Table 1 Summary characteristics of included systematic reviews
From: Models of integrated care for multi-morbidity assessed in systematic reviews: a scoping review
Study ID | Date of last search | Type and number of studies included | Country of included studies | Participants/ Conditions included | Intervention | Health outcomes addressed |
|---|---|---|---|---|---|---|
Atlantis 2014 [21] | August 2013 | Randomised control trials (RCTs) (n = 7) | USA (n = 6) Australia (n = 1) | Adults with comorbid depression and diabetes | Collaborative care | • Depression • HbA1C |
Bulstra 2021 [34] | September2021 | RCTs (n = 4) Interrupted time series (n = 2) Pre-post studies (n = 12) Retrospective cohort studies (n = 9) Prospective cohort studies (n = 7) Cross-sectional studies (n = 5) Prospective longitudinal controlled intervention study (n = 1) Modelling study (n = 1) | South Africa (n = 11) Ghana (n = 1) Uganda (n = 3) USA (n = 5) Malawi (n = 3) Ethiopia (n = 1) Zambia (n = 5) sub-Saharan Africa (9 countries not specified) (n = 1) Tanzania (n = 2) Cameroon (n = 1) Ukraine (n = 1) Mozambique (n = 1) Rwanda (n = 1) Kenya (n = 1) Eswatini (n = 1) Democratic Republic of the Congo (n = 1) Denmark (n = 1) China (n = 1) | Adults and adolescents with HIV and TB, or with HIV and seeking other health services including maternal and child health family planning, primary health care and sexual and reproductive health or sexually transmitted infection services | Bi-directional integration of HIV services into non-HIV programmes and non-HIV services into HIV programmes | • Uptake of HIV services • HIV testing yield • ART initiation • Time until ART Initiation • Retention in care • ART adherence • Viral suppression • HIV – free survival among infants • HIV infections averted • AIDS related mortality • Uptake of other health services • Treatment success for other diseases/ conditions • Non-AIDS related mortality • HIV only costs • Non-HIV costs • Costs of integrated services versus HIV only costs • Cost effectiveness |
Chuah 2017 [22] | October 2015 | RCTs (n = 7) Non-randomized intervention studies (n = 5) Cohort studies (n = 5) Case-series studies (n = 3) Cross-sectional (n = 3) Retrospective record reviews (n = 3) Mixed-method studies (n = 3) Programme or model descriptions (n = 14) Qualitative methods (n = 2) | USA (n = 32) UK (n = 3) Canada (n = 1) Australia (n = 1) France (n = 1) South Africa (n = 2) Uganda (n = 3) Zimbabwe (n = 1) Tanzania (n = 1) | Adults with comorbid HIV and at least one mental disorder | Integration of HIV care into mental health services, or integration of mental health services in HIV care | • Depression • Mental health problems • Alcohol and substance use • Social functioning • HIV symptoms • Viral suppression • CD4 count • HIV stigma • Risk behaviour • HIV knowledge • HIV adherence • Health-related quality of life |
Dudley 2011 [23] | September 2010 | RCTs (n = 5) Controlled before-after studies (CBAs) (n = 4) | India (n = 2) Tanzania (n = 1) Zambia (n = 1) Nepal (n = 1) Togo (n = 1) South Africa (n = 2) Zimbabwe (n = 1) | Patients using primary health care services | Integration of 1) family planning and immunisation (n = 1); maternal and child health services (n = 2); HIV counselling and testing (n = 1) 2) Integration of nutrition and infectious disease control (n = 1) 3) Integration of STI, HIV and TB services (n = 1) | • Health-care delivery • User views • Knowledge and behaviours of service users, • Health status • Users’ perceptions of the service |
Haldane 2018 [24] | October 2015 | Cohort study (n = 1) Retrospective record review (n = 2) Program description (n = 12) Cross-sectional study (n = 1) Qualitative study (n = 1) | USA (n = 4) UK (n = 1) Ethiopia (n = 1) Uganda (n = 3) Cambodia (n = 1) South Africa (n = 1) Kenya (n = 4) Nigeria (n = 1) Lesotho (n = 1) | Patients with HIV/AIDS and diabetes, hypertension or cardiovascular disease risk factors | Integration of HIV/AIDS and chronic disease services | • Blood pressure • HbA1C • Cholesterol levels • CD4 count |
