Abstract
Purpose (the aim of the study): Ostoearthritis (OA) is commonly comorbid with other long-term conditions (LTCs), increases the subsequent risk of developing comorbid LTCs, and exacerbates both the costs and the detriments of those LTCs. This meta-analysis of clinical trial data aimed to summarise evidence on the effectiveness of interventions used to improve the health outcomes of people with multimorbidity, compared to usual care.
Methods: We searched the MEDLINE, EMBASE and CINAHL databases, the Cochrane Library, two trials registers, and grey literature for articles published up to October-2023. Studies of adults with multimorbidity receiving care in primary or community care setting were included. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias and study certainty with the GRADE approach. Interventions were categorised as care coordination plus support for self-management (CC+SSM), support for self-management (SSM), or medicines management (MM). Our primary outcomes were health-related quality of life (HRQoL), healthcare utilisation, and healthcare costs. Narrative synthesis and meta-analysis for primary outcomes were conducted.
Results: A total of 34 articles with 12,508 patients were included: 18 studies of CC+SSM intervention, nine of SSM, and seven of MM. Compared to usual care, CC+SSM was associated with a lower rate of hospitalisation (OR=0.56, 95%CI 0.39–0.81, low certainty) and total length of hospital stay (–0.26days/year, 95% CI –0.51 to –0.01, moderate certainty), and slightly better HRQoL (measured by SF-12 PCS score; MD 0.8, 95%CI:0.2–1.4, moderate certainty), but slightly higher total healthcare costs (USD 1944/year, 95% CI 132–3755, moderate certainty). SSM was associated with reduction in hospital stay (–5.0days/year, 95%CI: –8.9 to –1.0, moderate certainty), and outpatient visits (–3.4/year, 95%CI: –4.7 to –2.1, moderate certainty). MM was associated with slightly better utility score (0.03, 95%CI:0.001–0.05, low certainty).
Conclusions: Our findings suggest that these interventions were variably associated with some evidence of improved health outcomes and reduced healthcare utilisation, especially on hospitalisation. There is little and variable evidence for reducing healthcare costs.