520 Mixed evidence on interventions for improving outcomes in patients with multimorbidity

August 30, 2017

written by Brian R McAvoy.

Clinical question
How effective are health-service or patient-oriented interventions designed to improve outcomes in patients with multimorbidity, in primary care and community settings?

Bottom line
Overall, the results regarding the effectiveness of interventions were mixed. There were no clear positive improvements in clinical outcomes, health service use, medication adherence, patient-related health behaviours, health professional behaviours or costs. There were modest improvements in mental health outcomes from 7 studies that targeted people with depression and in functional outcomes from 2 studies targeting functional difficulties in participants. Overall, the results indicate it is difficult to improve outcomes for people with multiple conditions. The review suggests interventions that are designed to target specific risk factors (for example, treatment for depression) or interventions that focus on difficulties people experience with daily functioning (for example, physiotherapy treatment to improve capacity for physical activity) may be more effective.

Caveat
The overall quality of these studies was good, although many studies did not fully report on all potential sources of bias. As definitions of multimorbidity varied among studies, the potential to reasonably combine study results and draw overall conclusions was limited.

Context
Many people with a chronic health problem or condition have more than one condition, referred to as multimorbidity. Little is known about the effectiveness of interventions to improve outcomes for people with multimorbidity.

Cochrane Systematic Review
Smith SM et al. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Reviews, 2016, Issue 3. Art. No.: CD006560.DOI: 10.1002/14651858. CD006560.pub2. This review contains 18 studies involving 8,727 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.