Open AccessMultidisciplinary collaborative care in the management of patients with uncontrolled diabetes: A systematic review and meta‐analysis
Author(s) -
Siaw Melanie Yee Lee,
Lee Joyce YuChia
Publication year - 2019
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.13288
Subject(s) - medicine , collaborative care , multidisciplinary approach , cinahl , psychological intervention , health care , meta analysis , medline , diabetes mellitus , intensive care medicine , family medicine , nursing , primary care , social science , endocrinology , sociology , political science , law , economics , economic growth
Summary Background Diabetes is a chronic and complex disease that requires a multidisciplinary collaborative care approach. Objective The primary objective was to evaluate the clinical outcomes of patients with uncontrolled diabetes within a multidisciplinary collaborative care model. The secondary objective was to evaluate the humanistic and economic outcomes of this model of care. Methods A search using PubMed, SCOPUS , and CINAHL from 2007 to 2017 was conducted. Articles selected included randomised controlled studies on multidisciplinary collaborative care (defined as care provision by ≥ two different care providers) vs usual care (defined as standard care provided solely by physicians) for patients with uncontrolled diabetes. In addition, the eligible article had to report at least two of the three outcomes such as clinical (glycated haemoglobin [HbA1c], systolic blood pressure [ SBP ], low‐density lipoprotein [ LDL ], and triglyceride [ TG ]), humanistic (patient‐reported measures), and economic (healthcare costs and utilisations) outcomes. Parameters examined included study characteristics, care interventions, patient characteristics, and study outcomes. Primary outcomes using mean differences ( MD s) with 95% confidence intervals ( CI s) were analysed either by fixed‐ or random‐effects models. Results A total of 16 studies were included in the review. Multidisciplinary collaborative care significantly improved HbA1c ( MD = –0.55%, 95% CI = –0.65% to –0.45%, P < 0.001, I 2 = 35%) and SBP ( MD = –4.89 mm Hg, 95% CI = –6.64 to –3.13 mm Hg, P < 0.001, I 2 = 46%) over 3‐12 months. The humanistic outcomes in the multidisciplinary collaborative care model were either improved or maintained over time. In comparison to usual care, the healthcare costs and utilisations in the multidisciplinary collaborative care model were comparable without incurring excessive costs. Conclusions Multidisciplinary collaborative care appeared to positively impact on the clinical, humanistic, and economic outcomes of patients with uncontrolled diabetes.