of the north West London integrated care pilot. Int J Integr Care. 2013:1–10.
    1. Urben S, Gloor A, Baier V, Mantzouranis G, Graap C, Cherix-Parchet M, et al. Patients’ satisfaction with community treatment: a pilot cross-sectional survey adopting multiple perspectives. J Psychiatr Ment Health Nurs. 2015;22:680–687. doi: 10.1111/jpm.12240.
    1. Wen J, Schulman KA. Can team-based care improve patient satisfaction? A systematic review of randomized controlled trials. PLoS ONE. 2014:1–9.
    1. Cox M, Cuff P, Brandt B, Reeves S, Zierler B. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. J Interprof Care. 2016;30:1–3. doi: 10.3109/13561820.2015.1111052.
    1. Telford R, Faulkner A. Learning about service user involvement in mental health research. J Ment Health. 2004;13:549–559. doi: 10.1080/09638230400017137.
    1. Furness PJ, Armitage H, Pitt R. An evaluation of practice-based interprofessional education initiatives involving service users. J Interprof Care. 2011;25(1):46–52. doi: 10.3109/13561820.2010.497748.
    1. Barnes D, Carpenter J, Dickinson C. The outcomes of partnerships with mental health service users in interprofessional education: a case study. Health Soc Care Commun. 2006;14(5):426–435. doi: 10.1111/j.1365-2524.2006.00661.x.
    1. Reilly S, Planner C, Gask L, Hann M, Knowles S, Druss B, et al. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev. 2013:1–51.
    1. Sawamura J, Ishigooka J, Nishimura K. Re-evaluation of the definition of remission on the 17-item Hamilton depression rating scale based on recovery in health-related quality of life in an observational post-marketing study. Health Qual Life Outcomes. 2018;16:14. doi: 10.1186/s12955-018-0838-6.
    1. Yatham LN, Lecrubier Y, Fieve RR, Davis KH, Harris SD, Krishnan AA. Quality of life in patients with bipolar I depression: data from 920 patients. Bipolar Disord. 2004;6:379–385. doi: 10.1111/j.1399-5618.2004.00134.x.
    1. Smith PC, Mossialos E, Papanicolas I. Performance Measurement for Health System Improvement Experiences, Challenges and Prospects. World Health. 2008. Available from: .
    1. Swanson KA, Bastani R, Rubenstein LV, Meredith LS, Ford DE. Effect of mental health care and shared decision making on patient satisfaction in a community sample of patients with depression. Med Care Res Rev. 2007;64:416–430. doi: 10.1177/1077558707299479.
    1. Carpenter J, Barnes D, Dickinson C, Wooff D. Outcomes of interprofessional education for community mental health services in England: the longitudinal evaluation of a postgraduate programme. J Interprof Care. 2006;20(2):145–161. doi: 10.1080/13561820600655653.
    1. Repper J, Breeze J. User and carer involvement in the training and education of health professionals: a review of the literature. Int J Nurs Stud. 2007;44:511–519. doi: 10.1016/j.ijnurstu.2006.05.013.
    1. Nørgaard B, Draborg E, Vestergaard E, Odgaard E, Jensen DC, Sørensen J. Interprofessional clinical training improves self-efficacy of health care students. Med Teach. 2013;35(6):e1235–e1242. doi: 10.3109/0142159X.2012.746452.
    1. Marcussen M, Norgaard B, Borgnakke K, Arnfred S. Interprofessional clinical training in mental health improves students’ readiness for interprofessional collaboration: a non-randomized intervention study. BMC Med Educ. 2019;19(1):27. doi: 10.1186/s12909-019-1465-6.
    1. Mainz J, Jensen JW. The patient’s team and the responsible doctor as a condition for efficient patient courses. Ugeskr Laeger. 2015;177:V05150436.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;8:701–741.
    1. Richards D, Hill JJ, Gask L, Lovell K, Chew-Graham C, Bower P, et al. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. BMJ. 2013;347:f4913. doi: 10.1136/bmj.f4913.
    1. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SLT, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32:959–976. doi: 10.1017/S0033291702006074.
    1. Thelin C, Mikkelsen B, Laier G, Turgut L, Henriksen B, Olsen LR, et al. Danish translation and validation of Kessler’s 10-item psychological distress scale–K10. Nord J Psychiatry. 2017;71:411–416. doi: 10.1080/08039488.2017.1312517.
    1. Aagaard J, Müller-Nielsen K. Clinical outcome of assertive community treatment (ACT) in a rural area in Denmark: a casecontrol study with a 2-year follow-up. Nord J Psychiatry. 2011;65:299–305. doi: 10.3109/08039488.2010.544405.
    1. De Wilde EF, Hendriks VM. The client satisfaction questionnaire: psychometric properties in a Dutch addict population. Eur Addict Res. 2005;11:157–162. doi: 10.1159/000086396.
    1. Lopez M. Estimation of Cronbach’s alpha for sparse datasets. Evaluation. 2007:151–56.
    1. Malling B, Bested KM, Skjelsager K, Østergaard HT, Ringsted C. Long-term effect of a course on in-training assessment in postgraduate specialist education. Med Teach. 2007;29, 966:–71.
    1. Papageorgiou A, Loke YK, Fromage M. Communication skills training for mental health professionals working with people with severe mental illness. Cochrane Database Syst Rev. 2017:1–27.
    1. Holman H, Lorig K. Patients as partners in managing chronic disease. Partnership is a prerequisite for effective and efficient health care. BMJ Clin Res. 2000:526–27.
    1. Carlier BE, Schuring M, Burdorf A. Influence of an interdisciplinary re-employment Programme among unemployed persons with mental health problems on health, social participation and paid employment. J Occup Rehabil. 2018;28:147–157. doi: 10.1007/s10926-017-9704-3.
    1. Rickwood DJ, Mazzer KR, Telford NR, Parker AG, Tanti CJ, Mc Gorry PD. Changes in psychological distress and psychosocial functioning in young people accessing headspace centres for mental health problems. Med J Aust. 2015;202:537–542. doi: 10.5694/mja14.01696.
    1. Lara-Cabrera ML, Salvesen Ø, Nesset MB, De las Cuevas C, Iversen VC, Gråwe RW. The effect of a brief educational programme added to mental health treatment to improve patient activation: A randomized controlled trial in community mental health centres. Patient Educ Couns. 2016;99:760–768. doi: 10.1016/j.pec.2015.11.028.
    1. Hylin U, Lonka K, Ponzer S. Students’ approaches to learning in clinical interprofessional context. Med Teach. 2011;33(4):e204–e210. doi: 10.3109/0142159X.2011.557410.
    1. Lindblom P, Scheja M, Torell E, Åstrand P, Felländer-Tsai L. Learning orthopaedics: assessing medical students’ experiences of interprofessional training in an orthopaedic clinical education ward. J Interprof Care. 2007;21(4):413–423. doi: 10.1080/13561820701401346.

Source: PubMed

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