Unclear evidence for chronic disease management interventions

Unclear evidence for chronic disease

Chronic diseases such as diabetes inflict a huge burden of suffering on patients and costs on health systems worldwide. Increasingly, health systems are being encouraged to take an integrated approach to their management.  This systematic rewiew looked at what sorts of interventions work best in these chronic disease management models.

Clinical question:

In the delivery of health care for chronic diseases, what interventions  are effective at improving patient outcomes, provider behaviour and cost-effectiveness?

The evidence

The reviewers looked for controlled trials of primary care and community interventions that specifically targeted patients more than one clinical condition.  They found ten randomised controlled trials (RCTs), with a total of 3,357 patients included.  Study duration ranged from eight weeks to two years.

The reviewers found that, due to lack of data,  they could not draw broad conclusions reflecting general health outcomes or costs.

Appraisal hints

Users of this research should consider:

  • Given the unclear conclusion of this review, it may be better to look for a good quality individual study that reports on an intervention that specifically relates to your setting.
  • The literature search was done in April 2011.  It is likely that relevant studies have been published since.
  • This is a difficult topic to search accurately for.  Did the reviewers use the right index terms and keywords, including synonyms and spelling variants?
  • They only searched medical and health care databases.  We might expect to find relevant publications in management science and social science databases.
  • It is likely, therefore, that the reviewers have missed important evidence.
  • The studies themselves were of variable quality.
  • Only one of the studies specifically looked at diabetes interventions, although in all but one of the other studies, diabetes would have included diabetes as one possible condition among patients identified as having multiple morbidities.


The full text of this systematic review is available from the Cochrane Library:

Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD006560. DOI: 10.1002/14651858.CD006560.pub2.

Douglas Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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