Impact of interprofessional collaboration between long-term care physicians and medical specialists on quality of care and quality of life of long-term care facility residents: a systematic review

Impact of interprofessional collaboration between long-term care physicians and medical specialists on quality of care and quality of life of long-term care facility residents: a systematic review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of interprofessional collaboration between long-term care physicians and medical specialists on quality of care and quality of life of long-term care facility residents: a systematic review Marleen van Oosterhout, Jos Schols, Danny Hommel, Elke de Jong, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7001320/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Purpose: The increasing population of long-term care facility (LTCF) residents with complex medical needs presents a growing challenge for healthcare systems. These residents often suffer from multiple chronic conditions, functional decline, cognitive impairments, and a limited social network, making access to medical specialists difficult. Our main aim is to identify the impact of interprofessional collaboration interventions between long-term care (LTC) physicians and medical specialists on the quality of life (QoL) and quality of care (QoC) of LTCF residents. Methods : A systematic literature search in PubMed, EMBASE, Cochrane Library, Cinahl and a manual screening of the reference lists was performed on the impact of interprofessional collaboration between LTC physicians and medical specialists on the QoL and QoC for LTCF residents. The final search was performed on March 3rd 2025 andaccording to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results : The searches identified 10364 studies of which ultimately 16 studies were included for analysis. Three ways of interprofessional collaboration were identified; teleconsultations, on-site consultation services, and multidisciplinary collaboration interventions. Conclusions : This review suggests that interprofessional collaboration between LTC physicians and medical specialists holds potential to improve the QoL and QoC of LTCF residents. Multidisciplinary collaboration interventions that integrate tele- and on-site consultations with additional elements and support, show promise for sustainable and positive impact. Given the heteogeneity in study designs and outcomes, further research is needed to identify which elements of multidisciplinary collaboration interventions have the greatest impact on the QoL and QoC of LTCF residents. Interprofessional collaboration Long term care physician Medical specialist Quality of life Quality of care Figures Figure 1 Figure 2 Key summary Points Aim The main aim of this study is to identify the impact of interprofessional collaboration interventions between long-term care (LTC) physicians and medical specialists on the quality of life (QoL) and quality of care (QoC) of long-term care facility (LTCF) residents in need of medical specialist expertise. Findings Three ways of interprofessional collaboration between LTC physicians and medical specialists were identified: teleconsultations, on-site consultation services, and multidisciplinary collaboration interventions. Most interprofessional collaboration interventions indicated a positive impact on LTCF residents’ QoL or QoC. Message Whereas teleconsultations eliminate residents’ travel burden, may reduce costs and support triage decisions, on-site consultation services remain essential when remote assessment is inadequate. Multidisciplinary collaboration interventions, combining tele- and on-site consultations with additional elements and support, demonstrate promising sustainable and positive impact on LTCF residents’ QoL and QoC. 1. Introduction The healthcare system is facing an increasing challenge due to the rising number of long-term care facility (LTCF) residents with complex medical needs.[1, 2] In many developed regions, demographic changes, driven by lower mortality rates and increased life expectancy, have led to a growing population of the oldest old.[3, 4] A substantial proportion of these oldest old suffers from multiple chronic conditions, functional decline, and cognitive impairments.[5, 6] As their conditions progress and care dependency increases, some eventually require continuous and specialised care (such as nursing care and memory care), as provided in LTCFs.[7] The progressive declining physical and mental functional status of LTCF residents, combined with their often limited social networks, not only impacts their QoL [8], but also poses significant challenges when it comes to traveling from the LTCF to a hospital. Given these challenges, it is not easy for residents to access medical specialists care, whose input may be essential for managing the residents‘ complex medical needs. While medical specialists have much expertise, they often tend to focus on treating single conditions without fully considering the complexities of multimorbidity. As a consequence, this fragmented approach leads to gaps in both knowledge and continuity of care, ultimately compromising outcomes for LTCF residents with multiple chronic illnesses.[9] To bridge these gaps and ensure a more holistic care, interprofessional collaboration becomes increasingly essential within the healthcare system. In recent years, researchers explored various interprofessional collaborative interventions in which general practitioners (GPs) work together with medical specialists to improve the quality of care and shared decision-making for the oldest old.[10–14] Although these previous initiatives of interprofessional collaboration showed promise in improving the QoC and reducing care fragmentation, they focused mainly on the oldest old living at home or in community care. Thus far, limited focus has been placed to LTCF residents, despite their vulnerability, and even more complex care needs.[15] Notably, in an era of rapid digitalisation, where technology allows for remote specialist input and digital collaboration, physical hospital visits may no longer be strictly necessary.[16, 17] Therefore, expanding such interprofessional collaboration interventions into LTCFs holds significant potential to improve access to specialised care and reduce unnecessary and burdensome hospital visits. In addition to these developments, the provision of medical care to LTCF residents varies significantly across countries and even within regions. In most countries GPs provide the medical care to LTCF residents. In others, specialised nurses, LTC physicians, geriatricians, internal medicine physicians and psychiatrists take this role, reflecting significant structural and professional diversity in care coordination in LTCFs.[18–20] A specialised and qualified LTC physician, also called elderly care physician, as seen in the Netherlands, has the potential to play a crucial role in the interprofessional collaboration.[21, 22] As part of their training, LTC physicians are skilled in care coordination, interprofessional collaboration and medical leadership.[23] These physicians can help to bridge the healthcare gaps and ensure that critical medical decisions are collaboratively based on expertise from a medical specialist and align with the unique needs of the LTCF resident. However, the collaboration between LTC physicians and medical specialists remains underexplored. The main aim of this study is to identify the impact of interprofessional collaboration interventions between LTC physicians and medical specialists on the QoL and QoC of LTCF residents in need of medical specialist expertise. 2. Methods We conducted a systematic literature review on the impact of interprofessional collaboration interventions between LTC physicians and medical specialists on the QoL and QoC for LTCF residents. The search and reporting were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.[24, 25] The study protocol was registered in PROSPERO, 2023 (CRD42023484096). 2.1 Search strategy A literature search in PubMed, EMBASE, Cochrane Library and Cinahl was performed, using the search strategy shown in Appendix 1. Articles in English, Dutch, French, German or Spanish were permitted. The search had no time limit and the final search was performed on March 3rd 2025. Two researchers (MvO and JS) independently carried out the screening of titles, abstracts and full-text articles using the Rayyan web tool.[26] Titles and abstracts were screened to determine whether the studies met the inclusion criteria. The full-text articles were retrieved to identify eligibility for final inclusion. In case of disagreement, a third researcher was consulted (SL). When the full text was not available, we contacted an (inter)national institutional librarian or reached out to the author of the study. In addition to the database search we performed a manual screening of the reference lists of the included studies to identify additional relevant publications. 2.2 Eligibility criteria 2.2.1. Types of studies We included studies with the following designs: experimental studies, including randomised controlled trials (RCT), quasi-randomised trials, and non-randomised controlled trials (such as controlled before-and-after studies and interrupted time series studies); observational studies (cohort and case series); and mixed-methods studies. Conference abstracts, case reports, study protocols, latent class analyses, and realist evaluations were excluded. 2.2.2. Types of setting and population We included any type of LTC physician or medical specialist providing medical care for LTCF residents in need of a medical specialist perspective or treatment. The role of LTC physician could be fulfilled by a GP, GP trainee, junior doctor, LTC physician, specialised and qualified LTC physician, geriatrician, internal medicine physician or psychiatrist, depending on the national healthcare system and regional context. Studies in which the role of the medical professional was undertaken by a specialised nurse, such as a physician assistant (PA) or nurse practitioner (NP), were excluded, since these roles differ in scope and training from that of physicians, which was our specific focus. We also excluded studies including frail elderly receiving dental care, specialist care at home, in clinics, subspecialised clinics (e.g., Huntington's, Parkinson's, young-onset dementia), community-based settings, or hospital-based settings, because these forms of care do not reflect the long-term care context we aimed to investigate. Exclusions were also applied to studies with a focus on emergency care, discharge or settings like geriatric rehabilitation care or hospice care, because of the short-term care aspect. 2.2.3. Types of interventions Studies were included if they evaluated medical interprofessional collaboration interventions or medical support between LTC physicians and medical specialists providing care to LTCF residents. This involved for example, multidisciplinary team meetings, consultations, teleconsultations and education if part of a durable interprofessional collaboration. Although no definition is provided, WHO documentation describes a multidisciplinary team as typically bringing together expertise from various professional fields and involving physicians, nurses, and paramedical staff.[27] We focussed on studies in which both the LTC physician and the medical specialist are part of the team, supported by nurses or paramedics. The comparison for this intervention was usual care, in which the LTCF resident is referred to a hospital-based medical specialist. Furthermore, studies focusing on the functionality of apps, bedside screening tools, protocols, or care pathways were excluded, as these represent instruments or methods facilitating collaboration rather than constituting the collaboration itself. COVID-19 collaborations specific for outbreak management were excluded as well, because of the short term crisis response aspect rather than long-term care. 2.2.4 Types of outcome measures Outcomes reported in the included studies related to both patient health outcomes and quality of care. Patient health outcomes included measures such as QoL, functional status, morbidity, and mortality. Quality of care outcomes included patient or caregiver satisfaction, physician satisfaction, hospital admissions, identified facilitators and barriers, as well as cost-related aspects such as cost-benefit and cost-effectiveness. 2.3 Data extraction A data extraction template was developed (by MvO) using Microsoft Excel. For each article we extracted the following items: general study characteristics (author, year of publication, title, country, language, journal, study design, study duration), patient characteristics (setting, comorbidities), physician characteristics (specialism, physician population size, role in collaboration), intervention details (type of intervention, duration, control group, follow-up period) and outcomes. 2.4 Quality Assessment We assessed the risk of bias and quality of the included trials using the Cochrane Risk of Bias tool [28] for randomised trials and ROBINS-1 tool [29] for non-randomised trials. The assessment was performed by two researchers (MvO and JS) until a shared agreement was reached. In case of disagreement, we consulted the third researcher (SL). A meta-analysis was not conducted because of the heterogeneity of outcome measures and study designs. 3. Results 3.1. Study selection The literature search resulted in 10364 publications, which resulted in 9380 unique articles after the removal of duplicates. Four articles were identified through reference list checking. After screening of titles and abstracts, 9334 articles were excluded. One article could not be retrieved despite help from (inter)national institutional librarians or contact with the author of the study.[30] The remaining 45 full-text articles were assessed for eligibility, resulting in16 studies included in this systematic review. Across the studies a total of 18 hospitals, 187 LTCFs and 8402 residents were involved. In the studies that reported data on physicians, the total number of physicians varied from 2–10. A flow diagram of the selection process is shown in Fig. 1 . Figure 1 Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) flow diagram 3.2. Study Characteristics The finally included studies [31–46] were conducted in western or high income countries (Australia, Austria, France, New Zealand, Spain, Switzerland, the Netherlands, UK, US). Among these, four studies were carried out in France, six in the US and the remaining studies where distributed over the other mentioned countries. The types of studies in this review included: 3 RCT studies, 1 interrupted time-series study, 4 before-and-after studies, 2 prospective observational studies, 2 prospective cohort studies, 3 retrospective descriptive studies and 1 mixed methods studies. All studies were performed between 2001 and 2025. The interprofessional collaboration interventions could be categorised into three ways; teleconsultations, on-site consultation services and multidisciplinary collaboration interventions. In most studies, the collaboration was realised between medical specialists based at a single hospital and LTC physicians spread across multiple regional LTCFs. The scale of collaboration varied, for example from 2 to 3 regional LTCFs [43–45], up to 60 LTCFs.[32] In four studies [33, 34, 37, 39] collaboration was limited to one single hospital and one single LTCF. In addition to variation in the scale of collaboration, the included studies also revealed heterogeneity in the professional roles of those providing medical care to LTCF residents. In nine studies the role of LTC physician was fulfilled by a GP (or primary care physician or family doctor), who often structurally visited the LTCF. In other studies, this role was taken on by a junior doctor, geriatrician (trainee) or psychiatrist (trainee) assigned to the LTCF. Medical care provided by specifically, qualified LTC physicians was assessed in only one study, conducted in the Netherlands.