{"doi":"10.1136/bmjopen-2023-073652","title":"Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis","abstract":"<jats:sec><jats:title>Objectives</jats:title><jats:p>This review aimed at identifying the elements of integrated care models for cardiometabolic multimorbidity in sub-Saharan Africa (SSA) and their effects on clinical or mental health outcomes including systolic blood pressure (SBP), blood sugar, depression scores and other patient-reported outcomes such as quality of life and medication adherence.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach.</jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p>We systematically searched PubMed, Embase, Scopus, Web of Science, Global Health CINAHL, African Journals Online, Informit, PsycINFO, ClinicalTrials.gov, Pan African Clinical Trials Registry and grey literature from OpenSIGLE for studies published between 1999 and 2022.</jats:p></jats:sec><jats:sec><jats:title>Eligibility criteria for selecting studies</jats:title><jats:p>We included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner’s chronic care model.</jats:p></jats:sec><jats:sec><jats:title>Data extraction and synthesis</jats:title><jats:p>Two independent reviewers used standardised methods to search and screen included studies. Publication bias was assessed using the Doi plot and Luis Furuya Kanamori Index. Meta-analysis was conducted using random effects models.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In all, we included 10 randomised controlled trials from 11 publications with 4864 participants from six SSA countries (South Africa, Kenya, Nigeria, Eswatini, Ghana and Uganda). The overall quality of evidence based on GRADE criteria was moderate. A random-effects meta-analysis of six studies involving 1754 participants shows that integrated compared with standard care conferred a moderately lower mean SBP (mean difference=−4.85 mm Hg, 95% CI −7.37 to −2.34) for people with cardiometabolic multimorbidity; Hedges’ g effect size (g=−0.25, (−0.39 to −0.11). However, integrated care compared with usual care showed mixed results for glycated haemoglobin, depression, medication adherence and quality of life.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Integrated care improved SBP among patients living with cardiometabolic multimorbidity in SSA. More studies on integrated care are required to improve the evidence pool on chronic care models for multimorbidity in SSA. These include implementation studies and cost-effectiveness studies.</jats:p></jats:sec><jats:sec><jats:title>PROSPERO registration number</jats:title><jats:p>CRD42020187756.</jats:p></jats:sec>","journal":"BMJ Open","year":2023,"id":618807,"datarank":0.519860385419959,"base_score":3.4657359027997265,"endowment":3.4657359027997265,"self_citation_contribution":0.519860385419959,"citation_network_contribution":0.0,"self_endowment_contribution":0.519860385419959,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":31,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":676620,"name":"Charles Agyemang","orcid":"0000-0001-7515-8214","position":1,"is_corresponding":false},{"id":768309,"name":"Hesborn Wao","orcid":"0000-0002-6823-0895","position":2,"is_corresponding":false},{"id":1051796,"name":"Elvis Omondi Achach Wambiya","orcid":"0000-0002-4149-3417","position":3,"is_corresponding":false},{"id":1596625,"name":"Maurine Ng’oda","orcid":null,"position":4,"is_corresponding":false},{"id":1596627,"name":"Daniel Mwanga","orcid":null,"position":5,"is_corresponding":false},{"id":1596630,"name":"James Oguta","orcid":null,"position":6,"is_corresponding":false},{"id":1595129,"name":"Peter Kibe","orcid":null,"position":7,"is_corresponding":false},{"id":426925,"name":"Gershim Asiki","orcid":"0000-0002-9966-1153","position":8,"is_corresponding":false},{"id":1480954,"name":"Peter Otieno","orcid":"0000-0001-6828-8301","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis","abstract":"<jats:sec><jats:title>Objectives</jats:title><jats:p>This review aimed at identifying the elements of integrated care models for cardiometabolic multimorbidity in sub-Saharan Africa (SSA) and their effects on clinical or mental health outcomes including systolic blood pressure (SBP), blood sugar, depression scores and other patient-reported outcomes such as quality of life and medication adherence.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach.</jats:p></jats:sec><jats:sec><jats:title>Data sources</jats:title><jats:p>We systematically searched PubMed, Embase, Scopus, Web of Science, Global Health CINAHL, African Journals Online, Informit, PsycINFO, ClinicalTrials.gov, Pan African Clinical Trials Registry and grey literature from OpenSIGLE for studies published between 1999 and 2022.</jats:p></jats:sec><jats:sec><jats:title>Eligibility criteria for selecting studies</jats:title><jats:p>We included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner’s chronic care model.