Table 1.
Characteristics of studies included in systematic reviews
| Study | Study participants | Duration and follow-up | Intervention elements; (theoretical framework, where specified) | Outcomes | Results (primary outcomes, where specified): intervention versus control |
|---|---|---|---|---|---|
| Predominantly organisational interventions: | |||||
| Bognor 200830 | Aged >50, depression and hypertension (n=64) | Intervention six weeks, follow-up two weeks later | Care manager, structured visits, telephone contact, and patient care plans (adherence based model) | Depression scores (CES-D score); systolic blood pressure; drug adherence | CES-D score 9.9 v 19.3, P=0.006; systolic blood pressure (mm Hg) 127.3 v 141.3, P=0.003; ≥80% adherence to antidepressants 23% v 10%, P=0.001, ≥80% adherence to antihypertensives 25% v 10%, P<0.001 |
| Boult 201122 | Aged >65, multiple conditions and high service use (n=904) | Intervention 18 months, follow-up at six and 18 months | Organisational: guided care nurse managers, enhanced multidisciplinary team, home assessments and monthly monitoring, patient care plans. Professional: education of nurse managers. Patient: self management support | Primary outcome: health service use hospital admissions, nursing facility use, visits, and home healthcare episodes. Secondary outcomes: quality of chronic care (PACIC) scores | Adjusted intervention:control ratio of service use: hospital 30 day readmissions 1.01 (95% CI 0.83 to 1.23); hospital days 0.79 (0.53 to 1.16); skilled nursing facility admissions 1.00 (0.77 to 1.30); skilled nursing facilities days 0.92 (0.6 to 1.4); emergency department visits 0.84 (0.48 to 1.47); primary care visits 1.04 (0.81 to 1.34); speciality care visits 1.02 (0.91 to 1.14); home healthcare episodes 1.07 (0.93 to 1.23); (PACIC) scores 0.70 (0.53 to 0.93) |
| Hogg 200826 | Aged >50, at least two conditions and at risk of experiencing adverse outcome (n=241) | Intervention 15 months, follow-up on completion of intervention | Enhanced multidisciplinary team with structured home visit, drug review, and patient care plans | Primary outcome: chronic disease management score. Secondary outcomes included preventive care delivery score, physical health outcomes, health service use, psychosocial measures, quality of life, and activities of daily living | Difference in chronic disease management score after intervention 0.091 (95% CI 0.037 to 0.144) |
| Katon 201031 | Depression and diabetes or coronary heart disease, or both (n=214) | Intervention 12 months, follow-up at 12 months | Organisational: TEAMcare nurses, structured visits, patient care plans and treatment targets, weekly team meetings, and use of electronic registry to track patient progress. Professional: education of nurse managers. Patient: support for self care (behavioural activation theory) | Primary outcomes: depression scores (SCL-20); diabetes (glycated haemoglobin); systolic blood pressure; and low density lipoprotein cholesterol. Secondary outcomes: increases in drug adjustments, quality of life, and satisfaction with care | Adjusted between group difference (95% CI): depression scores SCL-20) −0.41 (−0.56 to −0.26); glycated haemoglobin −0.56% (−0.85% to −0.27%); systolic blood pressure (mm Hg) −3.4 (−6.9 to 0.1); low density lipoprotein cholesterol (mg/dL) −9.1 (−17.5 to −0.8) |
| Krska 200127 | Aged >65, at least two conditions (n=332) | Intervention three months, follow-up three months after drug review | Senior care connections: structured visit with pharmaceutical patient care plan created by pharmacist and implemented by practice team | Primary outcome: pharmaceutical care issues. Secondary outcomes: medicine costs, quality of life, and health service use | Pharmaceutical care issues (%) resolved after intervention: 82.7% v 41.2%, P<0.001 |
