Interventions and management on multimorbidity: An overview of systematic reviews

Yaguan Zhou; Xiaochen Dai; Yujie Ni; Qingyong Zeng; Yangyang Cheng; Rodrigo M Carrillo-Larco; Lijing L Yan; Xiaolin Xu

doi:10.1016/j.arr.2023.101901

Interventions and management on multimorbidity: An overview of systematic reviews

Ageing Res Rev. 2023 Jun:87:101901. doi: 10.1016/j.arr.2023.101901. Epub 2023 Mar 9.

Authors

Yaguan Zhou¹, Xiaochen Dai², Yujie Ni¹, Qingyong Zeng¹, Yangyang Cheng¹, Rodrigo M Carrillo-Larco³, Lijing L Yan⁴, Xiaolin Xu⁵

Affiliations

¹ School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China.
² Department of Health Metrics Science, School of Medicine, University of Washington, Seattle, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.
³ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
⁴ Global Health Research Center, Duke Kunshan University, Kunshan, China; Ningbo Eye Hospital affiliated with Wenzhou Medical University, Ningbo, China; School of Public Health, Wuhan University, Wuhan, China; Peking University Institute for Global Health and Development, Beijing, China.
⁵ School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia. Electronic address: xiaolin.xu@zju.edu.cn.

PMID: 36905961
DOI: 10.1016/j.arr.2023.101901

Abstract

Background: Multimorbidity poses an immense burden on the healthcare systems globally, whereas the management strategies and guidelines for multimorbidity are poorly established. We aim to synthesize current evidence on interventions and management of multimorbidity.

Methods: We searched four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews). Systematic reviews (SRs) on interventions or management of multimorbidity were included and evaluated. The methodological quality of each SR was assessed by the AMSTAR-2 tool, and the quality of evidence on the effectiveness of interventions was assessed by the grading of recommendations assessment, development and evaluation (GRADE) system.

Results: A total of 30 SRs (464 unique underlying studies) were included, including 20 SRs of interventions and 10 SRs summarizing evidence on management of multimorbidity. Four categories of interventions were identified: patient-level interventions, provider-level interventions, organization-level interventions, and combined interventions (combining the aforementioned two or three- level components). The outcomes were categorized into six types: physical conditions/outcomes, mental conditions/outcomes, psychosocial outcomes/general health, healthcare utilization and costs, patients' behaviors, and care process outcomes. Combined interventions (with patient-level and provider-level components) were more effective in promoting physical conditions/outcomes, while patient-level interventions were more effective in promoting mental conditions/outcomes and psychosocial outcomes/general health. As for healthcare utilization and care process outcomes, organization-level and combined interventions (with organization-level components) were more effective. The challenges in the management of multimorbidity at the patient, provider and organizational levels were also summarized.

Conclusion: Combined interventions for multimorbidity at different levels would be favored to promote different types of health outcomes. Challenges exist in the management at the patient, provider, and organization levels. Therefore, a holistic and integrated approach of patient-, provider- and organization- level interventions is required to address the challenges and optimize care of patients with multimorbidity.

Keywords: Health outcome; Intervention; Management; Multimorbidity; Systematic review.

Publication types

Review

MeSH terms

Humans
Multimorbidity*
Systematic Reviews as Topic