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Table 2 Study phase and results of the included studies

From: Primary care team and its association with quality of care for people with multimorbidity: a systematic review

Studies

Study phase

Results

Aragonès, et al. 2019, Spain [34]

12 months

Clinical outcome measures: Severity of depression score, 0.23 points lower (1.11 vs. 1.34; 95%CI -0.42–0.04); Response rate to antidepressant treatment,18.9% higher (39.6% vs. 20.7%; OR = 2.74; 95% CI 1.12–6.67); Remission rate for depression, 9.0% higher (20.1% vs. 11.1%; OR = 2.13; 95%CI 0.94–4.85); Pain severity, pain response rate: no significant difference

Patient-reported measures, behavior measures, process measures: none

Chen, et al. 2010, USA [35]

12 months

Clinical outcome measures: BMI: + 85.0% compared with baseline (P < 0.001)

Patient-reported measures, behaviors measures: none

Process measures: Self-management plan made, + 35.6% compared with baseline (P < 0.001); Assessing smoking status, + 82.8% compared with baseline (P < 0.001); Testing for LDL, -5.8% lower compared with controls (P < 0.001)

Freund, et al. 2016, Germany [37]

24 months

Clinical outcome measures: Quality of life, 1.16 (95% CI 0.24–2.08) on SF-12 physical component and 1.68 (95% CI 0.60–2.77) on SF-12; Mental component improved significantly at 24 months; General health, EQ-5D, 0.03 (95%CI,0.00–0.05) improved significantly at 24 months; All-cause hospitalizations, no significant difference

Patient-reported measures, behaviors measures, process measures: none

Coventry, et al. 2015, UK [36]

4 months

Clinical outcome measures: Mean depressive scores, 0.23 SCL-D13 points lower (95% CI -0.41–0.05); Anxiety, a reduction of 1.45 points (95%CI -2.45–0.56) on the GAD-7;

Patient-reported measures: Satisfaction with care, more patient centered, total score on PACIC (2.37 (SD 1.0) vs 1.98 (SD 0.9); More satisfied with care, total score on CSQ (2.90 (SD 0.6) vs 2.62 (SD 0.6)); Self-efficacy, illness-perceptions, disability, social support, no significant difference

Behaviors measures: Self-management, better in self-management

Process measures: none

Jan, et al. 2021, China [38]

1 year

Clinical outcome measures: Hospitalization, lower for COPD/asthma (OR = 0.91, 95% CI 0.87–0.94, in 2015) and for diabetes or its complications (OR = 0.87, 95% CI 0.83- 0.92, in 2015)

Patient-reported measures, behaviors measures, process measures: none

Katon, et al. 2004, USA [52]

12 months

Clinical outcome measures: HbA1c levels, no significant difference; Depression severity, less severity over time (P = 0.004);Adequacy of dosage of antidepressant medication treatment, greater improvement in the first 6-month period (OR = 4.15, 95%CI 2.28–7.55) and the second 6-month period (OR = 2.90, 95%CI 1.69–4.98)

Patient-reported measures: Satisfaction with care, higher at 6 months (OR = 2.01, 95% CI 1.18–3.43) and 12 months (OR = 2.88, 95% CI 1.67- 4.97); Patient-rated global improvement, higher at 6 months (intervention 69.4% vs usual care 39.3%, OR = 3.50, 95%CI 2.16–5.68) and 12 months (intervention 71.9% vs usual care 42.3%, OR = 3.50, 95% CI 2.14–5.72)

Behaviors measures, process measures: none

Katon, et al. 2010, USA [40]

12 months

Clinical outcome measures: Glycated hemoglobin levels (difference, 0.58%); LDL cholesterol levels (difference, 6.9 mg per deciliter (0.2 mmol per liter)); Systolic BP (difference, 5.1 mm Hg); SCL-20 depression scores (difference, 0.40 points) (P < 0.001); Better quality of life (P < 0.001)

Patient-reported measures: Greater satisfaction with care for diabetes, coronary heart disease, or both (P < 0.001) and with care for depression (P < 0.001)

Behaviors measures: none

Process measures: More likely to have adjustments of insulin (P = 0.006), antihypertensive medications (P < 0.001), antidepressant medications (P < 0.001)

Lin, et al. 2012, USA [41]

12 months

Clinical outcome measures, patient-reported measures: none

Behaviors measures: No significant difference of medication adherence at 12 months

Process measures: Monitoring BP and glucose more frequently, RR = 1.28 (P = 0.006); Antihypertensive medications initiation and adjustment, RR = 1.86, (P < 0.001); Insulin initiation and adjustment, RR = 2.97, (P < 0.001); Anti-depressants initiation and adjustment, RR = 6.20, (P < 0.001)

Morgan, et al. 2013, Australia [42]

12 months

Clinical outcome measures: Mean depression scores, after 6 months of intervention for patients with moderate-to-severe depression decreased by 5.7 ± 1.3 compared with 4.3 ± 1.2 in control, a significant (p = 0.012) difference

Patient-reported measures: none

Behaviors measures: Exercise, increased by 19% (not change in the control practice); Visits to mental health workers, increased by 17% (decreased by 3%)

Process measures: Referrals to exercise program increased by 16% (decreased by 5%); Referrals to mental health workers increased by 7% (increased 12%)

Petersen, et al. 2019, South Africa [43]