[38] The medical specialists participating in the selected studies represented a broad range, including dermatologists, geriatricians, internal medicine physicians, infectious disease physicians, neurologists, ophthalmologists, and psychiatrists. Notably, thirteen studies were conducted in collaboration with psychiatrists or geriatricians. A summary of the included study characteristics, participants, interventions and study outcomes is available in Table 1 . Table 1 Characteristics of the included studies Study Study Design Setting and Participants Type of intervention Description of intervention Control Duration Results Conclusion Audiau, et al. 2021, France (31) Retrospective descriptive study Setting : 3 LTCFs 1 hospital Participants : 77 residents Multidisciplinary team : LTC physicians, nurses, cardiologists, geriatricians, and psychiatrist Multidisciplinary TokTokDoc project; teleconsultations in cardiology and neuropsychogeriatry using real-time remote assessment via tablet and connected stethoscope, the LTCF physicians role remains central and an on-site mobile nurse surves as coordinator. The medical specialist provides advice remotely and sends their recommendations via a secure platform to the LTC physician. Usual care 6 months - avoidance of hospital admissions in 10% (12/120), and avoidance of hospital visits in 55,8% (67/120) - therapeutic optimisation was achieved in 40% (38/120). Multidisciplinary teleconsultation and on-site consultation service is a relevant way for improving the healthcare of LTCF residents, by avoiding hospital visits and admissions. Complex medical assessments were carried out in the same way as a face-to-face consultation. Bermejo Boixareu, et al. 2022, Spain (32) Observational descriptive study Setting : 60 LTCFs 1 hospital Participants : 4600 residents Multidisciplinary team : LTC physicians, public health, geriatricians, and other medical specialists Multidisciplinary Multidisciplinary geriatrics program; using teleconsultation and support of a geriatric consultation liaison team. Geriatricians had the central role in transmitting medical specialists advice to LTC physician. In addition, on-site intravenous treatment of LTCF residents and training of LTC physicians where provided. Coordination via weekly or two-weekly zoom/phone/email meetings and protocolised teleconferences involving LTCF, public health, hospitals, and primary care. Usual care 16 months - an estimated cost reduction of 37.026 € (mean 187 € per resident) by avoiding ambulance tranfers and on-site consultations. - an estimated costs savings of 1.5 milion € and 2800 fewer hospital days by on-site intravenous treatment to 442 LTCF residents Multidisciplinary teleconsultation and on-site consultation service improves continuity of care for LTCF residents and highlights an estimated positive cost-effectiveness in the healthcare system. Bon, et al. 2020, France (33) Retrospective descriptive study Setting : 1 LTCF 1 hospital Participants : 67 residents Multidisciplinary team : LTC physicians, ophthalmologists, orthoptist, and nurses Multidisciplinary Ophthalmologic teleconsultation project; weekly teleconsultation with ophthalmologists and supported by on-site orthoptist and nurses. The examinations (visual acuity, intraocular pressure, wide field fundus photography, and optical coherence tomography) were performed at the LTCF. Data were securely transferred prior to teleconsultation. If necessary, the resident was scheduled for specialised consultation (e.a. intravitreal anti-VEGF injections) or follow-up examination. Usual care 6 months - ophthalmologic pathologies were detected in 55% (37/67) - treatment was initiated in 38% (14/37) of LTCF residents - glasses were prescribed to 45% (30/67) - low vision proportion was decreased from54 % to39 % (P = 0.02; OR = 1.86; CI 95%, [1.06—3.28]) - visual acuity improved from 0.67 (± 0.76) to 0.52 (± 0.72) for distance vision (P < 0.0001) and from 0.68 (± 0.84) to 0.53 (± 0.76) for near vision, P < 0.0001 Multidisciplinary teleconsultation and on-site consultation service allowed LTCF residents to access a comprehensive ophthalmology consultation and benefit from current diagnostic technologies. Buisson, et al. 2019, France (34) Prospective cohort study Setting : 1 LTCF 1 hospital Participants : 288 interventions, LTC physician, and psychiatrists Teleconsultation Neurology and gerontopsychiatry expertise teleconsultation for LTCF residents with dementia and behavioral problems. The Neuropsychiatric Inventory Nursing Home version (NPI-NH) was measured during intervention and reassessed after 30 days. Usual care 21 months - the average NPI-NH score decreased from 50 ± 19,2 (day 0) to 33.9 ± 19,6 (day 30), P < 0,001 - the percentage of avoided hospitalizations was 16% at day 30, corresponding to 46 cases over 21 months Teleconsultation recommendations help to decrease NPI-NH and reduce hospital admission of LTCF residents. Catic, et al. 2014, US (35) Prospective cohort study Setting : 11 LTCFs 1 hospital Participants : 47 residents LTC physicians, and psychiatrists Teleconsultation ECHO-AGE program; is based on the Extension for Community Healthcare Outcomes (Project ECHO) and is a case-based teleconsultation program. Bimonthly 1.5-hour long sessions between medical specialists and long-term care providers to improve the care of residents with dementia or delirium related behavioral issues. Sites were expected to engage in 8 sessions every 6 months. Usual care 12 months - clinical improvement in 74% of LTCF residents whose recommendations were followed versus 20% when recommendations were not followed, p < 0.03. - lower hospitalisation rates among LTCF residents for whom recommendations were followed (29% versus 60%, not significant) Teleconsultation can be successful in improving the care of LTCF residents with dementia and/or delirium related behavioral issues by linking medical specialists with LTC physician. Connolly, et al. 2016, New Zealand (36) Cluster RCT (post hoc analysis) Setting : 36 LTCFs (18 intervention, 18 control) 1 hospital Participants : 1998 residents Multidisciplinary team : LTC physicians, geriatricians, gerontology nurse specialist (GNS), and senior nurses Multidisciplinary ARCHUS program (The Aged Residential Care Healthcare Utilisation Study); multidisciplinary meetings for diagnosis-specific interventions for the "Big Five" diseases (cardiac failure, ischemic heart disease, COPD, stroke, pneumonia). The intervention combined several approaches; baseline LTCF assessment identifying need; benchmarking resident indicators linked to care quality; three 1-our meetings including geriatrician, gerontology nurse specialist, pharmacist, LTC physician, and senior nurses; enhanced education and clinical coaching was provided for nurses and caregivers. Usual care 14 months - LTCF residents in the intervention group were 34.7% less likely to have an admission for combined ‘big five’ diagnoses than controls after 3 months, hazart ratio = 0.65 (95% CI = 0.49–0.88; P = 0.005). - fewer 'big five' admissions during full 14-month follow-up, hazart ratio = 0.73 (95% CI = 0.54–0.99; P = 0.043) - No significant difference in the rate of other acute hospital admissions Multidisciplinary teleconsultation meetings and diagnosis-specific education may reduce admissions for common conditions in LTCF residents. Jump, et al. 2012, US (37) Interrupted time-series (ITS) Setting : 1 LTCF 1 hospital Participants : 160 residents Multidisciplinary team : LTC physicians, infectious disease physician, nurse practitioners, and physician assistants Multidisciplinary LID service; the LTCF Infectious Disease consult (LID) team for antimicrobial stewardship and infection control to LTCF residents. The LID team consisted of an infectious disease physician and nurse practitioner. Weekly on-site consultation services and urgent cases were managed immediately via phone or electronic medical record. Residents were referred by LTC physicians, nurse practitioners or physician assistant. Usual care 18 months − 30% reduction of total systemic antibiotic use in LTCF residents (p < 0.001) with a significant reduction in both oral (32%; P < 0.001) and intravenous agents (25%; P = 0.008) - C. difficile infection rates did not change significantly over time for the two individual time periods, - the rate of change for positive C. difficile tests between pre- and postintervention periods was significantly different, (P = 0.04) Multidisciplinary tele- and on-site consultation service led to a significant reduction in total antimicrobial use in LTCF residents. Bringing providers with infectious disease expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship. Klösters, et al. 2022, the Netherlands (38) Prospective multicentre observational study Setting : 20 LTCFs 1 hospital Participants : 270 residents LTC physicians, dermatologist (and dermatology residents) On-site consultation service On-site consultation service by dermatologists (or dermatology residents supervised by a dermatologist) who regularly visited LTCF residents and were experienced in using Store-and-forward teledermatology (SAF-TD); referral by LTC physician using a standardised referral letter. Tele-consulta-tion 72 months - dermatologists rated the estimated value of on-site consultation service of "added value" in 67.8% (183/270) and of “no added value in 32.2% (87/270 visits) compared to SAF-TD. - skin tumor diagnoses strongly predicted added value of on-site consultation service compared to SAF-TD. Benign: odds ratio (OR) = 27.6; 95% CI 7.3–104.3, premalignant: OR = 12.2; 95% CI 4.1–36.0 and malignant: OR = 10.1; 95% CI 3.3–30.5 - Eczema was associated with no added value of on-site consultation service compared to SAF-TD (OR = 0.1; 95% CI 0.1–0.3) On-site consultation services are estimated to have added value over teleconsultations in two-third of referrals, whereas using teleconsultation as a triage tool potentially reduces the need for additional on-site consultation services in one-third. To make optimal use of the limited capacity for on-site consultations by medical specialists, it could be helpful if LTC physicians use teleconsultation more frequently Lyketsos, et al. 2001, US (39) Pilot study, Before and after study Setting : 1 LTCF 1 hospital Participants : 66 residents Multidisciplinary team : LTC physician, psychiatrist, geriatrician, nurse, activity therapist, and social workers. Multidisciplinary Multidisciplinary teleconsultation project; Twice-weekly case based teleconsultations were held to discuss LTCF residents with behavioral or psychiatric problems who were at risk of hospitalisation. This intervention also included 24/7 phone support and standardised assessment forms were created and used by multidisciplinair team. Usual care 12 months - almost 50% reduction in number of hospital admissions, from 21 in the year before the intervention to 11 in the year after the intervention Multidisciplinary teleconsultation and case-based discussions served as an effective bridge between care teams in the continuum of care. This project brought about a crucial shift in perspective. Mauleon, et al. 2025, France (40) Cluster RCT (secondary analysis) Setting : 19 LTCFs 2 hospitals Participants : 141 residents; control n = 65, intervention n = 76 Multidisciplinary team : LTC physician, geriatrician, specialised nurse, psychologist, and LTCF residents Multidisciplinary DETECT project (Dementia in long-term care facilities Telemedicine for the management of neuropsychiatric symptoms); multidisciplinary teleconsultations between a geriatrician trained in neuropsychiatric symptoms (NPS), a specialised NPS nurse, LTC physician, psychologist and LTCF residents. Teleconsultation involved a tailored personal plan with a therapeutic strategy. Usual care 24 months - no difference regarding hospitalisations and psychotropic drug prescriptions between intervention and control group - improvement of Neuro Psychiatric Inventory (NPI) frequency x severity score (− 17.7 ± 4.9, P = 0.001), - improvement of NPI change in distress score (-5.7 ± 2.5, P = 0.03) - improvement of ADL (activities daily living) change total score (0.6 ± 0.2, P = 0.006). Multidisciplinary teleconsultation demonstrated advantages in reducing neuropsychiatric symptom severity, frequency, and distress, as well as improvement of functional disability (ADL score) compared to usual care McSweeney, et al. 2012, Australia (41) Randomised cluster trial Setting : 20 LTCFs 1 hospital Participants : 44 residents Multidisciplinary team : LTC physician, psychiatrists, and clinical psychologist Multidisciplinary Multidisciplinary on-site consultation service for depression in LTCF residents with dementia. On-site consultations service with psychiatrist and clinical psychologist involved individually tailored medical and psychosocial recommendations provided to LTCF residents and LTC physician; post-intervention assessment was conducted by a psychologist blind to study condition. Usual care 4 months - at follow-up, the mean Cornell Scale for Depression in Dementia (CSDD) score for the intervention group was significantly lower (mean score: 9.47, SD 5.57) compared to the control group (mean score: 14.23, SD 4.60; P < 0.05). - at follow-up 77% of the intervention group no longer met criteria for major depression. Multidisciplinary on-site consultations were significantly more effective than usual care in treating depression in LTCF residents with dementia. Psychosocial and medical management of depression in LTCF residents can be improved by increasing access to medical specialist and mental health care. Piau, et al. 2020, France (42) Pilot study, Before and after study Setting : 10 LTCFs 2 hospitals Participants : 90 residents Multidisciplinary team : LTC physician, geriatrician, specialised nurse, and psychologist Multidisciplinary Multidisciplinary teleconsultation for Neuropsychiatric symptoms (NPS) of dementia in LTCF residents. The LTC physicians had the role of medical investigators and requested the teleconsultation with the medical specialist when a LTCF resident presented a disruptive NPS. The teleconsultation was led by a geriatrician trained in NPS, specialised NPS nurses, and psychologists. A tailored personal plan with a therapeutic strategy was established after the teleconsultation. Usual care 24 months - no difference was identified regarding hospitalisations and psychotropic drug prescriptions before and after the intervention - the estimated total number of hospitalisations avoided is 33 - LTCF team positively perceived the impact of teleconsultations on health care organisation (77.8% stated teleconsultation to contribute to interdisciplinary collaboration, and 77,6% stated teleconsultation to impove the quality of NPS diagnosis) Multidisciplinary teleconsultation is not a downgraded version of medicine according to the LTCF team, and this intervention has the potential to improve the QoC for LTCF residents. Rabinowitz, et al. 2010, US (43) Retrospective descriptive study Setting : 2 LTCFs 1 hospital Participants : 106 residents, LTC physicians, and psychiatrists Teleconsultation Psychiatry teleconsultation for LTCF residents; referred by LTC physician Usual care or On-site consulta- tion service 68 months - minimum $ 13,000 (range 13,060–46,798) potential cost saved by providing teleconsultations compared to usual care. - maximum $ 232,000 (63,668–232,361) potential cost saved by providing teleconsultations compared to on-site consultation service. Teleconsultation is potentially cost-effective and the study emphasised that teleconsultation enabled access to psychiatric care that would otherwise be unavailable for LTCF residents living in rural areas. Schippinger, et al. 2012, Austria (44) Prospective controlled study Setting : 2 LTCFs (GEKO and control) 1 hospital Participants : 268 residents Multidisciplinary team : LTC physicians, geriatricians, and internal medicine physicians Multidisciplinary Mobile internal medicine geriatric consultation service (GEKO) for LTCF residents conducted of multidisciplinary weekly on-site consultation support to LTC physician, telephone service, intravenous infusions, ultrasound examinations, ECG, and paracentesis under ultrasound guidance. Usual care 10 months - the number of planned non-acute hospital presentations was lower in the GEKO group in comparison to the control group (mean number of hospital presentations/ 100 LTCF residents/month: 14.4 versus 18.0); not statistically significant - mortality: 19 LTCF residents died in control group and 21 LTCF residents died in the GEKO group. - a statistically significant lower frequency of acute transports to hospitals was observed in GEKO group (mean number of acute transports to hospitals/100 LTCF residents/month: 6.1 versus 11.7; P < 0.01). Multidisciplinary on-site consultation service can improve medical care in LTCFs resulting in a statistically significant reduction of acute hospital admissions. Steel, et al. 2022, UK (45) Case series with interventions Setting : 3 LTCFs 1 hospital Participants : 34 residents Multidisciplinary team : LTC physician (and GP trainees), geriatricians trainees, and psychiatrist trainees Multidisciplinary Multidisciplinary teleconsultation; a team comprising LTC physicians (and GP trainees), geriatrician trainees, psychiatrist trainees, pharmacist; intervention included Comprehensive Geriatric Assessment (CGA), case-based discussion followed by a clinical assessment and discussion of proposed management. Follow-up if necessary by LTC physician of psychiatrist trainee. Usual care 20 months - in one LTCF the multidisciplinary teleconsultation resulted in 75% (19/25) reduction in hospital admissions for those reviewed. - a reduction in the costs of hospital admissions, from £55,678 in the 12 months prior to intervention and £49,653 during the intervention year Multidisciplinary teleconsultation may create an opportunity for shared learning and enabling residents to receive more specialist care. Zumbach, et al. 2009, Switzerland (46) Mixed methods Setting : 14 LTCFs 1 Hospital Participants : 146 residents Multidisciplinary team : LTC physicians Psychiatrist Multidisciplinary Multidisciplinary pychiatric medical and nursing on-site consultation service; services included assist in psychiatric diagnoses, organisation of therapeutic consultations, and support LTCF residents with psychiatric disorders in their usual environment whenever possible. Usual care 12 months - physicians satisfaction suvey indicated a high to very high level of satisfaction 3–4 (on a 4-point scale) Multidisciplinary on-site consultation service may lead to better decision making and on-site educational dimensions were found to be very satisfying. Table 1 Summary of the included study characteristics 3.3. Quality Assessment The quality assessment revealed that a considerable proportion of the included studies had a moderate to serious risk of bias, especially in areas concerning confounding, deviations from intended interventions, missing data and measurement of outcomes. A traffic light visualisation of the quality assessment according to ROBINS-I and RoB 2 is provided in Fig. 2 . Figure 2 Traffic light visualisation of the quality assessment according to ROBINS-I and RoB 2 3.4 Impact of interventions 3.4.1. Teleconsultations Four of the included studies evaluated teleconsultation as an intervention to optimise interprofessional collaboration. Two of these studies compared teleconsultation to usual care [34, 35], while the other two studies compared teleconsultation to on-site consultation service.