| Sommers 200029 | Aged >65, at least two conditions (n=543) | Intervention two years, follow-up 12 months after intervention | Organisational: enhanced multidisciplinary team including social worker, home assessment, and patient care plans, professional: training of care coordinators | Health service use including admissions, office visits, emergency department visits, home care visits, and nursing home visits. Patient reported health status: social activities count, quality of life, depression scores, nutrition checklists, and drug adherence | Odds ratio admissions/patient/year 0.63 (95% CI 0.41 to 0.96); ≥1 60 day readmissions 0.26 (0.08 to 0.84). Not fully reported for seven other outcomes, non-significant for six. Difference in adjusted mean scores, social activities count 0.50 (95% CI 0.02 to 1.00). Symptom scale 0.50 (−3.20 to 0.16), SF-36 self rated health 0.10 (−0.27 to 0.02), not reported for four other outcomes, non-significant |
| Predominantly patient oriented: | |||||
| Eakin 200723 | Multimorbidity defined as at least two conditions (n=175) (data for multimorbidity group from authors) | Intervention 16 weeks, follow-up six months after intervention | Patient: self management support, diet, and exercise intervention delivered by health educator; organisational: structured visits and telephone contact (chronic care model: patient self management) | Dietary behaviour, support for healthy lifestyles, and physical activity | Adjusted mean (SE): dietary behaviour (lower score better) 2.20 (0.05) v 2.41 (0.05), P<0.5; support for healthy lifestyle (higher score better) 2.98 (0.06) v 2.68 (0.06), P<0.05; change minutes walking/week 8 (22) v −10 (27), P>0.5 |
| Gitlin 200624 32 | Aged >70, multiple conditions and reported difficulties with activities of daily living (n=319) | 12 months intervention, follow-up at completion of intervention, four year mortality follow-up | Patient (Advancing Better Living for Elders, ABLE): occupational therapy and physiotherapy home based intervention including balance and muscle strengthening and fall recovery techniques, patient: problem solving techniques (lifespan theory of control) | Primary outcomes: functional difficulty (activities of daily living, activities of daily living, instrumental activities of daily living, and mobility), self efficacy and fear of falling (self efficacy for falls). Secondary outcomes: adaptive strategy use and presence of home hazards. Four year follow-up: mortality | Difference in adjusted means at 12 months: activities of daily living −0.10 (95% CI −0.21 to 0.02); instrumental activities of daily living −0.12 (−0.26 to 0.03); mobility −0.14 (−0.29 to 0.01); overall self efficacy 0.09 (−0.06 to 0.23); fear of falling 0.56 (0.15 to 0.97); mortality at two years 5.6% (9 deaths) v 13.2% (21 deaths), P=0.02. Mortality at four years no significant difference, intervention increased survivorship by 3.5 years |
| Hochhalter 201025 | Aged >65, at least two of seven chronic conditions (n=79) | Intervention three months, follow-up three months after intervention | Patient engagement intervention led by “coaches” with focus on making most of healthcare (chronic care model: patient self management) | Primary outcome: patient activation measure. Secondary outcomes: total unhealthy days, self efficacy, and self rated health | Patient activation measure: reported as no significant difference between intervention and control at follow-up |
| Lorig 199928 | Aged >40, at least two of heart disease, lung disease, arthritis, or stroke (n=536) (subgroup of patients with comorbidities) | Intervention seven weeks, follow-up at six months | Patient (weekly community based meetings led by trained volunteer lay leaders focusing on self management and peer support) (Bandura’s self efficacy theory) | Health service use: admissions, emergency department plus visits to physician. Health behaviours: four measures. Health status: eight measures | Adjusted mean difference (SD). Number of admissions 0.19 (0.73) v 0.33 (1.2), P<0.5; nights in hospital 1.05 (6.3) v 2.1 (6.8), P<0.5; number of physician visits 4.96 (6.1) v 6.87 (7.2), P>0.5. Significance of 12 measures relating to health behaviours and health status in comorbidity subgroup not reported |