TY - JOUR
T1 - Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa
T2 - a systematic review and meta-analysis
AU - Otieno, Peter
AU - Agyemang, Charles
AU - Wao, Hesborn
AU - Wambiya, Elvis
AU - Ng'oda, Maurine
AU - Mwanga, Daniel
AU - Oguta, James
AU - Kibe, Peter
AU - Asiki, Gershim
N1 - Funding Information: This systematic review was supported by funding from the Joep Lange Institute and in part by the Dutch Ministry of Foreign Affairs under the Joep Lange Chairs and Fellows Program. JO and AW are funded by Wellcome Trust (218462/Z/19/Z) doctoral training grant to the University of Sheffield. The funders had no role in the design of the study and collection, analysis and interpretation of data and in writing the manuscript. Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
PY - 2023/6/27
Y1 - 2023/6/27
N2 - Objectives This 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. Design Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Data sources We 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 studies We included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner's chronic care model. Data extraction and synthesis Two 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. Results In 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. Conclusion Integrated 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 number CRD42020187756.
AB - Objectives This 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. Design Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Data sources We 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 studies We included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner's chronic care model. Data extraction and synthesis Two 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. Results In 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. Conclusion Integrated 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 number CRD42020187756.
KW - hypertension
KW - patient-centered care
KW - primary health care
KW - self care
UR - http://www.scopus.com/inward/record.url?scp=85164211588&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bmjopen-2023-073652
DO - https://doi.org/10.1136/bmjopen-2023-073652
M3 - Article
C2 - 37369405
SN - 2044-6055
VL - 13
JO - BMJ Open
JF - BMJ Open
IS - 6
M1 - e073652
ER -