[38, 43] The format of teleconsultation varied across studies, including both real-time and store-and-forward methods. Three studies focused on collaborations between LTC physicians and psychiatrists [34, 35, 43] and one study assessed collaboration between LTC physicians and dermatologists.[38] Teleconsultations could be requested by the LTCF resident, their caregiver, specialised nurse, or the LTC physician. The frequency of teleconsultations varied from structured sessions once every one or two weeks to on-demand consultations. Buisson et al. (2019) examined neuropsychogeriatric expertise teleconsultation for LTCF residents. Using the Neuro Psychiatric Inventory Nursing Home (NPI-NH), they measured an average NPI-NH score decrease of 50 ± 19,2 (during intervention) to 33,9 ± 19,6 (30 days following intervention), P < 0,001. Catic et al. (2014) described case based teleconsultations between psychiatrists from an academic hospital and LTC physicians delivering medical care to 11 regional LTCFs. They discussed challenging cases of residents with dementia or delirium related behavioral problems and, additionally, collected data on compliance, improvement, hospitalisation, and mortality. Following the recommendations led to clinical improvement of behavioral problems in 74% of LTCF residents, compared to 20% when recommendations were not followed (P < 0.03). 3.4.2. On-site consultation services compared to teleconsultations Two studies focused on the impact of on-site consultation services from medical specialist to LTCFs compared to teleconsultations. Rabinowitz et al. (2010) assessed the cost-effectiveness (in $ USD) of psychiatric teleconsultations comparing them to both usual care and on-site consultation service in rural areas.[43] Estimated cost savings ranged from $ 13,000 (teleconsultation compared to LTCF residents usual visit to hospital) to $ 232,000 (teleconsultation versus on-site consultation service). Beyond estimated financial benefits, the study emphasised that teleconsultation enabled access to psychiatric care that would otherwise be unavailable in rural LTCFs. Klösters et al. (2022) examined the estimated value of on-site consultation services compared to teleconsultations between LTC physicians and dermatologists. Using a 5-point Likert scale followed by stratification in two groups (added value or no added value). They concluded 67.8% (183 /270) of on-site consultations being of added value compared to teleconsultation, primarily due to the need for diagnostic procedures such as dermatoscopy and punch biopsy. Notably, the remaining 32,2% (87/270) of cases were considered to be manageable via teleconsultation. The authors therefore suggest the use of teleconsultations as a triage tool to reduce unnecessary on-site consultations in LTCFs. 3.4.3. Multidisciplinary collaboration interventions The majority of our included studies involved multidisciplinary collaboration interventions. These interventions encompassed team approaches, programs and projects in which the collaboration between medical specialists and LTC physicians was supported by intermediaries such as specialised nurses or paramedics. All multidisciplinary interventions utilised teleconsultations or on-site consultation services, with teleconsultations representing a substantial proportion of these interventions. Studies that reported on role allocation, primarily indicated that on-site consultations were conducted by intermediaries. Based on the data from the included studies, we endentified five multidisciplinary collaboration interventions that mentioned on-site consultations by medical specialists.[32, 37, 41, 44, 46] Most multidisciplinary collaboration interventions were combined with additional components such as case conferences, shared care planning, and joint training or education. A recurring focus across multidisciplinary interprofessional collaboration interventions was the optimisation of psychiatric care within LTCFs. Steel et al. (2022) highlighted a multidisciplinary teleconsultation project involving LTC physicians, geriatricians, psychiatrists, trainees and social care professionals, aimed at improving the physical and mental health of LTCF residents. Shared learning opportunities were facilitated through case-based discussions, comprehensive geriatric assessments and educational sessions led by a member of the multidisciplinary team. The study reported a reduction in the costs of hospital admissions, from £55,678 in the 12 months prior to intervention and £49,653 during the intervention year. Additionally, a 75% reduction in hospital admission (19/25) among residents over 12 months was noted. However, no statistical testing was performed to determine the significance of both these differences. Mc Sweeney et al. (2012) conducted a cluster RCT assessing the impact of on-site psychiatric and psychosocial consultation services. Residents in the intervention group showed significantly lower levels of depression, as measured by the Cornell Scale for Depression in Dementia (CSDD) (mean score: 9.47, SD 5.57) compared to the control group (mean score: 14.23, SD 4.60; p < 0.05). The study suggests that multidisciplinary on-site consultation services are more effective than usual care in treating depression in residents with dementia. Piau et al. (2020) evaluated the impact of multidisciplinary teleconsultations between hospital geriatricians with expertise in neuropsychogeriatric symtoms (NPS), specialised NPS nurse, psychologists, and LTC physicians over a two-year period, focusing on the development of a tailored personal care plan. This study identified no difference regarding hospital admission and psychotropic drug prescriptions between the intervention group and control group. Mauleon et al. (2025) involved a secondary and exploratory analysis of Piau et al, including 9 more LTCFs and 51 more residents. This cluster RCT underscored that multidisciplinary teleconsultations for NPS had no significant impact on hospital admission or prescriptions for residents. However, the secondary analyses did demonstrate statistical significant improvement for NPI (Neuro Psychiatric Inventory) change frequency x severity score (− 17.7 ± 4.9, P = 0.001), NPI change in distress score (-5.7 ± 2.5, P = 0.03) and ADL (activities daily living) change total score (0.6 ± 0.2, P = 0.006). Mauleon et al. concluded multidisciplinary teleconsultations to reduce the severity of neuropsychiatric symptoms and improve functional abilities compared to usual care. Zumbach et al. (2009) studied the psychiatric medical and nursing on-site consultation services between a single hospital and fourteen LTCFs. The medical on-site consultation services supported LTC physicians in the establishment and refinement of psychiatric diagnosis, as well as in the organisation of therapeutic consultations. Satisfaction among LTC physicians was high to very high (score 3 to 4 out of a 4-point Likert scale), indicating a positive impact on the quality of psychiatric care delivered. Several multidisciplinary collaboration intervention studies examined collaborations of multiple medical specialists. For example, Audiau et al. (2022) reported a multidisciplinary teleconsultation involving cardiologists, geriatricians, psychiatrists and LTC physicians, with participation of caregivers and a coordinating mobile nurse. The cardiologist consulted remotely from the hospital and a connected stethoscope facilitated auscultation at a distance. The program resulted in 10% avoidance of hospital admissions (12/120) and 55,8% avoidance of hospital visits (67/120). Additionally, therapeutic optimisation was achieved in 38 cases (40%). Some studies highlighted the use of structured meetings, case-based discussions or case conferences as a key component of collaboration. For instance, Lyketsos et al. (2010) described an intervention of case-based discussions involving LTC physicians, geriatricians, psychiatrists, nurses, social workers, and activity therapists. Twice-weekly teleconsultations were held to discuss residents with newly emerging behavioral or psychiatric symptoms who were at risk of hospitalisation. This intervention was associated with a reduction in number of hospital admissions from 21 in the year prior to the intervention to 11 in the year following the intervention. However, this difference was not subjected to statistical testing. Similarly, Bermejo et al. (2022) described a program of weekly multidisciplinary meetings involving LTC physicians, geriatricians, cardiologists, pneumologists, and also public health professionals. In addition to these weekly meetings, the program also included teleconsultations, on-site consultation services, intravenous treatment, blood test and diagnostics, and also educational sessions. Teleconsultation resulted in a potential cost reduction of €187 per LTCF resident by avoiding hospital visits and on-site consultations. Furthermore, this intervention had an estimated potential costs savings of 1.5 million € and 2800 fewer hospital days because 442 residents received on-site intravenous treatment instead of hospital-based treatment. Also Schippinger et al. (2012) studied weekly multidisciplinary on-site consultations and weekday teleconsultations between LTC physicians, internal medicine physicians, and geriatricians. Specialised treatments, such as intravenous treatments, ultrasound examinations, ECGs, and ultrasound-guided paracentesis, were provided within the LTCF. The intervention resulted in 14.4 hospital admissions per 100 residents per month over a 10-month period, compared to 18.0 in the control group (not statistically significant). Mortality rates were comparable, with 21 deaths in the intervention group and 19 in the control group. Connolly et al. (2016) described one-hour multidisciplinary meetings between LTC physicians, geriatricians, gerontology nurse specialist (GNS), pharmacists and senior nurses. These meetings focused on diagnosis-specific interventions for the five most common diseases (cardiac failure, ischemic heart disease, COPD, stroke and pneumonia), while also incorporating medication review, education and clinical coaching. Although this intervention did not impact overall rates of acute hospitalisations or mortality, it did result in fewer non-acute hospital admissions related to the five most common diseases (hazard ratio = 0.73, 95% CI: 0.54–0.99, P = 0.043). Bon et al. (2019) described a multidisciplinary teleconsultation and on-site consultation service between LTC physicians and ophthalmologists. Consultations were held one afternoon a week, with an average of five residents assessed per session. At the LTCF, an orthoptist and assisting nurse performed ophthalmologic examinations, including measurements of the visual acuity and intraocular pressure. Measurement data were securely and digitally transferred to the ophthalmologist at the hospital, who analysed them prior to the teleconsultation. If necessary, the patient was scheduled for an on-site consultation, follow-up or visit to the hospital. This collaboration resulted in identification of ophthalmological pathology in 55% (37/67) of patients, implementation of treatment plan in 37,8% (14/37) of them and a significant decrease of low vision proportion from 54–39% (odds ratio = 1.86; 95% CI: 1.06—3.28, P = 0.02) was observed after 6 months. Jump et al. (2012) evaluated a multidisciplinary weekly tele- and on-site consultation service supporting antimicrobial stewardship and infection control for LTCF residents. The LTCF infectious disease (LID) team, consisting of an infectious disease physician and a NP, visited the LTCF and supported the LTC physicians, and NPs remotely. They demonstrated a 30% reduction in antimicrobial use (from 175.1 ± 28.0 pre-intervention to 122.3 ± 26.9 post-intervention, P < 0.001). Additionally, Clostridium difficile infection rates declined, with a significant change in trend (mean change of slopes: 0.1, 95% CI: 0.00–0.1, P = 0.04). 3.5 Facilitators and barriers The included studies identified several facilitators to optimise interprofessional collaborations. Firstly, dependable technological and logistical infrastructure (such as a stable internet connection), are crucial for smooth teleconsultations, case-based teleconferences, and remote assessments.(33, 43) Additionally, autonomous devices, such as portable stethoscopes equipped with Wi-Fi or 4G connectivity, allow remote assessments without relying on the LTCF’s internet infrastructure.(31) Furthermore, accessible software and secure message system between LTCFs and hospitals improve communication, allowing efficient sharing of residents’ health data and enhancing QoC.[32, 35] In addition, structured and recurring consultations, such as multidisciplinary case-based teleconsultations, enabled consistent follow-up and high commitment to the intervention.(32, 35, 45) Also, reflection on team-based decision-making was emphasised as valuable for improving interprofessional collaborations.[45] The main barriers to effective interprofessional collaboration, were the coordination and implementation costs of teleconsultation programs.[39] Funding by public health and regional coordination may contribute to overcome these barriers and facilitate successful implementation.[32, 36] 4. Discussion In this systematic review we identified 16 studies exploring interprofessional collaboration interventions between LTC physicians and medical specialists. The available literature regarding medical care for LTCF residents remain scarce, highlighting significant gaps in evidence. Importantly, although most included studies had an intermediate or high risk of bias, they still provided valuable insights in how interprofessional collaborations can improve medical care for LTCF residents. We identified three ways of interprofessional collaboration interventions: teleconsultations, on-site consultation services, and multidisciplinary collaboration interventions. Across the studies, a variety of medical specialists collaborated with LTC physicians. Most frequently, this included medical specialists such as geriatricians and psychiatrists. The studies reported a wide range of outcomes, including patient health outcomes (such as NPI, ADL, vision, and CSDD), impact on care plans, cost reduction, diagnostic accuracy, hospital admissions, and satisfaction of patients, caregivers and physicians. Despite this considerable heterogeneity in outcome measures, most interventions demonstrated at least some positive impact, suggesting improvements in both QoL and QoC for LTCF residents. Teleconsultations between medical specialists and LTC physicians consistently demonstrated a positive impact on health outcomes and QoC for LTCF residents, as well as on satisfaction and estimated cost-reductions. These findings are in line with previous studies on teleconsultation in primary care settings, where remote collaboration between GPs and medical specialists has shown to reduce hospital admissions and unnecessary visits.