Effectiveness of Person-centred Integrated Care for Community-dwelling People With Hypertension and Diabetes in High-income Countries: Protocol for a Systematic Review and Meta-analysis

Abstract

Background: Hypertension and diabetes are two of the high prevalent non-communicable diseases. Inadequate care coordination among health systems and between health professionals as well as limited self-care capability of patients lead to the suboptimal care for people with hypertension and diabetes. Person-centred integrated care aiming to address these three levels of barriers has been proposed by World Health Organization as a global strategy to enhance the quality of care for people with chronic diseases. However, the effectiveness and characteristics of integrated care for community-dwelling people with hypertension and diabetes has not been systematically assessed.Methods: A systematic literature search will be conducted in seven databases including MEDLINE, Emcare, CINAHL, EMBASE, Cochrane Library of systematic reviews, Scopus and ProQuest. Additional studies will be identified through manual searching of reference lists and grey literatures. Quantitative studies (e.g. randomized controlled trials, quasi-randomized trials, before-and-after studies) evaluating the effects of integrated care for community-dwelling people with hypertension and diabetes will be included. Primary outcomes will be systolic and diastolic blood pressure. Secondary outcomes will include the proportion of patients achieving target blood pressure, glycated haemoglobin, fasting blood glucose, blood lipid, treatment adherence, health knowledge, mortality, quality of life, hospitalisation, emergency department use, patient satisfaction, adverse events and caregiver burden. Two reviewers will independently screen articles, extract data and assess study quality. Methodological quality of the selected studies will be assessed using the Revised Cochrane risk-of-bias tool and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Disagreements will be resolved through team discussion. Random effects model will be used for data synthesis if feasible.Discussion: This systematic review will summarise the evidence regarding the overall effectiveness, core components and implementation mechanism of integrated care interventions for people with hypertension and diabetes. Findings from the review will provide crucial evidence to inform the development of health policy, clinical practice and health resources to relieve the burden of hypertension and diabetes on healthcare systems.Registration: The protocol is registered with PROSPERO (registration number CRD42021271338)