慢性疾患のための共有医療予約を理解する

タイトル: Effectiveness of shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials

概要: ObjectivesShared medical appointments (SMAs) have the potential to address interlinked challenges of limited capacity in primary healthcare and rising prevalence of patients with multiple long-term conditions (LTCs). This review aimed to examine the effectiveness of SMAs compared to one-to-one appointments in primary care at improving health outcomes and reducing demand on healthcare services. MethodsWe searched for randomised controlled trials (RCTs) of SMAs involving patients with LTCs in primary care across six databases from 2013-2020 and added eligible papers identified from previous relevant reviews. Data were extracted and outcomes narratively synthesised, meta-analysis was undertaken where possible. ResultsTwenty-three unique trials were included. SMA models varied in terms of components, mode of delivery and target population. Most trials recruited patients with a single LTC, most commonly diabetes (n=12), although eight trials selected patients with multiple LTCs. There was substantial heterogeneity in outcome measures which we categorised into health outcomes (biomedical indicators, psychological and well-being measures), healthcare utilisation, and cost and resource use. Meta-analysis showed that participants in SMA groups had lower diastolic blood pressure than those in usual care (d=-0.123, 95%CI = - 0.22, -0.03, n=8). No statistically significant differences were found across other outcomes. Compared with usual care, SMAs had no significant effect on healthcare service use. ConclusionsSMAs were at least as effective as usual care in terms of health outcomes and did not lead to increased healthcare service use in the short-term. To strengthen the evidence base, future studies should target standardised behavioural and health outcomes and clearly report SMA components so key behavioural ingredients can be identified. Similarly, transparent approaches to measuring costs would improve comparability between studies. To better understand SMAs potential to reduce demand on healthcare services, further investigation is needed as to how SMAs can be best incorporated in the patient care pathway. PROSPERO protocol registrationCRD42020173084 299/300 STRENGTHS AND LIMITATIONSO_LIFocus on randomised controlled trials, highest quality evidence of the effectiveness of SMAs in primary care for long term conditions C_LIO_LIRobust search strategy, based on previous high-quality review; refined by information specialists to focus on primary care C_LIO_LIRapidly evolving area of practice and publications and the most recent evidence may be missing. C_LIO_LISmall number of studies reported resource use and costs limiting conclusions regarding efficacy of SMAs in primary care. C_LI FUNDINGThis paper is independent research commissioned and funded by the NIHR PRU in Behavioural Science (Award: PR-PRU-1217-20501). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arms length bodies, and other Government Departments. The funders had no role in the design of the study, collection, analysis or interpretation of data or in the writing of the manuscript. COMPETING INTERESTSNone to declare. CHECKLISTSee supplementary material for PRISMA checklist.