[13] While teleconsultations offer clear benefits, they are not suitable for all medical conditions. Some conditions require physical examinations or a contextual understanding of the resident’s environment. For instance, assessment of depression or delirium, and diagnostics of dementia often necessitate on-site consultations.[46] On-site consultations remain essential in some cases, however the organisation presents significant logistical and financial challenges. In particular, the travel involved for medical specialists from hospital to LTCFs is time-consuming and costly, which can be challenging in rural areas and settings with already limited healthcare capacity.[43] Consequently, a potential practical approach could be to use teleconsultation as an initial triage tool, reserving on-site consultation services for cases where they are really necessary or offer added value. For example, in dermatology, on-site consultations may be necessary as addition to teleconsultation for suspected (pre)malignant skin diseases, where a diagnostic biopsy can be performed immediately.[38] Further research is needed to determine which conditions are considered to be manageable via teleconsultation and which medical disciplines and clinical scenarios benefit most from on-site consultation services. Most of the study interventions included in our review concerned multidisciplinary collaboration interventions. All of these involved either tele-or on-site consultations, while some also incorporated structured case-based discussions, education and learning. Collaborations were supported by intermediaries, such as nurses and paramedics, depending on the intervention. Although multidisciplinary collaboration interventions show overall promise, it remains unclear which specific component has the greatest impact on LTCF residents’ QoL or QoC. Structured case-based discussions and team decision-making processes support commitment to the intervention and could therefore lead to a sustainable collaboration.[35, 45] Future research should focus on identifying which elements of multidisciplinary collaboration interventions contribute most to improvement of QoL, QoC, and cost-effectiveness. To optimise multidisciplinary collaboration interventions, it is important to identify which elements are most impactful, but also to define roles and responsibilities of all involved professionals.[47] Nevertheless, most studies do not clearly define the role of the LTC physician and global substantial differences exist in who provides medical care to LTCF residents. For example, in the Netherlands, specially trained LTC physicians have formally provided nearly all of the medical care for LTCF residents since 1990 [21], whereas in many other European countries, only 5 to 10% of the medical care is delivered by LTC physicians.[22] The role of LTC physicians is often fulfilled by GPs, geriatricians, psychiatrists, or internal medicine physicians, depending on the country and its healthcare system. Despite global variations and unclear role definition in multidisciplinary collaboration interventions, our study, in line with the WHO report, supports embedding multidisciplinary components to interprofessional collaborations has the potential to improve patients’ satisfaction, health status, and effective use of health services. [48] We advocate for a clear and essential role of the LTC physician as a clinical gatekeeper, to ensure the appropriate use of medical specialist expertise and the integration of specialist advice into the resident’s care plan. We believe this is fundamental for safeguarding the quality of medical care within LTCFs. Moreover, we support the active involvement of intermediaries, such as specialised nurses and paramedics, to complement LTC physicians and medical specialists in key functions including assessment, treatment management, and follow-up. We also emphasise the important participation of medical specialists in consultation and educational roles, as previously reported by Wagner et al.[49] A recurring barrier identified in the studies was the need for user-friendly and reliable internet infrastructure, essential for effective teleconsultation and remote assessments.[35] This is consistent with earlier findings by Johnston et al. 2001, who noted that low-cost ISDN videoconferencing systems introduced significant motion artefacts, hindering the accurate assessment of movement disorders.[50] However, with ongoing advances in digital technology, it is reasonable to assume that such technical limitations are increasingly being addressed. Other barriers included institutional firewalls that hinder digital communication. A common potential solution cited was the implementation of secure messaging systems between LTCFs and hospitals.[35] The successful integration of interprofessional collaborations into routine LTC practice could be facilitated trough appropriate funding and mutual commitment from all stakeholders. In addition to LTC physicians, medical specialists, and intermediaries, stakeholders should also include governments, insurers, and care organisations. Their involvement is expected to be necessary to meet the growing need for interprofessional collaborations.[51, 52] 5. Limitations There are limitations to this review: the variation in which physician fulfilled the role of the LTC physician, combined with limited definition of role distribution within multidisciplinary teams, may limit the generalisability of the findings. Most included studies had an intermediate to high risk of bias. While findings suggest that interprofessional collaboration between LTC physicians and medical specialists can positively impact residents’ QoL and QoC, substantial heterogeneity in outcomes limits firm conclusions. It remains unclear which aspects of the multidisciplinary collaboration intervention, such as teleconsultations, on-site consultation services, and regular structured meetings contribute most to positive outcomes. Moreover, few studies considered the perspectives of LTCF residents and their caregivers on the interventions, representing a critical gap. Further research should incorporate these perspectives to enhance the relevance and impact of interprofessional collaborations. 6. Conclusion In conclusion, this review suggest that interprofessional collaboration interventions between LTC physicians and medical specialists hold substantial potential to enhance residents’ QoL and QoC. While heterogeneity among studies exist, the overall results point to achieving meaningful improvements in care for LTCF residents. A sustainable interprofessional collaboration may be achieved by multidisciplinary collaboration interventions that integrate tele- or on-site consultations and combine this with regionally structured and coordinated care, case conferences, professional learning possibilities, and intermediary support. Further research should identify the most impactful elements of multidisciplinary collaboration interventions and incorporate LTCF residents and caregivers perspectives on these interventions. Declarations Authors contribution All authors contributed to the database search. JS, SL, and MvO contributed to the screening of title and abstract, full text, and risk of bias assessment. The manuscript was written by MvO and all authors contributed by reviewing and editing the manuscript. All authors read and approved the final manuscript. Funding No funding was received. Conflicts of interest None declared. Ethical approval Ethical approval was not required for this systematic review. Informed consent Informed consent was not required for this systematic review. PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023484096). References Knickman JR, Snell EK (2002) The 2030 problem: caring for aging baby boomers. Health Serv Res 37(4):849-84. 10.1034/j.1600-0560.2002.56.x American Healthcare Association / National Center for Assisted Living (2024) Report: Access to Nursing Home Care is Worsening. Available from: https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/Report-Access-to-Nursing-Home-Care-is-Worsening-.aspx. Accessed 10 june 2025. Eurostat (2025) Population structure and aging. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_structure_and_ageing#Data_sources. Accessed 10 june 2025. World Health Organisation. 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Bmj 320(7234):569-572. 10.1136/bmj.320.7234.569 Johnston D, Jones BN 3 rd (2001) Telepsychiatry consultations to a rural nursing facility: a 2-year experience. J Geriatr Psychiatry Neurol 14(2):72-75. 10.1177/089198870101400205 Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al (2016) The World report on ageing and health: a policy framework for healthy ageing. Lancet 387(10033):2145-2154. 10.1016/S0140-6736(15)00516-4 Perracini MR, Arias-Casais N, Thiyagarajan JA, Rapson C, Isaac V, Ullah S, et al (2022) A Recommended Package of Long-Term Care Services to Promote Healthy Ageing Based on a WHO Global Expert Consensus Study. J Am Med Dir Assoc 23(2):297-303.e14. 10.1016/j.jamda.2021.12.019 Supplementary Files Appendixsearchstringpubmed.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revisions 27 Sep, 2025 Reviewers agreed at journal 10 Jul, 2025 Reviewers invited by journal 10 Jul, 2025 Editor invited by journal 10 Jul, 2025 Editor assigned by journal 03 Jul, 2025 First submitted to journal 28 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7001320","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":483480014,"identity":"33331a2c-dedc-412b-aef8-e2920ea0f5d1","order_by":0,"name":"Marleen van Oosterhout","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0002-7524-6243","institution":"Radboudumc","correspondingAuthor":true,"prefix":"","firstName":"Marleen","middleName":"van","lastName":"Oosterhout","suffix":""},{"id":483480015,"identity":"39546103-1a64-4a1a-a9a6-d3d9e343dfde","order_by":1,"name":"Jos Schols","email":"","orcid":"https://orcid.org/0000-0002-4062-2061","institution":"UM CAPHRI: Universiteit Maastricht Care and Public Health Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Jos","middleName":"","lastName":"Schols","suffix":""},{"id":483480016,"identity":"6583160e-097b-437c-94b5-674a74b9b61b","order_by":2,"name":"Danny Hommel","email":"","orcid":"https://orcid.org/0000-0003-4616-2745","institution":"Universitair Medisch Centrum Sint Radboud: Radboudumc","correspondingAuthor":false,"prefix":"","firstName":"Danny","middleName":"","lastName":"Hommel","suffix":""},{"id":483480017,"identity":"6838f929-a4f2-4b9f-ab49-3370b9f7876e","order_by":3,"name":"Elke de Jong","email":"","orcid":"https://orcid.org/0000-0003-3872-5704","institution":"Universitair Medisch Centrum Sint Radboud: Radboudumc","correspondingAuthor":false,"prefix":"","firstName":"Elke","middleName":"","lastName":"de Jong","suffix":""},{"id":483480018,"identity":"08eb5fd3-0945-4da0-aaba-1d5a042fbeb0","order_by":4,"name":"Satish Lubeek","email":"","orcid":"https://orcid.org/0000-0003-2694-6059","institution":"Universitair Medisch Centrum Sint Radboud: Radboudumc","correspondingAuthor":false,"prefix":"","firstName":"Satish","middleName":"","lastName":"Lubeek","suffix":""}],"badges":[],"createdAt":"2025-06-29 07:44:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7001320/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7001320/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86656001,"identity":"8c14ce5f-f3b5-420a-9590-e84c4e7e6f21","added_by":"auto","created_at":"2025-07-14 10:17:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":151024,"visible":true,"origin":"","legend":"\u003cp\u003ePreferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) flow diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7001320/v1/28b524b99cf8ff06253e043b.png"},{"id":86656007,"identity":"b940310e-01bd-414a-aeec-e28f20690d3c","added_by":"auto","created_at":"2025-07-14 10:17:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":397124,"visible":true,"origin":"","legend":"\u003cp\u003eTraffic light visualisation of the quality assessment according to ROBINS-I and RoB 2. Risk of Bias; green = low risk; orange = intermediate risk or unclear; red = high risk.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7001320/v1/77609423b8c0686b24918423.png"},{"id":86660041,"identity":"1867f19d-cf30-4306-b04d-1c3939bde55a","added_by":"auto","created_at":"2025-07-14 10:33:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2144781,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7001320/v1/533d5fab-e896-407f-88b7-e6ba1e6d79b7.pdf"},{"id":86656004,"identity":"a83033fa-dbe0-4dbc-8ab5-f81485d07f33","added_by":"auto","created_at":"2025-07-14 10:17:26","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":24220,"visible":true,"origin":"","legend":"","description":"","filename":"Appendixsearchstringpubmed.docx","url":"https://assets-eu.researchsquare.com/files/rs-7001320/v1/94adfed7ab9c8691fe332f43.docx"}],"financialInterests":"","formattedTitle":"Impact of interprofessional collaboration between long-term care physicians and medical specialists on quality of care and quality of life of long-term care facility residents: a systematic review","fulltext":[{"header":"Key summary Points","content":"\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e The main aim of this study is to identify the impact of interprofessional collaboration interventions between long-term care (LTC) physicians and medical specialists on the quality of life (QoL) and quality of care (QoC) of long-term care facility (LTCF) residents in need of medical specialist expertise.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings\u003c/strong\u003e Three ways of interprofessional collaboration between LTC physicians and medical specialists were identified: teleconsultations, on-site consultation services, and multidisciplinary collaboration interventions. Most interprofessional collaboration interventions indicated a positive impact on LTCF residents’ QoL or QoC. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMessage\u003c/strong\u003e Whereas teleconsultations eliminate residents’ travel burden, may reduce costs and support triage decisions, on-site consultation services remain essential when remote assessment is inadequate. Multidisciplinary collaboration interventions, combining tele- and on-site consultations with additional elements and support, demonstrate promising sustainable and positive impact on LTCF residents’ QoL and QoC.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eThe healthcare system is facing an increasing challenge due to the rising number of long-term care facility (LTCF) residents with complex medical needs.[1, 2] In many developed regions, demographic changes, driven by lower mortality rates and increased life expectancy, have led to a growing population of the oldest old.[3, 4] A substantial proportion of these oldest old suffers from multiple chronic conditions, functional decline, and cognitive impairments.[5, 6] As their conditions progress and care dependency increases, some eventually require continuous and specialised care (such as nursing care and memory care), as provided in LTCFs.[7]\u003c/p\u003e\u003cp\u003eThe progressive declining physical and mental functional status of LTCF residents, combined with their often limited social networks, not only impacts their QoL [8], but also poses significant challenges when it comes to traveling from the LTCF to a hospital. Given these challenges, it is not easy for residents to access medical specialists care, whose input may be essential for managing the residents\u0026lsquo; complex medical needs.\u003c/p\u003e\u003cp\u003eWhile medical specialists have much expertise, they often tend to focus on treating single conditions without fully considering the complexities of multimorbidity. As a consequence, this fragmented approach leads to gaps in both knowledge and continuity of care, ultimately compromising outcomes for LTCF residents with multiple chronic illnesses.[9]\u003c/p\u003e\u003cp\u003eTo bridge these gaps and ensure a more holistic care, interprofessional collaboration becomes increasingly essential within the healthcare system. In recent years, researchers explored various interprofessional collaborative interventions in which general practitioners (GPs) work together with medical specialists to improve the quality of care and shared decision-making for the oldest old.[10\u0026ndash;14]\u003c/p\u003e\u003cp\u003eAlthough these previous initiatives of interprofessional collaboration showed promise in improving the QoC and reducing care fragmentation, they focused mainly on the oldest old living at home or in community care. Thus far, limited focus has been placed to LTCF residents, despite their vulnerability, and even more complex care needs.[15]\u003c/p\u003e\u003cp\u003eNotably, in an era of rapid digitalisation, where technology allows for remote specialist input and digital collaboration, physical hospital visits may no longer be strictly necessary.[16, 17] Therefore, expanding such interprofessional collaboration interventions into LTCFs holds significant potential to improve access to specialised care and reduce unnecessary and burdensome hospital visits.