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Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting
BACKGROUND: With the rise in pre-mature mortality rate from non-communicable disease (NCD), there is a need for evidence-based interventions. We evaluated existing systematic reviews on effectiveness of integration of healthcare services, in particular with focus on delivery of care designed to impr...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6011271/ https://www.ncbi.nlm.nih.gov/pubmed/29925356 http://dx.doi.org/10.1186/s12913-018-3290-8 |
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author | Yiu, Kristy C Rohwer, Anke Young, Taryn |
author_facet | Yiu, Kristy C Rohwer, Anke Young, Taryn |
author_sort | Yiu, Kristy C |
collection | PubMed |
description | BACKGROUND: With the rise in pre-mature mortality rate from non-communicable disease (NCD), there is a need for evidence-based interventions. We evaluated existing systematic reviews on effectiveness of integration of healthcare services, in particular with focus on delivery of care designed to improve health and process outcomes in people with multi-morbidity, where at least one of the conditions was diabetes or hypertension. METHODS: We searched MEDLINE, EMBASE, Cochrane Library, and Health Evidence to November 8, 2016 and consulted experts. One review author screened titles, abstracts and two review authors independently screened short listed full-texts and selected reviews for inclusion. We considered systematic reviews evaluating integration of care, compared to usual care, for people with multi-morbidity. One review author extracted data and another author verified it. Two review authors independently evaluated risk of bias using ROBIS and AMSTAR. Inter-rater reliability was analysed for ROBIS and AMSTAR using Cohen’s kappa and percent agreement. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used to assess reporting. RESULTS: We identified five systematic reviews on integration of care. Four reviews focused on comorbid diabetes and depression and two covered hypertension and comorbidities of cardiovascular disease, depression, or diabetes. Interventions were poorly described. The health outcomes evaluated included risk of all-cause mortality, measures of depression, cholesterol levels, HbA1c levels, effect of depression on HbA1c levels, symptom improvement, systolic blood pressure, and hypertension control. Process outcomes included access and utilisation of healthcare services, costs, and quality of care. Overall, three reviews had a low and medium risk of bias according to ROBIS and AMSTAR respectively, while two reviews had high risk of bias as judged by both ROBIS and AMSTAR. Findings have demonstrated that collaborative care in general resulted in better health and process outcomes when compared to usual care for both depression and diabetes and hypertension and diabetes. CONCLUSIONS: Several knowledge gaps were identified on integration of care for comorbidities with diabetes and/or hypertension: limited research on this topic for hypertension, limited reviews that included primary studies based in low-middle income countries, and limited reviews on collaborative care for communicable and NCDs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-3290-8) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6011271 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-60112712018-06-27 Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting Yiu, Kristy C Rohwer, Anke Young, Taryn BMC Health Serv Res Research Article BACKGROUND: With the rise in pre-mature mortality rate from non-communicable disease (NCD), there is a need for evidence-based interventions. We evaluated existing systematic reviews on effectiveness of integration of healthcare services, in particular with focus on delivery of care designed to improve health and process outcomes in people with multi-morbidity, where at least one of the conditions was diabetes or hypertension. METHODS: We searched MEDLINE, EMBASE, Cochrane Library, and Health Evidence to November 8, 2016 and consulted experts. One review author screened titles, abstracts and two review authors independently screened short listed full-texts and selected reviews for inclusion. We considered systematic reviews evaluating integration of care, compared to usual care, for people with multi-morbidity. One review author extracted data and another author verified it. Two review authors independently evaluated risk of bias using ROBIS and AMSTAR. Inter-rater reliability was analysed for ROBIS and AMSTAR using Cohen’s kappa and percent agreement. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used to assess reporting. RESULTS: We identified five systematic reviews on integration of care. Four reviews focused on comorbid diabetes and depression and two covered hypertension and comorbidities of cardiovascular disease, depression, or diabetes. Interventions were poorly described. The health outcomes evaluated included risk of all-cause mortality, measures of depression, cholesterol levels, HbA1c levels, effect of depression on HbA1c levels, symptom improvement, systolic blood pressure, and hypertension control. Process outcomes included access and utilisation of healthcare services, costs, and quality of care. Overall, three reviews had a low and medium risk of bias according to ROBIS and AMSTAR respectively, while two reviews had high risk of bias as judged by both ROBIS and AMSTAR. Findings have demonstrated that collaborative care in general resulted in better health and process outcomes when compared to usual care for both depression and diabetes and hypertension and diabetes. CONCLUSIONS: Several knowledge gaps were identified on integration of care for comorbidities with diabetes and/or hypertension: limited research on this topic for hypertension, limited reviews that included primary studies based in low-middle income countries, and limited reviews on collaborative care for communicable and NCDs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12913-018-3290-8) contains supplementary material, which is available to authorized users. BioMed Central 2018-06-20 /pmc/articles/PMC6011271/ /pubmed/29925356 http://dx.doi.org/10.1186/s12913-018-3290-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Yiu, Kristy C Rohwer, Anke Young, Taryn Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting |
title | Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting |
title_full | Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting |
title_fullStr | Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting |
title_full_unstemmed | Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting |
title_short | Integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting |
title_sort | integration of care for hypertension and diabetes: a scoping review assessing the evidence from systematic reviews and evaluating reporting |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6011271/ https://www.ncbi.nlm.nih.gov/pubmed/29925356 http://dx.doi.org/10.1186/s12913-018-3290-8 |
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