</jats:p></jats:sec><jats:sec><jats:title>Data extraction and synthesis</jats:title><jats:p>Two independent reviewers used standardised methods to search and screen included studies. Publication bias was assessed using the Doi plot and Luis Furuya Kanamori Index. Meta-analysis was conducted using random effects models.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In all, we included 10 randomised controlled trials from 11 publications with 4864 participants from six SSA countries (South Africa, Kenya, Nigeria, Eswatini, Ghana and Uganda). The overall quality of evidence based on GRADE criteria was moderate. A random-effects meta-analysis of six studies involving 1754 participants shows that integrated compared with standard care conferred a moderately lower mean SBP (mean difference=−4.85 mm Hg, 95% CI −7.37 to −2.34) for people with cardiometabolic multimorbidity; Hedges’ g effect size (g=−0.25, (−0.39 to −0.11). However, integrated care compared with usual care showed mixed results for glycated haemoglobin, depression, medication adherence and quality of life.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Integrated care improved SBP among patients living with cardiometabolic multimorbidity in SSA. More studies on integrated care are required to improve the evidence pool on chronic care models for multimorbidity in SSA. These include implementation studies and cost-effectiveness studies.</jats:p></jats:sec><jats:sec><jats:title>PROSPERO registration number</jats:title><jats:p>CRD42020187756.</jats:p></jats:sec>","is_dataset_classified":null,"base_score":3.4657359027997265,"endowment":3.4657359027997265,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"37369405","pmcid":"PMC10410889","openalex_id":"https://openalex.org/W4382344214","authors":[],"funders":[{"funder_name":"Wellcome Trust","grant_id":"218462/Z/19/Z","title":null},{"funder_name":"Wellcome Trust","grant_id":"218462","title":"Wellcome Trust Doctoral Training Centre in Public Health, Economics and Decision Science (PHEDS): Assessing the effectiveness and cost-effectiveness of policies and prevention strategies that reduce noncommunicable disease burden and health inequity"},{"funder_name":"Joep Lange Institute","grant_id":"","title":null},{"funder_name":"Dutch Ministry of Foreign Affairs","grant_id":"","title":null}],"total_grants":4,"fwci":2.1006,"citation_percentile":0.89235516,"influential_citations":0,"citation_trend":[{"year":2024,"count":7},{"year":2025,"count":12},{"year":2026,"count":12}],"oa_status":"gold","license":"cc-by","oa_locations":[{"url":"https://bmjopen.bmj.com/content/bmjopen/13/6/e073652.full.pdf","host_type":"journal"},{"url":"https://bmjopen.bmj.com/content/bmjopen/13/6/e073652.full.pdf","host_type":"publisher"},{"url":"https://syndication.highwire.org/content/doi/10.1136/bmjopen-2023-073652","host_type":"publisher"},{"url":"https://doi.org/10.1136/bmjopen-2023-073652","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/37369405","host_type":"repository"},{"url":"https://eprints.whiterose.ac.uk/201852/1/Effectiveness%20of%20integrated%20chronic%20care%20models%20for%20cardiometabolic%20multimorbid.pdf","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/10410889","host_type":"repository"},{"url":"https://pure.amsterdamumc.nl/en/publications/e395d132-3b5e-4106-be55-7be697124437","host_type":"repository"},{"url":"https://doaj.org/article/8b40a579256f4c4ea301a86d4a3eb5b5","host_type":"repository"},{"url":"http://bmjopen.bmj.com/cgi/content/short/13/6/e073652","host_type":"repository"},{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC10410889/pdf/bmjopen-2023-073652.pdf","host_type":"repository"},{"url":"https://pure.amsterdamumc.nl/ws/files/150121963/Effectiveness-of-integrated-chronic-care-models-for-cardiometabolic-multimorbidity-in-sub-saharan-africa.pdf","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC10410889","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC10410889?pdf=render","host_type":"Europe_PMC"},{"url":"http://dx.doi.org/10.1136/bmjopen-2023-073652","host_type":""},{"url":"https://eprints.whiterose.ac.uk/id/eprint/201852/","host_type":""}],"fields_of_study":["Chronic Disease Management Strategies","Diabetes Management and Education","Primary Care and Health Outcomes","03 medical and health sciences","0302 clinical medicine","Humans","Quality of Life","Multimorbidity","Long-Term Care","Cardiovascular Diseases","Kenya"],"mesh_terms":["Multimorbidity","Cardiovascular Diseases","Humans","Kenya","Long-Term Care","Quality of Life"],"keywords":["Medicine","CINAHL","Meta-analysis","PsycINFO","Scopus","MEDLINE","Randomized controlled trial","Systematic review","Random effects model","Family medicine","Physical therapy","Internal medicine","Psychiatry","Psychological intervention","Hypertension","Primary Health Care","Self Care","Patient-centered Care","R","Multimorbidity","Cardiovascular Medicine","Long-Term Care","Kenya","Cardiovascular Diseases","Quality of Life","Humans"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Partnerships for the goals"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-03T05:18:51.789985Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}