\u003c/p\u003e\u003cp\u003eIn addition to these developments, the provision of medical care to LTCF residents varies significantly across countries and even within regions. In most countries GPs provide the medical care to LTCF residents. In others, specialised nurses, LTC physicians, geriatricians, internal medicine physicians and psychiatrists take this role, reflecting significant structural and professional diversity in care coordination in LTCFs.[18\u0026ndash;20]\u003c/p\u003e\u003cp\u003eA specialised and qualified LTC physician, also called elderly care physician, as seen in the Netherlands, has the potential to play a crucial role in the interprofessional collaboration.[21, 22] As part of their training, LTC physicians are skilled in care coordination, interprofessional collaboration and medical leadership.[23] These physicians can help to bridge the healthcare gaps and ensure that critical medical decisions are collaboratively based on expertise from a medical specialist and align with the unique needs of the LTCF resident. However, the collaboration between LTC physicians and medical specialists remains underexplored.\u003c/p\u003e\u003cp\u003eThe main aim of this study is to identify the impact of interprofessional collaboration interventions between LTC physicians and medical specialists on the QoL and QoC of LTCF residents in need of medical specialist expertise.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e We conducted a systematic literature review on the impact of interprofessional collaboration interventions between LTC physicians and medical specialists on the QoL and QoC for LTCF residents. The search and reporting were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.[24, 25] The study protocol was registered in PROSPERO, 2023 (CRD42023484096).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Search strategy\u003c/h2\u003e\u003cp\u003eA literature search in PubMed, EMBASE, Cochrane Library and Cinahl was performed, using the search strategy shown in Appendix 1. Articles in English, Dutch, French, German or Spanish were permitted. The search had no time limit and the final search was performed on March 3rd 2025.\u003c/p\u003e\u003cp\u003eTwo researchers (MvO and JS) independently carried out the screening of titles, abstracts and full-text articles using the Rayyan web tool.[26] Titles and abstracts were screened to determine whether the studies met the inclusion criteria. The full-text articles were retrieved to identify eligibility for final inclusion. In case of disagreement, a third researcher was consulted (SL). When the full text was not available, we contacted an (inter)national institutional librarian or reached out to the author of the study.\u003c/p\u003e\u003cp\u003eIn addition to the database search we performed a manual screening of the reference lists of the included studies to identify additional relevant publications.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Eligibility criteria\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e2.2.1. Types of studies\u003c/h2\u003e\u003cp\u003eWe included studies with the following designs: experimental studies, including randomised controlled trials (RCT), quasi-randomised trials, and non-randomised controlled trials (such as controlled before-and-after studies and interrupted time series studies); observational studies (cohort and case series); and mixed-methods studies. Conference abstracts, case reports, study protocols, latent class analyses, and realist evaluations were excluded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e2.2.2. Types of setting and population\u003c/h2\u003e\u003cp\u003eWe included any type of LTC physician or medical specialist providing medical care for LTCF residents in need of a medical specialist perspective or treatment. The role of LTC physician could be fulfilled by a GP, GP trainee, junior doctor, LTC physician, specialised and qualified LTC physician, geriatrician, internal medicine physician or psychiatrist, depending on the national healthcare system and regional context. Studies in which the role of the medical professional was undertaken by a specialised nurse, such as a physician assistant (PA) or nurse practitioner (NP), were excluded, since these roles differ in scope and training from that of physicians, which was our specific focus. We also excluded studies including frail elderly receiving dental care, specialist care at home, in clinics, subspecialised clinics (e.g., Huntington's, Parkinson's, young-onset dementia), community-based settings, or hospital-based settings, because these forms of care do not reflect the long-term care context we aimed to investigate. Exclusions were also applied to studies with a focus on emergency care, discharge or settings like geriatric rehabilitation care or hospice care, because of the short-term care aspect.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e2.2.3. Types of interventions\u003c/h2\u003e\u003cp\u003eStudies were included if they evaluated medical interprofessional collaboration interventions or medical support between LTC physicians and medical specialists providing care to LTCF residents. This involved for example, multidisciplinary team meetings, consultations, teleconsultations and education if part of a durable interprofessional collaboration. Although no definition is provided, WHO documentation describes a multidisciplinary team as typically bringing together expertise from various professional fields and involving physicians, nurses, and paramedical staff.[27] We focussed on studies in which both the LTC physician and the medical specialist are part of the team, supported by nurses or paramedics. The comparison for this intervention was usual care, in which the LTCF resident is referred to a hospital-based medical specialist. Furthermore, studies focusing on the functionality of apps, bedside screening tools, protocols, or care pathways were excluded, as these represent instruments or methods facilitating collaboration rather than constituting the collaboration itself. COVID-19 collaborations specific for outbreak management were excluded as well, because of the short term crisis response aspect rather than long-term care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.2.4 Types of outcome measures\u003c/h2\u003e\u003cp\u003eOutcomes reported in the included studies related to both patient health outcomes and quality of care. Patient health outcomes included measures such as QoL, functional status, morbidity, and mortality. Quality of care outcomes included patient or caregiver satisfaction, physician satisfaction, hospital admissions, identified facilitators and barriers, as well as cost-related aspects such as cost-benefit and cost-effectiveness.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data extraction\u003c/h2\u003e\u003cp\u003eA data extraction template was developed (by MvO) using Microsoft Excel. For each article we extracted the following items: general study characteristics (author, year of publication, title, country, language, journal, study design, study duration), patient characteristics (setting, comorbidities), physician characteristics (specialism, physician population size, role in collaboration), intervention details (type of intervention, duration, control group, follow-up period) and outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Quality Assessment\u003c/h2\u003e\u003cp\u003eWe assessed the risk of bias and quality of the included trials using the Cochrane Risk of Bias tool [28] for randomised trials and ROBINS-1 tool [29] for non-randomised trials. The assessment was performed by two researchers (MvO and JS) until a shared agreement was reached. In case of disagreement, we consulted the third researcher (SL). A meta-analysis was not conducted because of the heterogeneity of outcome measures and study designs.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Study selection\u003c/h2\u003e\u003cp\u003eThe literature search resulted in 10364 publications, which resulted in 9380 unique articles after the removal of duplicates. Four articles were identified through reference list checking. After screening of titles and abstracts, 9334 articles were excluded. One article could not be retrieved despite help from (inter)national institutional librarians or contact with the author of the study.[30] The remaining 45 full-text articles were assessed for eligibility, resulting in16 studies included in this systematic review. Across the studies a total of 18 hospitals, 187 LTCFs and 8402 residents were involved. In the studies that reported data on physicians, the total number of physicians varied from 2\u0026ndash;10. A flow diagram of the selection process is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) flow diagram\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Study Characteristics\u003c/h2\u003e\u003cp\u003eThe finally included studies [31\u0026ndash;46] were conducted in western or high income countries (Australia, Austria, France, New Zealand, Spain, Switzerland, the Netherlands, UK, US). Among these, four studies were carried out in France, six in the US and the remaining studies where distributed over the other mentioned countries. The types of studies in this review included: 3 RCT studies, 1 interrupted time-series study, 4 before-and-after studies, 2 prospective observational studies, 2 prospective cohort studies, 3 retrospective descriptive studies and 1 mixed methods studies.\u003c/p\u003e\u003cp\u003eAll studies were performed between 2001 and 2025. The interprofessional collaboration interventions could be categorised into three ways; teleconsultations, on-site consultation services and multidisciplinary collaboration interventions. In most studies, the collaboration was realised between medical specialists based at a single hospital and LTC physicians spread across multiple regional LTCFs. The scale of collaboration varied, for example from 2 to 3 regional LTCFs [43\u0026ndash;45], up to 60 LTCFs.[32] In four studies [33, 34, 37, 39] collaboration was limited to one single hospital and one single LTCF.\u003c/p\u003e\u003cp\u003e In addition to variation in the scale of collaboration, the included studies also revealed heterogeneity in the professional roles of those providing medical care to LTCF residents. In nine studies the role of LTC physician was fulfilled by a GP (or primary care physician or family doctor), who often structurally visited the LTCF. In other studies, this role was taken on by a junior doctor, geriatrician (trainee) or psychiatrist (trainee) assigned to the LTCF. Medical care provided by specifically, qualified LTC physicians was assessed in only one study, conducted in the Netherlands.[38] The medical specialists participating in the selected studies represented a broad range, including dermatologists, geriatricians, internal medicine physicians, infectious disease physicians, neurologists, ophthalmologists, and psychiatrists. Notably, thirteen studies were conducted in collaboration with psychiatrists or geriatricians.\u003c/p\u003e\u003cp\u003eA summary of the included study characteristics, participants, interventions and study outcomes is available in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of the included studies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSetting and Participants\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eType of intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDescription \u003c/p\u003e\u003cp\u003eof intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDuration\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eResults\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eConclusion\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAudiau, et al. 2021, France (31)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetrospective descriptive study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e3 LTCFs\u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e77 residents\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e: \u003c/p\u003e\u003cp\u003eLTC physicians, nurses, cardiologists, geriatricians, and psychiatrist \u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTokTokDoc project; teleconsultations in cardiology and neuropsychogeriatry using real-time remote assessment via tablet and connected stethoscope, the LTCF physicians role remains central and an on-site mobile nurse surves as coordinator. The medical specialist provides advice remotely and sends their recommendations via a secure platform to the LTC physician.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- avoidance of hospital admissions in 10% (12/120), and avoidance of hospital visits in 55,8% (67/120) \u003c/p\u003e\u003cp\u003e- therapeutic optimisation was achieved in 40% (38/120).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary teleconsultation and on-site consultation service is a relevant way for improving the healthcare of LTCF residents, by avoiding hospital visits and admissions. Complex medical assessments were carried out in the same way as a face-to-face consultation.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBermejo Boixareu, et al. 2022, Spain (32)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObservational descriptive study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e60 LTCFs \u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e4600 residents\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e: \u003c/p\u003e\u003cp\u003eLTC physicians, public health, geriatricians, and other medical specialists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMultidisciplinary geriatrics program; using teleconsultation and support of a geriatric consultation liaison team. Geriatricians had the central role in transmitting medical specialists advice to LTC physician. In addition, on-site intravenous treatment of LTCF residents and training of LTC physicians where provided. Coordination via weekly or two-weekly zoom/phone/email meetings and protocolised teleconferences involving LTCF, public health, hospitals, and primary care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- an estimated cost reduction of 37.026 \u0026euro; (mean 187 \u0026euro; per resident) by avoiding ambulance tranfers and on-site consultations. \u003c/p\u003e\u003cp\u003e- an estimated costs savings of 1.5 milion \u0026euro; and 2800 fewer hospital days by on-site intravenous treatment to 442 LTCF residents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary teleconsultation and on-site consultation service improves continuity of care for LTCF residents and highlights an estimated positive cost-effectiveness in the healthcare system.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBon, et al. 2020, France (33)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetrospective descriptive study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e1 LTCF\u003c/p\u003e\u003cp\u003e1 hospital \u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e67 residents\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eLTC physicians, \u003c/p\u003e\u003cp\u003eophthalmologists, orthoptist, and nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOphthalmologic teleconsultation project; weekly teleconsultation with ophthalmologists and supported by on-site orthoptist and nurses. The examinations (visual acuity, intraocular pressure, wide field fundus photography, and optical coherence tomography) were performed at the LTCF. Data were securely transferred prior to teleconsultation. If necessary, the resident was scheduled for specialised consultation (e.a. intravitreal anti-VEGF injections) or follow-up examination.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- ophthalmologic pathologies were detected in 55% (37/67) \u003c/p\u003e\u003cp\u003e- treatment was initiated in 38% (14/37) of LTCF residents \u003c/p\u003e\u003cp\u003e- glasses were prescribed to 45% (30/67) \u003c/p\u003e\u003cp\u003e- low vision proportion was decreased from54 % to39 % (P\u0026thinsp;=\u0026thinsp;0.02; OR\u0026thinsp;=\u0026thinsp;1.86; CI 95%, [1.06\u0026mdash;3.28]) \u003c/p\u003e\u003cp\u003e- visual acuity improved from 0.67 (\u0026plusmn;\u0026thinsp;0.76) to 0.52 (\u0026plusmn;\u0026thinsp;0.72) for distance vision (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and from 0.68 (\u0026plusmn;\u0026thinsp;0.84) to 0.53 (\u0026plusmn;\u0026thinsp;0.76) for near vision, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary teleconsultation and on-site consultation service allowed LTCF residents to access a comprehensive ophthalmology consultation and benefit from current diagnostic technologies.