Effectiveness of interventions for the management of multimorbidity in primary care and community settings: systematic review and meta-analysis

BACKGROUND: Multimorbidity-the co-existence of two or more chronic health conditions in the same individual, without reference to an index condition-has become a global health issue and creates enormous pressure on the healthcare system. This review aimed to summarize evidence on the effectiveness of interventions used to manage people with multimorbidity.

METHODS: MEDLINE, EMBASE, CINAHL, Cochrane Library, two trials registers, and grey literature were searched for studies of adults with multimorbidity receiving care in primary or community care settings up to 30 September 2024. Two reviewers independently screened studies for eligibility, extracted data, and assessed risk of bias and study certainty. Interventions were categorized as medicines management (MM), support for self-management (SSM), or care coordination plus support for self-management (CC + SSM). Meta-analyses for primary outcomes (health-related quality of life, healthcare utilization, and healthcare costs) were conducted.

RESULTS: From 10 272 titles screened, 33 eligible studies (this review: 18, previous review: 15; MM: 6, SSM: 9, CC + SSM: 18) were identified, of which 26 studies with 9449 participants were included in meta-analysis. Overall, there was little significant evidence of benefit of the interventions compared with usual care for most outcomes. SSM was associated with lower hospitalization risk and medication costs, but slightly more emergency department (ED) visits; and CC + SSM with better SF-12 PCS score, lower hospitalization risk and fewer ED visits, but more outpatient and general practitioner visits.

CONCLUSION: This review found some suggestions of improved outcomes and reduced healthcare utilization (especially hospitalization) for these interventions. There is a paucity of evidence reporting on health outcomes, especially healthcare costs, in the management of multimorbidity.