Hopman 2016 [25] | March 2014 | Included a total of 18 studies, of which 4 are relevant to this scoping review: RCTs (n = 3) Cohort study (n = 1) | USA (n = 3) Canada (n = 1) | Patients with multiple chronic diseases | Comprehensive care | • Patient satisfaction • Health related quality of life • Depressive symptoms • Functional status • Mortality |
Huang 2013 [26] | March 2013 | RCTs (n = 8) | USA (n = 8) | Patients with comorbid depression and diabetes | Collaborative care | • Depression treatment response • Depression remission • HbA1c control • Adherence |
John 2020 [35] | March 2020 | RCTs (n = 28) | USA (n = 14) Netherlands (n = 5) South Africa (n = 1) Puerto Rico (n = 1) UK (n = 4) Germany (n = 1) Spain (n = 2) | Primary care patients with diagnosis of one or more chronic conditions | Integrated or multi-disciplinary care | • Blood pressure • Glycated haemoglobin (HbA1c) • Low density lipoprotein cholesterol (LDL-C) • High density lipoprotein cholesterol (HDL-C) • Serum total cholesterol • Depression • Health-related quality of life • Self-management • Hospital admissions • Emergency department visits • Medications use • Incremental cost-effectiveness ratio (ICER) |
Kadia 2021 [36] | July 2019 | Prospective cohort studies (n = 6) Retrospective cohort studies (n = 12) Prospective and retrospective cohort study (n = 1) Cross-sectional studies (n = 3) Case study (n = 1) | Uganda (n = 2) Benin (n = 1) Malawi (n = 5) Rwanda (n = 2) Zambia (n = 1) South Africa (n = 2) Kenya (n = 3) Cameroon (n = 1) Ghana (n = 1) Democratic Republic of the Congo (n = 2) Eswatini (n = 1) Zimbabwe (n = 1) Ethiopia (n = 1) | TB/HIV co-infected adult patients | Collaborative care | • ART uptake • barriers to ART uptake • enablers of ART uptake |
Kappelin 2021 [37] | December 2019 | RCTs (n = 12) | Spain (n = 1) USA (n = 6) England (n = 1) Canada (n = 1) Netherlands (n = 1) Puerto Rico (n = 1) Australia (n = 1) | Adults with mental health issues and one physical diseases | Collaborative Care | • Improvement in depressive symptoms • Improvement in anxiety symptoms |
Kastner 2018 [27] | December 2017 | RCTs (n = 15) Cluster RCTs (n = 6) Mixed methods studies (n = 3) Uncontrolled studies (n = 1) | USA (n = 11) Australia (n = 7) Canada (n = 1) Spain (n = 1) Germany (n = 1) Russia (n = 1) The Netherlands (n = 1) Other European countries (n = 2) | Adults with multi-morbidity | Multi-morbidity interventions | • Depression • HbA1C • Systolic blood pressure • Mortality • Quality of life • Antidepressant use • Physical activity |
Lee 2021 [38] | March 2018 | RCT (n = 15) Prospective cohort studies (n = 7) Retrospective cohort (n = 1) prospective pre-post studies (n = 2) Retrospective pre-post (n = 14) | Mexico (n = 2) Brazil (n = 4) USA (n = 18) Canada (n = 4) Taiwan (n = 1) Israel (n = 1) Malaysia (n = 1) Saudi Arabia (n = 2) Hong Kong (n = 2) The Netherlands (n = 1) Iran (n = 1) Australia (n = 1) American Samoa (n = 1) | Adults with Diabetes and Hypertension | Interprofessional collaborative practice | • (HbA1c) • Systolic blood pressure (SBP) • Diastolic blood pressure (DBP) levels |
Li 2017 [28] | January 2015 | RCTs (n = 25); of which 7 assessed collaborative care interventions (relevant to this scoping review) | USA (n = 4) Scotland (n = 3) | Adult cancer patients with major depression or other non-bipolar depressive disorders | Collaborative care | • Depression |
Martens 2021 [39] | January 2020 | RCT (n = 8) Quasi-experimental study (n = 1) | Denmark (n = 1) USA (n = 7) Spain (n = 1) | Persons with severe mental illness and at least one chronic condition | Implementation of organizational models of care | • Body weight • Body Mass Index • HbA1C • Blood glucose • Cardiovascular risk • Low density lipids • Total cholesterol • Systolic blood pressure • Diastolic blood pressure • Quality of life • Number of screening visits |