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBuisson, et al. 2019, France (34)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProspective cohort study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e1 LTCF\u003c/p\u003e\u003cp\u003e1 hospital \u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e288 interventions, LTC physician, and psychiatrists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTeleconsultation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNeurology and gerontopsychiatry expertise teleconsultation for LTCF residents with dementia and behavioral problems. The Neuropsychiatric Inventory Nursing Home version (NPI-NH) was measured during intervention and reassessed after 30 days.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- the average NPI-NH score decreased from 50\u0026thinsp;\u0026plusmn;\u0026thinsp;19,2 (day 0) to 33.9\u0026thinsp;\u0026plusmn;\u0026thinsp;19,6 (day 30), P\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\u003cp\u003e- the percentage of avoided hospitalizations was 16% at day 30, corresponding to 46 cases over 21 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTeleconsultation recommendations help to decrease NPI-NH and reduce hospital admission of LTCF residents.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCatic, et al. 2014, US (35)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProspective cohort study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e11 LTCFs \u003c/p\u003e\u003cp\u003e1 hospital \u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e47 residents\u003c/p\u003e\u003cp\u003eLTC physicians, and psychiatrists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTeleconsultation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eECHO-AGE program; is based on the Extension for Community Healthcare Outcomes (Project ECHO) and is a case-based teleconsultation program. Bimonthly 1.5-hour long sessions between medical specialists and long-term care providers to improve the care of residents with dementia or delirium related behavioral issues. Sites were expected to engage in 8 sessions every 6 months.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- clinical improvement in 74% of LTCF residents whose recommendations were followed versus 20% when recommendations were not followed, p\u0026thinsp;\u0026lt;\u0026thinsp;0.03. \u003c/p\u003e\u003cp\u003e- lower hospitalisation rates among LTCF residents for whom recommendations were followed (29% versus 60%, not significant)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTeleconsultation can be successful in improving the care of LTCF residents with dementia and/or delirium related behavioral issues by linking medical specialists with LTC physician.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConnolly, et al. 2016, New Zealand (36)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCluster RCT (post hoc analysis)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e36 LTCFs (18 intervention, 18 control)\u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e1998 residents\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eLTC physicians, geriatricians, gerontology nurse specialist (GNS), and senior nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eARCHUS program (The Aged Residential Care Healthcare Utilisation Study); multidisciplinary meetings for diagnosis-specific interventions for the \"Big Five\" diseases (cardiac failure, ischemic heart disease, COPD, stroke, pneumonia). The intervention combined several approaches; baseline LTCF assessment identifying need; benchmarking resident indicators linked to care quality; three 1-our meetings including geriatrician, gerontology nurse specialist, pharmacist, LTC physician, and senior nurses; enhanced education and clinical coaching was provided for nurses and caregivers.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- LTCF residents in the intervention group were 34.7% less likely to have an admission for combined \u0026lsquo;big five\u0026rsquo; diagnoses than controls after 3 months, hazart ratio\u0026thinsp;=\u0026thinsp;0.65 (95% CI\u0026thinsp;=\u0026thinsp;0.49\u0026ndash;0.88; P\u0026thinsp;=\u0026thinsp;0.005). \u003c/p\u003e\u003cp\u003e- fewer 'big five' admissions during full 14-month follow-up, hazart ratio\u0026thinsp;=\u0026thinsp;0.73 (95% CI\u0026thinsp;=\u0026thinsp;0.54\u0026ndash;0.99; P\u0026thinsp;=\u0026thinsp;0.043)\u003c/p\u003e\u003cp\u003e- No significant difference in the rate of other acute hospital admissions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary teleconsultation meetings and diagnosis-specific education may reduce admissions for common conditions in LTCF residents.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eJump, et al. 2012, US (37)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterrupted time-series (ITS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e1 LTCF\u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e160 residents \u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eLTC physicians, infectious disease physician, nurse practitioners, and physician assistants \u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLID service; the LTCF Infectious Disease consult (LID) team for antimicrobial stewardship and infection control to LTCF residents. The LID team consisted of an infectious disease physician and nurse practitioner. Weekly on-site consultation services and urgent cases were managed immediately via phone or electronic medical record. Residents were referred by LTC physicians, nurse practitioners or physician assistant.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;30% reduction of total systemic antibiotic use in LTCF residents (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with a significant reduction in both oral (32%; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and intravenous agents (25%; P\u0026thinsp;=\u0026thinsp;0.008)\u003c/p\u003e\u003cp\u003e- C. difficile infection rates did not change significantly over time for the two individual time periods, \u003c/p\u003e\u003cp\u003e- the rate of change for positive C. difficile tests between pre- and postintervention periods was significantly different, (P\u0026thinsp;=\u0026thinsp;0.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary tele- and on-site consultation service led to a significant reduction in total antimicrobial use in LTCF residents. Bringing providers with infectious disease expertise to the LTCF represents a new and effective means to achieve antimicrobial stewardship.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eKl\u0026ouml;sters, et al. 2022, the Netherlands (38)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProspective multicentre observational study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e20 LTCFs\u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e270 residents\u003c/p\u003e\u003cp\u003eLTC physicians, \u003c/p\u003e\u003cp\u003edermatologist (and dermatology residents)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOn-site consultation service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOn-site consultation service by dermatologists (or dermatology residents supervised by a dermatologist) who regularly visited LTCF residents and were experienced in using Store-and-forward teledermatology (SAF-TD); referral by LTC physician using a standardised referral letter.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTele-consulta-tion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e72 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- dermatologists rated the estimated value of on-site consultation service of \"added value\" in 67.8% (183/270) and of \u0026ldquo;no added value in 32.2% (87/270 visits) compared to SAF-TD. \u003c/p\u003e\u003cp\u003e- skin tumor diagnoses strongly predicted added value of on-site consultation service compared to SAF-TD. Benign: odds ratio (OR)\u0026thinsp;=\u0026thinsp;27.6; 95% CI 7.3\u0026ndash;104.3, premalignant: OR\u0026thinsp;=\u0026thinsp;12.2; 95% CI 4.1\u0026ndash;36.0 and malignant: OR\u0026thinsp;=\u0026thinsp;10.1; 95% CI 3.3\u0026ndash;30.5\u003c/p\u003e\u003cp\u003e- Eczema was associated with no added value of on-site consultation service compared to SAF-TD (OR\u0026thinsp;=\u0026thinsp;0.1; 95% CI 0.1\u0026ndash;0.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOn-site consultation services are estimated to have added value over teleconsultations in two-third of referrals, whereas using teleconsultation as a triage tool potentially reduces the need for additional on-site consultation services in one-third. To make optimal use of the limited capacity for on-site consultations by medical specialists, it could be helpful if LTC physicians use teleconsultation more frequently\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLyketsos, et al. 2001, US (39)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePilot study, Before and after study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e1 LTCF\u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e66 residents \u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e: \u003c/p\u003e\u003cp\u003eLTC physician, psychiatrist, geriatrician, nurse, activity therapist, and social workers.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMultidisciplinary teleconsultation project; Twice-weekly case based teleconsultations were held to discuss LTCF residents with behavioral or psychiatric problems who were at risk of hospitalisation. This intervention also included 24/7 phone support and standardised assessment forms were created and used by multidisciplinair team.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- almost 50% reduction in number of hospital admissions, from 21 in the year before the intervention to 11 in the year after the intervention\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary teleconsultation and case-based discussions served as an effective bridge between care teams in the continuum of care. This project brought about a crucial shift in perspective.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMauleon, et al. 2025, France (40)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCluster RCT (secondary analysis)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e19 LTCFs\u003c/p\u003e\u003cp\u003e2 hospitals \u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e141 residents; control n\u0026thinsp;=\u0026thinsp;65, intervention n\u0026thinsp;=\u0026thinsp;76\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e: \u003c/p\u003e\u003cp\u003eLTC physician, geriatrician, specialised nurse, psychologist, and LTCF residents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDETECT project (Dementia in long-term care facilities Telemedicine for the management of neuropsychiatric symptoms); multidisciplinary teleconsultations between a geriatrician trained in neuropsychiatric symptoms (NPS), a specialised NPS nurse, LTC physician, psychologist and LTCF residents. Teleconsultation involved a tailored personal plan with a therapeutic strategy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- no difference regarding hospitalisations and psychotropic drug prescriptions between intervention and control group\u003c/p\u003e\u003cp\u003e- improvement of Neuro Psychiatric Inventory (NPI) frequency x severity score (\u0026minus;\u0026thinsp;17.7 \u0026plusmn; 4.9, P\u0026thinsp;=\u0026thinsp;0.001), \u003c/p\u003e\u003cp\u003e- improvement of NPI change in distress score (-5.7 \u0026plusmn; 2.5, P\u0026thinsp;=\u0026thinsp;0.03) \u003c/p\u003e\u003cp\u003e- improvement of ADL (activities daily living) change total score (0.6 \u0026plusmn; 0.2, P\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary teleconsultation demonstrated advantages in reducing neuropsychiatric symptom severity, frequency, and distress, as well as improvement of functional disability (ADL score) compared to usual care\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMcSweeney, et al. 2012, Australia (41)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRandomised cluster trial\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e20 LTCFs\u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e44 residents\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e: \u003c/p\u003e\u003cp\u003eLTC physician, psychiatrists, and clinical psychologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMultidisciplinary on-site consultation service for depression in LTCF residents with dementia. On-site consultations service with psychiatrist and clinical psychologist involved individually tailored medical and psychosocial recommendations provided to LTCF residents and LTC physician; post-intervention assessment was conducted by a psychologist blind to study condition.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- at follow-up, the mean Cornell Scale for Depression in Dementia (CSDD) score for the intervention \u003c/p\u003e\u003cp\u003egroup was significantly lower (mean score: 9.47, SD 5.57) compared to the control group (mean score: 14.23, SD 4.60; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e- at follow-up 77% of the intervention group no longer met criteria for major depression.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary on-site consultations were significantly more effective than usual care in treating depression in LTCF residents with dementia. Psychosocial and medical management of depression in LTCF residents can be improved by increasing access to medical specialist and mental health care.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePiau, et al. 2020, France (42)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePilot study, Before and after study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e10 LTCFs \u003c/p\u003e\u003cp\u003e2 hospitals\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e90 residents\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e: \u003c/p\u003e\u003cp\u003eLTC physician, geriatrician, specialised nurse, and psychologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMultidisciplinary teleconsultation for Neuropsychiatric symptoms (NPS) of dementia in LTCF residents. The LTC physicians had the role of medical investigators and requested the teleconsultation with the medical specialist when a LTCF resident presented a disruptive NPS. The teleconsultation was led by a geriatrician trained in NPS, specialised NPS nurses, and psychologists. A tailored personal plan with a therapeutic strategy was established after the teleconsultation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- no difference was identified regarding hospitalisations and psychotropic drug prescriptions before and after the intervention\u003c/p\u003e\u003cp\u003e- the estimated total number of hospitalisations avoided is 33\u003c/p\u003e\u003cp\u003e- LTCF team positively perceived the impact of teleconsultations on health care organisation (77.8% stated teleconsultation to contribute to interdisciplinary collaboration, and 77,6% stated teleconsultation to impove the quality of NPS diagnosis)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary teleconsultation is not a downgraded version of medicine according to the LTCF team, and this intervention has the potential to improve the QoC for LTCF residents.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRabinowitz, et al. 2010, US (43)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRetrospective descriptive study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e2 LTCFs\u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e106 residents, LTC physicians, and \u003c/p\u003e\u003cp\u003epsychiatrists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTeleconsultation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePsychiatry teleconsultation for LTCF residents; referred by LTC physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003cp\u003eor\u003c/p\u003e\u003cp\u003eOn-site consulta-\u003c/p\u003e\u003cp\u003etion service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e68 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- minimum \u003cspan\u003e$\u003c/span\u003e13,000 (range 13,060\u0026ndash;46,798) potential cost saved by providing teleconsultations compared to usual care.\u003c/p\u003e\u003cp\u003e- maximum \u003cspan\u003e$\u003c/span\u003e232,000 (63,668\u0026ndash;232,361) potential cost saved by providing teleconsultations compared to on-site consultation service.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eTeleconsultation is potentially cost-effective and the study emphasised that teleconsultation enabled access to psychiatric care that would otherwise be unavailable for LTCF residents living in rural areas.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSchippinger, et al. 2012, Austria (44)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProspective controlled study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e2 LTCFs (GEKO and control)\u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e268 residents\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eLTC physicians, geriatricians, and internal medicine physicians\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMobile internal medicine geriatric consultation service (GEKO) for LTCF residents conducted of multidisciplinary weekly on-site consultation support to LTC physician, telephone service, intravenous infusions, ultrasound examinations, ECG, and paracentesis under ultrasound guidance.