12 months

Patient-reported measures: PHQ-9: patients with depressive symptoms having more than a 50% reduction in PHQ-9 scores were greater in the treatment group (n = 69, 55.2%) compared to the comparison group (n = 49, 23.4%) at 3 months (RR = 2.10, p < 0.001); 12 months follow-up (intervention: n = 57, 47.9%, comparison, n = 60, 30.8%, RR = 1.52, p = 0.006); Remission (PHQ-9 ≤ 5) was greater in the intervention group (n = 32, 26.9%) than comparison group (n = 33, 16.9%) at 12 months (RR = 1.72, p = 0.016)

Clinical outcome measures, behaviors measures: none

Process measures: Increased identification in depression, (5.8 to 16.4%, 95%CI, 2.9–19.1) and AUD (0–13.8%, 95%CI, 0.6–24.9)

Petersen, et al. 2021, South Africa [44]

12 months

Patient-reported measures: Proportion of patients with at least 50% reduction in PHQ-9 scores at 6 months, no significant difference, (N = 256/456 vs N = 232/492), (55.9% vs 50.9%, RR-0.04, 95%CI, -0.19–0.11, p = 0.6)

Clinical outcome measures, behaviors measures: none

Salisbury, et al. 2018, UK [45]

15 months

Clinical outcome measures: Number of deaths, illness burden, number of hospital admissions or outpatient attendances, no evident of difference; Quality of life, no difference in the primary outcome of quality of life (adjusted difference in mean EQ-5D-5L 0.00, 95%CI, –0.02–0.02; p = 0.93)

Patient-reported measures, behaviors measures: none

Process measures: Patient-centered care, all measures of patient-centered care showed benefits from the intervention after 15 months; Process of care, a significant difference in the Continuity of Care Index; Quality of disease management and number of indicators of high-risk prescribing, no evident of a difference; Consultations, more nurse consultations and more primary care physician consultations over 15 months in the intervention group, no evidence of difference

Sharpe, et al. 2014, UK [46]

12 months

Clinical outcome measures: Less depression, anxiety, pain, and fatigue; Better functioning, overall health, quality of life (all p < 0.05) Treatment response (at least a 50% reduction in depression severity from baseline on the self-rated SCL-20); The primary outcome of treatment response was achieved by 62% (143/231) of participants allocated to depression care for people with cancer and 17% (40/231) of those allocated to usual care; The absolute difference in outcome between the treatment groups was 45% (95% CI 37–53%); The OR for the treatment response in the two groups was 8.5 (95% CI, 5.5–13.4, p < 0.0001)

Patient-reported measures: better perceived quality of depression care at all timepoints (p < 0.05)

behaviors measures, process measures: none

Towfighi, et al. 2021, USA [47]

12 months

Clinical outcome measures: Mean systolic BP, improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mmHg at 12 months in the usual care group, with no differences in the change between groups; Serum CRP level: greater improvements in CRP level (difference in log CRP =  − 0.4, 95%CI − 0.7- − 0.1, P = 0.003); LDL, HbA1c, BMI, no differences;

Patient-reported measures: none

Behaviors measures: reduced consumption in self-reported salt intake (difference, 15.4, 95% CI 4.4–26.0, P = 0.004); Antithrombotic adherence, physical activity level, diet, smoking status, no differences

Process measures: none

Walker, et al. 2014, UK [53]

32 weeks

Clinical outcome measures: Self-rated depression improvement, anxiety, quality of life, role functioning, perceived quality of care, all improved in the treatment group;

Patient-reported measures: Average depression severity, significantly lower in patients allocated to depression care for people with lung cancer (mean score on the SCL-20 1.24 (SD 0·64)) than in those allocated to usual care (mean score 1.61 (SD 0.58)), difference = –0·38 (95% CI –0.58- –0.18), difference = –0.62 (95% CI –0.94- –0.29)

Behaviors measures, process measures: none

Wolff, et al. 2021, USA [49]

12 months

Clinical outcome measures: Significantly lower HbA1c (β =  − 0.14, P = 0.02) at 12 months; Significantly lower PHQ-9 scores (β =  − 0.39, P = 0.03) at 12 months; BP, quality of life, no significant difference

Patient-reported measures, behaviors change, process measures: none

Wood, et al. 2008, USA [50]

1 year

Clinical outcome measures: BP, target of less than 140/90 mm Hg was attained by both coronary (615 (65%) vs 547 (55%), difference = 10.4%, 95%CI 0.6–20.2, p = 0.04) and high-risk (586 (58%) vs 407 (41%), difference = 16.9%, 95%CI 2.0–31.8, p = 0.03)

patient-reported measures: Total cholesterol of less than 5 mmol/L did not differ between groups; in high-risk patients the difference in change from baseline to 1 year was 12.7% (95%CI 2.4- 23.0, p = 0.02) in favor of INT

Behaviors measures: no difference in those who did not smoke 1 year afterwards (difference = 10.4%, 95% CI − 0.3–21.2, p = 0.06); reduced consumption of saturated fat (196 (55%) vs 168 (40%), 17.3%, 6.4 to 28.2, p = 0.009); increased consumption of fruit and vegetables (680 (72%) vs 349 (35%), 37.3%, 18.1 to 56.5, p = 0.004), and oily fish (156 (17%) vs 81 (8%), 8.9%, 0.3 to 17.5, p = 0.04) at 1 year; High-risk individuals and partners showed changes only for fruit and vegetables (p = 0.005)

Process measures: higher prescriptions for statins in the hospitals (difference = 6.0%, 95%CI − 0.5–11.5, p = 0.04); more frequent prescribed for angiotensin-converting enzyme inhibitors (difference = 8.5%, 95%CI 1.8–15.2, p = 0.02) and statins (difference = 14.6%, 95%CI 2.5–26.7, p = 0.03)