Nyirenda 2022 [40] | October 2021 | RCT (n = 1) Prospective cohort study (n = 1) Cross-sectional studies (n = 4) Prospective observational (n = 3) Retrospective cohort (n = 1) | Mexico (n = 1) China (n = 3) India (n = 2) Indonesia (n = 1) Zimbabwe (n = 1) Angola (n = 1) Uganda (n = 1) | Patients with tuberculosis and/or diabetes | Integrated care for TB and Diabetes | • Screening coverage • Treatment loss to follow-up • Blood glucose control • Cure rate |
Rohwer 2021 [41] | December 2019 | Cluster RCTs (n = 3) Interrupted time series study (n = 2) | South Africa (n = 3) Uganda/Kenya (n = 1) India (n = 1) | Adults and children with diabetes and hypertension | Full or partial integration of services at PHC and community level | • All-cause mortality • Blood pressure control • NCD control • HIV control • Access to care • Depression • Quality of life • HbA1C • Systolic blood pressure • Total cholesterol • Adherence • Retention in care • Quality of care |
Sigfrid 2017 [29] | December 2015 | Cohort studies (n = 4) Cross-sectional studies (n = 15) Retrospective record reviews (n = 3) Before-after study (n = 1) | Kenya (n = 3) Uganda (n = 1) Mozambique (n = 1) Zambia (n = 4) Ivory Coast (n = 2) Tanzania (n = 3) Guyana (n = 3) Thailand (n = 1) UK (n = 1) Nigeria (n = 1) Argentina (n = 1) Botswana (n = 1) Ethiopia (n = 1) | Women with HIV and cervical cancer | Integrated care | • Cervical cancer screening • Referral • Cryotherapy • Colposcopy • Pathology results • Cancer diagnosis • CD4 counts • Proportion on ART • Sexually transmitted infections • HIV screening |
Smith 2021a [30] | September 2015 | RCTs (n = 18) | USA (n = 16) UK (n = 1) Canada (n = 1) | Adults with multi-morbidity | Interventions designed to improve multi-morbidity | • Physical health • Mental health • Psychosocial outcomes • Health service use • Patient related behaviours • Medication adherence |
Smith 2021b [42] | September 2019 | RCTs (n = 9) | Germany (n = 1) UK (n = 2) USA (n = 4) Canada (n = 1) Spain (n = 1) | Adults with multimorbidity | Coordinated care | • Health service use • Self-management (Health Education Impact Questionnaire) • Emergency admissions • Self-management • Health-related quality of life • Well-being (W-BQ12) • Number medications • Health services use • Self-rated health • Dietary behaviour • Physical activity • Activity participation • Quality of medication therapy • Pharmaceutical care issues • Medication Appropriateness Index |
Tully 2015 [31] | April 2014 | RCTs (n = 6) | USA (n = 5) Australia (n = 1) | Adults with comorbid depression and coronary heart disease | Collaborative care | • Major adverse cardiac events • Depression symptoms • Depression remission • Anxiety |
Van Eck van der Sluijs 2018 [32] | August 2017 | RCTs (n = 20) | USA (n = 18) UK (n = 1) The Netherlands (n = 1) | Adults with a chronic medical condition and a depressive and/or anxiety disorder | Collaborative care | • Symptom-load related to chronic medical condition • Incidence of MACE, angina pectoris, post infarct • Arthritis-related pain • Arthritis-related physical functioning • Cancer-related pain • Cancer-related physical functioning • Dyspnea related disability • HbA1C • Epilepsy-related seizures • HIV symptom severity • Blood pressure • Physical functioning • Depressive symptoms |
Watson 2013 [33] | June 2012 | RCTs (n = 12) | USA (n = 11) UK (n = 1) | Patients with depression and one or more chronic conditions | Practice-based interventions that include coordinated care, integrated care and collaborative care | • Depression • Symptom improvements • Depression-free days • Remission • Recurrence • Treatment adherence • Treatment satisfaction • Use of antidepressants • Mental health-related Quality of life • Mental Health care utilisation |