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- the number of planned non-acute hospital presentations was lower in the GEKO group in comparison to the control group (mean number of hospital presentations/ 100 LTCF residents/month: 14.4 versus 18.0); not statistically significant\u003c/p\u003e\u003cp\u003e- mortality: 19 LTCF residents died in control group and 21 LTCF residents died in the GEKO group.\u003c/p\u003e\u003cp\u003e- a statistically significant lower frequency of acute transports to hospitals was observed in GEKO group (mean number of acute transports to hospitals/100 LTCF residents/month: 6.1 versus 11.7; P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary on-site consultation service can improve medical care in LTCFs resulting in a statistically significant reduction of acute hospital admissions.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSteel, et al. 2022, UK (45)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCase series with interventions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e3 LTCFs\u003c/p\u003e\u003cp\u003e1 hospital\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e34 residents\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e: \u003c/p\u003e\u003cp\u003eLTC physician (and GP trainees), geriatricians trainees, and psychiatrist trainees\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMultidisciplinary teleconsultation; a team comprising LTC physicians (and GP trainees), geriatrician trainees, psychiatrist trainees, pharmacist; intervention included Comprehensive Geriatric Assessment (CGA), case-based discussion followed by a clinical assessment and discussion of proposed management. Follow-up if necessary by LTC physician of psychiatrist trainee.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e20 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- in one LTCF the multidisciplinary teleconsultation resulted in 75% (19/25) reduction in hospital admissions for those reviewed. \u003c/p\u003e\u003cp\u003e- a reduction in the costs of hospital admissions, from \u0026pound;55,678 in the 12 months prior to intervention and \u0026pound;49,653 during the intervention year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary teleconsultation may create an opportunity for shared learning and enabling residents to receive more specialist care.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eZumbach, et al. 2009, Switzerland (46)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMixed methods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eSetting\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e14 LTCFs\u003c/p\u003e\u003cp\u003e1 Hospital \u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e: \u003c/p\u003e\u003cp\u003e146 residents \u003c/p\u003e\u003cp\u003e\u003cb\u003eMultidisciplinary team\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eLTC physicians\u003c/p\u003e\u003cp\u003ePsychiatrist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMultidisciplinary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMultidisciplinary pychiatric medical and nursing on-site consultation service; services included assist in psychiatric diagnoses, organisation of therapeutic consultations, and support LTCF residents with psychiatric disorders in their usual environment whenever possible.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUsual care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- physicians satisfaction suvey indicated a high to very high level of satisfaction 3\u0026ndash;4 (on a 4-point scale)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMultidisciplinary on-site consultation service may lead to better decision making and on-site educational dimensions were found to be very satisfying.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Summary of the included study characteristics\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Quality Assessment\u003c/h2\u003e\u003cp\u003eThe quality assessment revealed that a considerable proportion of the included studies had a moderate to serious risk of bias, especially in areas concerning confounding, deviations from intended interventions, missing data and measurement of outcomes. A traffic light visualisation of the quality assessment according to ROBINS-I and RoB 2 is provided in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e Traffic light visualisation of the quality assessment according to ROBINS-I and RoB 2\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Impact of interventions\u003c/h2\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e3.4.1. Teleconsultations\u003c/h2\u003e\u003cp\u003eFour of the included studies evaluated teleconsultation as an intervention to optimise interprofessional collaboration. Two of these studies compared teleconsultation to usual care [34, 35], while the other two studies compared teleconsultation to on-site consultation service.[38, 43] The format of teleconsultation varied across studies, including both real-time and store-and-forward methods.\u003c/p\u003e\u003cp\u003eThree studies focused on collaborations between LTC physicians and psychiatrists [34, 35, 43] and one study assessed collaboration between LTC physicians and dermatologists.[38] Teleconsultations could be requested by the LTCF resident, their caregiver, specialised nurse, or the LTC physician. The frequency of teleconsultations varied from structured sessions once every one or two weeks to on-demand consultations.\u003c/p\u003e\u003cp\u003eBuisson et al. (2019) examined neuropsychogeriatric expertise teleconsultation for LTCF residents. Using the Neuro Psychiatric Inventory Nursing Home (NPI-NH), they measured an average NPI-NH score decrease of 50\u0026thinsp;\u0026plusmn;\u0026thinsp;19,2 (during intervention) to 33,9\u0026thinsp;\u0026plusmn;\u0026thinsp;19,6 (30 days following intervention), P\u0026thinsp;\u0026lt;\u0026thinsp;0,001.\u003c/p\u003e\u003cp\u003eCatic et al. (2014) described case based teleconsultations between psychiatrists from an academic hospital and LTC physicians delivering medical care to 11 regional LTCFs. They discussed challenging cases of residents with dementia or delirium related behavioral problems and, additionally, collected data on compliance, improvement, hospitalisation, and mortality. Following the recommendations led to clinical improvement of behavioral problems in 74% of LTCF residents, compared to 20% when recommendations were not followed (P\u0026thinsp;\u0026lt;\u0026thinsp;0.03).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e3.4.2. On-site consultation services compared to teleconsultations\u003c/h2\u003e\u003cp\u003eTwo studies focused on the impact of on-site consultation services from medical specialist to LTCFs compared to teleconsultations. Rabinowitz et al. (2010) assessed the cost-effectiveness (in \u003cspan\u003e$\u003c/span\u003eUSD) of psychiatric teleconsultations comparing them to both usual care and on-site consultation service in rural areas.[43] Estimated cost savings ranged from \u003cspan\u003e$\u003c/span\u003e13,000 (teleconsultation compared to LTCF residents usual visit to hospital) to \u003cspan\u003e$\u003c/span\u003e232,000 (teleconsultation versus on-site consultation service). Beyond estimated financial benefits, the study emphasised that teleconsultation enabled access to psychiatric care that would otherwise be unavailable in rural LTCFs.\u003c/p\u003e\u003cp\u003eKl\u0026ouml;sters et al. (2022) examined the estimated value of on-site consultation services compared to teleconsultations between LTC physicians and dermatologists. Using a 5-point Likert scale followed by stratification in two groups (added value or no added value). They concluded 67.8% (183 /270) of on-site consultations being of added value compared to teleconsultation, primarily due to the need for diagnostic procedures such as dermatoscopy and punch biopsy. Notably, the remaining 32,2% (87/270) of cases were considered to be manageable via teleconsultation. The authors therefore suggest the use of teleconsultations as a triage tool to reduce unnecessary on-site consultations in LTCFs.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e\u003cem\u003e3.4.3. Multidisciplinary collaboration interventions\u003c/em\u003e\u003c/h2\u003e\u003cp\u003eThe majority of our included studies involved multidisciplinary collaboration interventions. These interventions encompassed team approaches, programs and projects in which the collaboration between medical specialists and LTC physicians was supported by intermediaries such as specialised nurses or paramedics. All multidisciplinary interventions utilised teleconsultations or on-site consultation services, with teleconsultations representing a substantial proportion of these interventions. Studies that reported on role allocation, primarily indicated that on-site consultations were conducted by intermediaries. Based on the data from the included studies, we endentified five multidisciplinary collaboration interventions that mentioned on-site consultations by medical specialists.[32, 37, 41, 44, 46] Most multidisciplinary collaboration interventions were combined with additional components such as case conferences, shared care planning, and joint training or education.\u003c/p\u003e\u003cp\u003eA recurring focus across multidisciplinary interprofessional collaboration interventions was the optimisation of psychiatric care within LTCFs. Steel et al. (2022) highlighted a multidisciplinary teleconsultation project involving LTC physicians, geriatricians, psychiatrists, trainees and social care professionals, aimed at improving the physical and mental health of LTCF residents. Shared learning opportunities were facilitated through case-based discussions, comprehensive geriatric assessments and educational sessions led by a member of the multidisciplinary team. The study reported a reduction in the costs of hospital admissions, from \u0026pound;55,678 in the 12 months prior to intervention and \u0026pound;49,653 during the intervention year. Additionally, a 75% reduction in hospital admission (19/25) among residents over 12 months was noted. However, no statistical testing was performed to determine the significance of both these differences.\u003c/p\u003e\u003cp\u003eMc Sweeney et al. (2012) conducted a cluster RCT assessing the impact of on-site psychiatric and psychosocial consultation services. Residents in the intervention group showed significantly lower levels of depression, as measured by the Cornell Scale for Depression in Dementia (CSDD) (mean score: 9.47, SD 5.57) compared to the control group (mean score: 14.23, SD 4.60; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The study suggests that multidisciplinary on-site consultation services are more effective than usual care in treating depression in residents with dementia.\u003c/p\u003e\u003cp\u003ePiau et al. (2020) evaluated the impact of multidisciplinary teleconsultations between hospital geriatricians with expertise in neuropsychogeriatric symtoms (NPS), specialised NPS nurse, psychologists, and LTC physicians over a two-year period, focusing on the development of a tailored personal care plan. This study identified no difference regarding hospital admission and psychotropic drug prescriptions between the intervention group and control group. Mauleon et al. (2025) involved a secondary and exploratory analysis of Piau et al, including 9 more LTCFs and 51 more residents. This cluster RCT underscored that multidisciplinary teleconsultations for NPS had no significant impact on hospital admission or prescriptions for residents. However, the secondary analyses did demonstrate statistical significant improvement for NPI (Neuro Psychiatric Inventory) change frequency x severity score (\u0026minus;\u0026thinsp;17.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9, P\u0026thinsp;=\u0026thinsp;0.001), NPI change in distress score (-5.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5, P\u0026thinsp;=\u0026thinsp;0.03) and ADL (activities daily living) change total score (0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2, P\u0026thinsp;=\u0026thinsp;0.006). Mauleon et al. concluded multidisciplinary teleconsultations to reduce the severity of neuropsychiatric symptoms and improve functional abilities compared to usual care.\u003c/p\u003e\u003cp\u003eZumbach et al. (2009) studied the psychiatric medical and nursing on-site consultation services between a single hospital and fourteen LTCFs. The medical on-site consultation services supported LTC physicians in the establishment and refinement of psychiatric diagnosis, as well as in the organisation of therapeutic consultations. Satisfaction among LTC physicians was high to very high (score 3 to 4 out of a 4-point Likert scale), indicating a positive impact on the quality of psychiatric care delivered.\u003c/p\u003e\u003cp\u003eSeveral multidisciplinary collaboration intervention studies examined collaborations of multiple medical specialists. For example, Audiau et al. (2022) reported a multidisciplinary teleconsultation involving cardiologists, geriatricians, psychiatrists and LTC physicians, with participation of caregivers and a coordinating mobile nurse. The cardiologist consulted remotely from the hospital and a connected stethoscope facilitated auscultation at a distance. The program resulted in 10% avoidance of hospital admissions (12/120) and 55,8% avoidance of hospital visits (67/120). Additionally, therapeutic optimisation was achieved in 38 cases (40%).\u003c/p\u003e\u003cp\u003eSome studies highlighted the use of structured meetings, case-based discussions or case conferences as a key component of collaboration. For instance, Lyketsos et al. (2010) described an intervention of case-based discussions involving LTC physicians, geriatricians, psychiatrists, nurses, social workers, and activity therapists. Twice-weekly teleconsultations were held to discuss residents with newly emerging behavioral or psychiatric symptoms who were at risk of hospitalisation. This intervention was associated with a reduction in number of hospital admissions from 21 in the year prior to the intervention to 11 in the year following the intervention. However, this difference was not subjected to statistical testing.\u003c/p\u003e\u003cp\u003eSimilarly, Bermejo et al. (2022) described a program of weekly multidisciplinary meetings involving LTC physicians, geriatricians, cardiologists, pneumologists, and also public health professionals. In addition to these weekly meetings, the program also included teleconsultations, on-site consultation services, intravenous treatment, blood test and diagnostics, and also educational sessions. Teleconsultation resulted in a potential cost reduction of \u0026euro;187 per LTCF resident by avoiding hospital visits and on-site consultations. Furthermore, this intervention had an estimated potential costs savings of 1.5\u0026nbsp;million \u0026euro; and 2800 fewer hospital days because 442 residents received on-site intravenous treatment instead of hospital-based treatment.\u003c/p\u003e\u003cp\u003eAlso Schippinger et al. (2012) studied weekly multidisciplinary on-site consultations and weekday teleconsultations between LTC physicians, internal medicine physicians, and geriatricians. Specialised treatments, such as intravenous treatments, ultrasound examinations, ECGs, and ultrasound-guided paracentesis, were provided within the LTCF. The intervention resulted in 14.4 hospital admissions per 100 residents per month over a 10-month period, compared to 18.0 in the control group (not statistically significant). Mortality rates were comparable, with 21 deaths in the intervention group and 19 in the control group.\u003c/p\u003e\u003cp\u003eConnolly et al. (2016) described one-hour multidisciplinary meetings between LTC physicians, geriatricians, gerontology nurse specialist (GNS), pharmacists and senior nurses. These meetings focused on diagnosis-specific interventions for the five most common diseases (cardiac failure, ischemic heart disease, COPD, stroke and pneumonia), while also incorporating medication review, education and clinical coaching. Although this intervention did not impact overall rates of acute hospitalisations or mortality, it did result in fewer non-acute hospital admissions related to the five most common diseases (hazard ratio\u0026thinsp;=\u0026thinsp;0.73, 95% CI: 0.54\u0026ndash;0.99, P\u0026thinsp;=\u0026thinsp;0.043).