Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews

Abstract

To cite: Mansour MHH, Pokhrel S, Anokye N. Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews. ABSTRACT To examine the effectiveness of integrated care intervention (ICI) models (stand-alone or combination of self-management, discharge management, case management and multidisciplinary teams models) targeting patients with one or more chronic conditions, and to identify outcome measures/indicators of effectiveness, we conducted a systematic review of published systematic reviews and meta-analyses. Included reviews comprise ICIs targeting adult patients with one or more long-term conditions. We searched MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews: 60 reviews were included in the final analysis; 28 reviews evaluated ICIs focused on self-management, 4 on case management, 10 on discharge management and 5 on multidisciplinary teams; 13 reviews assessed multiple interventions that were labelled as complex. Across all reviews, only 19 reviews included intervention with multiple ICIs. Overall, interventions with multiple components, compared with interventions with single components, were more likely to improve hospital use outcomes effectively. Clinical/ lifestyle/condition-specific outcomes were more likely to be improved by self-management interventions. Outcome measures identified could be classified into three main categories: organisational, patient-centred and clinical/ lifestyle/condition-specific. The findings of this review may provide inputs to future design and evaluation of ICIs. BACKGROUND According to WHO, long-term conditions (LTCs), also known as chronic diseases, are the leading cause of death and disability worldwide. 1 It has been estimated that chronic diseases account for around 60% of all deaths worldwide. 1 As a result, WHO proposed a plan for an integrated approach in 2002 to target the major risk factors for the common chronic diseases, including cardiovascular diseases, chronic respiratory diseases, cancer and diabetes. 2 However, along with prevention , providing high-quality care for patients with LTCs is also a vital issue. Patients with LTCs often experience fragmented care and require access to multiple health and social care settings. 3 The gaps in