Evidence map›Paper›PMID 34666828›Full record

SynthesisSystematic reviews2021

Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic review.

Susan M Smith, Emma Wallace, Barbara Clyne, Fiona Boland, Martin Fortin

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Systematic reviews, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 130 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
130citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

130 citing papers in PubMed, 11 syntheses or guidelines pooled it.

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70 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Susan M SmithDepartment of General Practice and HRB Centre for Primary Care Research, Royal College of Surgeons, 123 St Stephens Green, Dublin 2, Ireland. susansmith@rcsi.ie.ORCID 0000-0001-6027-2727
Emma WallaceDepartment of General Practice and HRB Centre for Primary Care Research, Royal College of Surgeons, 123 St Stephens Green, Dublin 2, Ireland.
Barbara ClyneDepartment of General Practice and HRB Centre for Primary Care Research, Royal College of Surgeons, 123 St Stephens Green, Dublin 2, Ireland.
Fiona BolandData Science Centre and HRB Centre for Primary Care Research, Royal College of Surgeons, 123 St Stephens Green, Dublin 2, Ireland.
Martin FortinDepartment of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada.

Funding

Health Research Board HRB CDA-2018-003Health Research Board HRB CRC-2014-1Health Research Board HRB EIA-2019-09
6 · The paper itself

Abstract

backgroundMultimorbidity, defined as the co-existence of two or more chronic conditions, presents significant challenges to patients, healthcare providers and health systems. Despite this, there is ongoing uncertainty about the most effective ways to manage patients with multimorbidity. This review updated and narrowed the focus of a previous Cochrane review and aimed to determine the effectiveness of interventions designed to improve outcomes in people with multimorbidity in primary care and community settings, compared to usual care.

methodsWe searched eight databases and two trials registers up to 9 September 2019. Two review authors independently screened potentially eligible titles and selected studies, extracted data, evaluated study quality and judged the certainty of the evidence (GRADE). Interventions were grouped by their predominant focus into care-coordination/self-management support, self-management support and medicines management. Main outcomes were health-related quality of life (HRQoL) and mental health. Meta-analyses were conducted, where possible, but the synthesis was predominantly narrative.

resultsWe included 16 RCTs with 4753 participants, the majority being older adults with at least three conditions. There were eight care-coordination/self-management support studies, four self-management support studies and four medicines management studies. There was little or no evidence of an effect on primary outcomes of HRQoL (MD 0.03, 95% CI -0.01 to 0.07, I

conclusionsThere are remaining uncertainties about the effectiveness of interventions for people with multimorbidity, despite the growing number of RCTs conducted in this area. Our findings suggest that future research should consider patient experience of care, optimising medicines management and targeted patient health behaviours such as exercise.

Indexed as

MultimorbiditySelf-ManagementAgedChronic DiseaseHumansPrimary Health CareQuality of Life

Identifiers

PMID34666828
PMCPMC8527775

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.