\u003c/p\u003e\u003cp\u003eBon et al. (2019) described a multidisciplinary teleconsultation and on-site consultation service between LTC physicians and ophthalmologists. Consultations were held one afternoon a week, with an average of five residents assessed per session. At the LTCF, an orthoptist and assisting nurse performed ophthalmologic examinations, including measurements of the visual acuity and intraocular pressure. Measurement data were securely and digitally transferred to the ophthalmologist at the hospital, who analysed them prior to the teleconsultation. If necessary, the patient was scheduled for an on-site consultation, follow-up or visit to the hospital. This collaboration resulted in identification of ophthalmological pathology in 55% (37/67) of patients, implementation of treatment plan in 37,8% (14/37) of them and a significant decrease of low vision proportion from 54\u0026ndash;39% (odds ratio\u0026thinsp;=\u0026thinsp;1.86; 95% CI: 1.06\u0026mdash;3.28, P\u0026thinsp;=\u0026thinsp;0.02) was observed after 6 months.\u003c/p\u003e\u003cp\u003eJump et al. (2012) evaluated a multidisciplinary weekly tele- and on-site consultation service supporting antimicrobial stewardship and infection control for LTCF residents. The LTCF infectious disease (LID) team, consisting of an infectious disease physician and a NP, visited the LTCF and supported the LTC physicians, and NPs remotely. They demonstrated a 30% reduction in antimicrobial use (from 175.1\u0026thinsp;\u0026plusmn;\u0026thinsp;28.0 pre-intervention to 122.3\u0026thinsp;\u0026plusmn;\u0026thinsp;26.9 post-intervention, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, Clostridium difficile infection rates declined, with a significant change in trend (mean change of slopes: 0.1, 95% CI: 0.00\u0026ndash;0.1, P\u0026thinsp;=\u0026thinsp;0.04).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Facilitators and barriers\u003c/h2\u003e\u003cp\u003eThe included studies identified several facilitators to optimise interprofessional collaborations. Firstly, dependable technological and logistical infrastructure (such as a stable internet connection), are crucial for smooth teleconsultations, case-based teleconferences, and remote assessments.(33, 43) Additionally, autonomous devices, such as portable stethoscopes equipped with Wi-Fi or 4G connectivity, allow remote assessments without relying on the LTCF\u0026rsquo;s internet infrastructure.(31) Furthermore, accessible software and secure message system between LTCFs and hospitals improve communication, allowing efficient sharing of residents\u0026rsquo; health data and enhancing QoC.[32, 35]\u003c/p\u003e\u003cp\u003eIn addition, structured and recurring consultations, such as multidisciplinary case-based teleconsultations, enabled consistent follow-up and high commitment to the intervention.(32, 35, 45) Also, reflection on team-based decision-making was emphasised as valuable for improving interprofessional collaborations.[45]\u003c/p\u003e\u003cp\u003eThe main barriers to effective interprofessional collaboration, were the coordination and implementation costs of teleconsultation programs.[39] Funding by public health and regional coordination may contribute to overcome these barriers and facilitate successful implementation.[32, 36]\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e In this systematic review we identified 16 studies exploring interprofessional collaboration interventions between LTC physicians and medical specialists. The available literature regarding medical care for LTCF residents remain scarce, highlighting significant gaps in evidence. Importantly, although most included studies had an intermediate or high risk of bias, they still provided valuable insights in how interprofessional collaborations can improve medical care for LTCF residents. We identified three ways of interprofessional collaboration interventions: teleconsultations, on-site consultation services, and multidisciplinary collaboration interventions.\u003c/p\u003e\u003cp\u003eAcross the studies, a variety of medical specialists collaborated with LTC physicians. Most frequently, this included medical specialists such as geriatricians and psychiatrists. The studies reported a wide range of outcomes, including patient health outcomes (such as NPI, ADL, vision, and CSDD), impact on care plans, cost reduction, diagnostic accuracy, hospital admissions, and satisfaction of patients, caregivers and physicians. Despite this considerable heterogeneity in outcome measures, most interventions demonstrated at least some positive impact, suggesting improvements in both QoL and QoC for LTCF residents.\u003c/p\u003e\u003cp\u003eTeleconsultations between medical specialists and LTC physicians consistently demonstrated a positive impact on health outcomes and QoC for LTCF residents, as well as on satisfaction and estimated cost-reductions. These findings are in line with previous studies on teleconsultation in primary care settings, where remote collaboration between GPs and medical specialists has shown to reduce hospital admissions and unnecessary visits.[13]\u003c/p\u003e\u003cp\u003eWhile teleconsultations offer clear benefits, they are not suitable for all medical conditions. Some conditions require physical examinations or a contextual understanding of the resident\u0026rsquo;s environment. For instance, assessment of depression or delirium, and diagnostics of dementia often necessitate on-site consultations.[46]\u003c/p\u003e\u003cp\u003eOn-site consultations remain essential in some cases, however the organisation presents significant logistical and financial challenges. In particular, the travel involved for medical specialists from hospital to LTCFs is time-consuming and costly, which can be challenging in rural areas and settings with already limited healthcare capacity.[43]\u003c/p\u003e\u003cp\u003eConsequently, a potential practical approach could be to use teleconsultation as an initial triage tool, reserving on-site consultation services for cases where they are really necessary or offer added value. For example, in dermatology, on-site consultations may be necessary as addition to teleconsultation for suspected (pre)malignant skin diseases, where a diagnostic biopsy can be performed immediately.[38] Further research is needed to determine which conditions are considered to be manageable via teleconsultation and which medical disciplines and clinical scenarios benefit most from on-site consultation services.\u003c/p\u003e\u003cp\u003e Most of the study interventions included in our review concerned multidisciplinary collaboration interventions. All of these involved either tele-or on-site consultations, while some also incorporated structured case-based discussions, education and learning. Collaborations were supported by intermediaries, such as nurses and paramedics, depending on the intervention.\u003c/p\u003e\u003cp\u003eAlthough multidisciplinary collaboration interventions show overall promise, it remains unclear which specific component has the greatest impact on LTCF residents\u0026rsquo; QoL or QoC. Structured case-based discussions and team decision-making processes support commitment to the intervention and could therefore lead to a sustainable collaboration.[35, 45] Future research should focus on identifying which elements of multidisciplinary collaboration interventions contribute most to improvement of QoL, QoC, and cost-effectiveness.\u003c/p\u003e\u003cp\u003eTo optimise multidisciplinary collaboration interventions, it is important to identify which elements are most impactful, but also to define roles and responsibilities of all involved professionals.[47] Nevertheless, most studies do not clearly define the role of the LTC physician and global substantial differences exist in who provides medical care to LTCF residents. For example, in the Netherlands, specially trained LTC physicians have formally provided nearly all of the medical care for LTCF residents since 1990 [21], whereas in many other European countries, only 5 to 10% of the medical care is delivered by LTC physicians.[22] The role of LTC physicians is often fulfilled by GPs, geriatricians, psychiatrists, or internal medicine physicians, depending on the country and its healthcare system.\u003c/p\u003e\u003cp\u003eDespite global variations and unclear role definition in multidisciplinary collaboration interventions, our study, in line with the WHO report, supports embedding multidisciplinary components to interprofessional collaborations has the potential to improve patients\u0026rsquo; satisfaction, health status, and effective use of health services. [48] We advocate for a clear and essential role of the LTC physician as a clinical gatekeeper, to ensure the appropriate use of medical specialist expertise and the integration of specialist advice into the resident\u0026rsquo;s care plan. We believe this is fundamental for safeguarding the quality of medical care within LTCFs.\u003c/p\u003e\u003cp\u003eMoreover, we support the active involvement of intermediaries, such as specialised nurses and paramedics, to complement LTC physicians and medical specialists in key functions including assessment, treatment management, and follow-up. We also emphasise the important participation of medical specialists in consultation and educational roles, as previously reported by Wagner et al.[49]\u003c/p\u003e\u003cp\u003eA recurring barrier identified in the studies was the need for user-friendly and reliable internet infrastructure, essential for effective teleconsultation and remote assessments.[35] This is consistent with earlier findings by Johnston et al. 2001, who noted that low-cost ISDN videoconferencing systems introduced significant motion artefacts, hindering the accurate assessment of movement disorders.[50] However, with ongoing advances in digital technology, it is reasonable to assume that such technical limitations are increasingly being addressed. Other barriers included institutional firewalls that hinder digital communication. A common potential solution cited was the implementation of secure messaging systems between LTCFs and hospitals.[35]\u003c/p\u003e\u003cp\u003eThe successful integration of interprofessional collaborations into routine LTC practice could be facilitated trough appropriate funding and mutual commitment from all stakeholders. In addition to LTC physicians, medical specialists, and intermediaries, stakeholders should also include governments, insurers, and care organisations. Their involvement is expected to be necessary to meet the growing need for interprofessional collaborations.[51, 52]\u003c/p\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eThere are limitations to this review: the variation in which physician fulfilled the role of the LTC physician, combined with limited definition of role distribution within multidisciplinary teams, may limit the generalisability of the findings.\u003c/p\u003e\u003cp\u003eMost included studies had an intermediate to high risk of bias. While findings suggest that interprofessional collaboration between LTC physicians and medical specialists can positively impact residents\u0026rsquo; QoL and QoC, substantial heterogeneity in outcomes limits firm conclusions. It remains unclear which aspects of the multidisciplinary collaboration intervention, such as teleconsultations, on-site consultation services, and regular structured meetings contribute most to positive outcomes. Moreover, few studies considered the perspectives of LTCF residents and their caregivers on the interventions, representing a critical gap. Further research should incorporate these perspectives to enhance the relevance and impact of interprofessional collaborations.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003e In conclusion, this review suggest that interprofessional collaboration interventions between LTC physicians and medical specialists hold substantial potential to enhance residents\u0026rsquo; QoL and QoC. While heterogeneity among studies exist, the overall results point to achieving meaningful improvements in care for LTCF residents. A sustainable interprofessional collaboration may be achieved by multidisciplinary collaboration interventions that integrate tele- or on-site consultations and combine this with regionally structured and coordinated care, case conferences, professional learning possibilities, and intermediary support. Further research should identify the most impactful elements of multidisciplinary collaboration interventions and incorporate LTCF residents and caregivers perspectives on these interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the database search. JS, SL, and MvO contributed to the screening of title and abstract, full text, and risk of bias assessment. The manuscript was written by MvO and all authors contributed by reviewing and editing the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was not required for this systematic review.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was not required for this systematic review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePROSPERO:\u0026nbsp;\u003c/strong\u003ehttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023484096).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKnickman JR, Snell EK (2002) The 2030 problem: caring for aging baby boomers. 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J Am Med Dir Assoc 23(2):297-303.e14.\u0026nbsp;10.1016/j.jamda.2021.12.019\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Interprofessional collaboration, Long term care physician, Medical specialist, Quality of life, Quality of care","lastPublishedDoi":"10.21203/rs.3.rs-7001320/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7001320/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e \u003c/em\u003eThe increasing population of long-term care facility (LTCF) residents with complex medical needs presents a growing challenge for healthcare systems. These residents often suffer from multiple chronic conditions, functional decline, cognitive impairments, and a limited social network, making access to medical specialists difficult. Our main aim is to identify the impact of interprofessional collaboration interventions between long-term care (LTC) physicians and medical specialists on the quality of life (QoL) and quality of care (QoC) of LTCF residents.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eA systematic literature search in PubMed, EMBASE, Cochrane Library, Cinahl and a manual screening of the reference lists was performed on the impact of interprofessional collaboration between LTC physicians and medical specialists on the QoL and QoC for LTCF residents. The final search was performed on March 3rd 2025 andaccording to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. \u003cem\u003e\u003cbr\u003e\n\u003c/em\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eThe searches identified 10364 studies of which ultimately 16 studies were included for analysis. Three ways of interprofessional collaboration were identified; teleconsultations, on-site consultation services, and multidisciplinary collaboration interventions. \u003cbr\u003e\n\u003cem\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: \u003c/em\u003eThis review suggests that interprofessional collaboration between LTC physicians and medical specialists holds potential to improve the QoL and QoC of LTCF residents. Multidisciplinary collaboration interventions that integrate tele- and on-site consultations with additional elements and support, show promise for sustainable and positive impact. Given the heteogeneity in study designs and outcomes, further research is needed to identify which elements of multidisciplinary collaboration interventions have the greatest impact on the QoL and QoC of LTCF residents.\u003c/p\u003e","manuscriptTitle":"Impact of interprofessional collaboration between long-term care physicians and medical specialists on quality of care and quality of life of long-term care facility residents: a systematic review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 10:17:22","doi":"10.21203/rs.3.rs-7001320/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revisions","date":"2025-09-27T09:38:45+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2025-07-10T12:25:06+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-10T11:37:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"European Geriatric Medicine","date":"2025-07-10T07:56:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-03T06:33:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Geriatric Medicine","date":"2025-06-29T03:44:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"bc9f7cb5-f8fb-48fb-b2cd-1c6b4be044bc","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-12T11:44:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-14 10:17:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7001320","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7001320","identity":"rs-7001320","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}