Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

ObjectivesThis review aimed at identifying the elements of integrated care models for cardiometabolic multimorbidity in sub-Saharan Africa (SSA) and their effects on clinical or mental health outcomes including systolic blood pressure (SBP), blood sugar, depression scores and other patient-reported outcomes such as quality of life and medication adherence.DesignSystematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach.Data sourcesWe systematically searched PubMed, Embase, Scopus, Web of Science, Global Health CINAHL, African Journals Online, Informit, PsycINFO, ClinicalTrials.gov, Pan African Clinical Trials Registry and grey literature from OpenSIGLE for studies published between 1999 and 2022.Eligibility criteria for selecting studiesWe included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner’s chronic care model.Data extraction and synthesisTwo independent reviewers used standardised methods to search and screen included studies. Publication bias was assessed using the Doi plot and Luis Furuya Kanamori Index. Meta-analysis was conducted using random effects models.ResultsIn all, we included 10 randomised controlled trials from 11 publications with 4864 participants from six SSA countries (South Africa, Kenya, Nigeria, Eswatini, Ghana and Uganda). The overall quality of evidence based on GRADE criteria was moderate. A random-effects meta-analysis of six studies involving 1754 participants shows that integrated compared with standard care conferred a moderately lower mean SBP (mean difference=−4.85 mm Hg, 95% CI −7.37 to −2.34) for people with cardiometabolic multimorbidity; Hedges’ g effect size (g=−0.25, (−0.39 to −0.11). However, integrated care compared with usual care showed mixed results for glycated haemoglobin, depression, medication adherence and quality of life.ConclusionIntegrated care improved SBP among patients living with cardiometabolic multimorbidity in SSA. More studies on integrated care are required to improve the evidence pool on chronic care models for multimorbidity in SSA. These include implementation studies and cost-effectiveness studies.PROSPERO registration numberCRD42020187756.

Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review

“… 27 In sub-Saharan Africa, there was moderate-grade evidence for integrated care models in primary care settings for people with cardiometabolic morbidity. 28 A Cochrane review of the interventions for multimorbidity published in 2021 could not make strong recommendations for the care of people with multimorbidity but suggested that organisational changes that target specific problems and align with outcomes of interest specific to the patient could be successful and that more research was needed. This review included 17 RCTs, all from HICs.…”