Models of comprehensive care for older persons with chronic diseases: a systematic review with a focus on effectiveness

Abstract

IntroductionAgeing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services. The care models implemented by health systems should provide comprehensive long-term healthcare. We conducted this systematic review to determine whether any model of care for older persons have proven to be effective.MethodsA systematic review of literature was carried out to identify randomised clinical trials that have assessed how effective a care model for older patients with chronic diseases. A searches electronic databases such as MEDLINE, Turning Research Into Practice Database, Cochrane Library and Cochrane Central Register of controlled Trials was conducted from January 1966 to January 2021. Two independent reviewers assessed the eligibility of the studies. Interventions were identified and classified according to the taxonomies developed by the Cochrane Effective Practice and Organisation of Care and Cochrane Consumers and Communication groups.ResultsOf the 4952 bibliographic references that were screened, 577 were potentially eligible and the final sample included 25 studies that evaluated healthcare models in older people with chronic diseases. In the 25 care models, the most frequently implemented interventions were educational, and those based on the provision of healthcare. Only 22% of the outcomes of interventions were identified as being effective, whereas 21% were identified as being partially effective; thus, more than 50% of the outcomes were identified as being ineffective.ConclusionsIt was not possible to determine a care model as effective. The interventions implemented in the models are variable. The most effective outcomes were focused on improving the patient–healthcare professional relationship in the early stages of the intervention. The interventions addressed in the studies were similar to public health interventions as their main objectives focused on promoting health. Most studies were of low methodological quality.

Development, successes, and potential pitfalls of multidisciplinary chronic disease management clinics in a family health team: a qualitative study

“…Yet, the optimal approach to the provision of such care to older persons remains to be determined. A systematic review identified twenty-five different care models, over half of which were ineffective, and only five of which explicitly addressed interprofessional or multidisciplinary practice [ 22 ]. Our study findings show how emphasizing work-place collegiality allows professionals to define their clinical roles more clearly within a primary care practice, which is essential to ensure mutual accountability and provide quality care that meets patient needs [ 23 , 24 ].…”

“…Our finding of internal care fragmentation within one family practice setting following the development of multiple clinics for complex chronic diseases is novel. In the aforementioned systematic review, most programs targeted a limited aspect of health promotion for patients with hypertension, diabetes, arthritis, pain and COPD, and few addressed the comprehensive care of patients with more complex conditions [ 22 ]. Primary care practices have finite resources with which they must support the needs of a wide spectrum of individuals from “cradle to death”.…”

Effects of an integrated ambulatory care program on healthcare utilization and costs in older patients with multimorbidity: a propensity score-matched cohort study

“…Although there is a widespread belief that integrated care can control or reduce healthcare utilization and related costs, relatively few studies have evaluated the economic impact of integrated care approaches [ 8 , 11 – 14 ]. Earlier studies suggested that integrated care is cost-effective [ 13 ] and is likely to reduce costs and improve healthcare outcomes [ 12 ].…”

“…Earlier studies suggested that integrated care is cost-effective [ 13 ] and is likely to reduce costs and improve healthcare outcomes [ 12 ]. However, a recent systematic review of randomized clinical trials assessing the effectiveness of integrated models for older patients with chronic diseases in 2022 found that interventions implemented in the models are varied, and it was not possible to determine a single care model as effective [ 11 ]. The present body of literature is inconclusive regarding the potential economic impact of integrated care.…”

“…Nevertheless, little is known about the impact of integrated care, particularly outpatient-based interventions, on healthcare utilization and costs among older patients with multimorbidity in Asian countries. In four recent systematic reviews on the effectiveness of integrated care models that included 252 studies [ 8 , 11 , 12 , 14 ] only two were conducted in Asia [ 18 , 19 ]. Lin et al identified 23 integrated care programs in 7 Asian countries; however, only one examined outpatient attendance changes, and only four examined cost changes, indicating that more research is needed for the development of integrated care programs [ 20 ].…”