Figure 1
The search results. PRISMA 2020 Flow Diagram detailing the identification of relevant articles. Abbreviations: n; number.
Table 1
Study Characteristics.
| TRIAL | DURATION AND FOLLOW-UP | STUDY PARTICIPANTS | SETTING | CONTROL | INTERVENTION | MDT MEETING DESCRIPTION | OUTCOMES | RESULTS |
|---|---|---|---|---|---|---|---|---|
| Counsell et al 2007 [25] | Intervention: 24 months Follow-up: 6, 12, 18 and 24 months | Aged ≥ 65, Annual income 200% < federal poverty level, comorbidities (n = 951) | Primary care practice serving approximately 6000 patients | Usual care (n = 477) | Geriatric care management model: GRACE intervention (n = 474) | Weekly interdisciplinary team meetings (nurse practioner, social worker, primary care physician) to review support team success in implementing care protocols and problem solve barriers to implementation | Physical health, Function health, Utilisation of health services, |
|
| Harpole et al 2005 [26] | Intervention: 12 months Follow-up: 3, 6, 12 months | Aged ≥ 60, Major depression or dysthymia and ≥ 1 other chronic condition. (n = 1801) | 18 primary care clinics | Usual care (n = 895) | IMPACT intervention (n = 906) | The district care nurse met weekly with the supervising psychiatrist and the liaison primary care physician to monitor progress and adjust treatment plans as needed | Mental health, Functional health |
|
| Katon et al 2010/2012 [23, 24] | Intervention: 24 months Follow-up: 6, 12, 18, 24 months | Depression and diabetes, or coronary heart disease, or both (n = 214) | 14 primary care clinics | Enhanced usual care (n = 108) | TEAMcare program (n = 106) | Nurses met weekly for systematic case reviews with the family physician, consulting psychiatrist and internist, to enhance care coordination and ensure accountability for follow-up to guideline level disease management and achieve clinical goals | Physical health, Mental health, Functional health, Provider behaviour, Acceptability of services, Costs and cost-effectiveness |
|
| Sommers et al 2000 [27] | Intervention: 24 months Follow-up: 12 months post-intervention | Aged > 65, ≥ 2 chronic conditions (n = 543) | 18 primary care clinics | Usual care (n = 263) | Collaborative Care (n = 280) | The physician, the nurse and the social worker met at least monthly to review each patient’s status and revise care plans. | Physical health, Functional health, Utilisation of health services, Costs and cost-effectiveness |
|
[i] Abbreviations: SF-36; short form survey 36, MDT; multidisciplinary team, ADL; activities of daily living, ED; emergency department, SCL-30; check list of symptoms 30, GRACE; geriatric resources for the assessment and care of elders, IMPACT; improving mood-promoting access to collaborative treatment, LDL; low-density lipoprotein, n; number of participants.
Table 2
Reporting of the 10 key features of multidisciplinary team meetings in primary care, when managing the care of individuals living with multimorbidity.
| FACTOR | DESCRIPTION | APPEARS IN STUDIES |
|---|---|---|
| Definition | Periodic gathering of different professionals who provide care for the multimorbid patients; for transdisciplinary discussion and adoption of clinical/and or organisational decisions | NR |
| Ideal setting | Meeting room (or another room with appropriate conditions) | NR |
| Duration | Less than 60 minutes, not exceeding 120 minutes in length | NR |
| Frequency | Every 2 weeks – dependant on number and complexity of multimorbid patients. Should not exceed a one-month interval | [23, 24, 25, 26, 27] |
| Number of participants | All the necessary players, considering the capacity of the room | [23, 24, 25, 26, 27] |
| Professional presence | Family physicians should always be present. Other health professionals should also be present: hospital doctors, nurses, social worker, psychologist, physiotherapist, pharmacist, and nutritionist. | [23, 24, 25, 26, 27] |
| Patient presence | Normally not, except if necessary to expose the clinical case or if the estimated treatment burden imposes the need for the patient’s presence to decide therapeutic options | [23, 24, 25, 26, 27] |
| Number of patient cases to address per meeting | Due to the complexity of the multimorbid patient, approach up to two clinical cases per meeting. This number will vary depending on the team’s experience in dealing with multimorbidity and the frequency and the duration of the meetings. | NR |
| Structure | A chairman of these meetings should be appointed to identify, leading the meeting. Each case should be presented by the family doctor or nurse, listing difficulties/doubts in management, followed by a discussion and a final definition of the consensus interventions. A facilitator is assigned. | NR |
| Dissemination | The results of the meeting regarding the management of the patients should be shared with all care providers in an effective and tailored way for each health professional, the patient, or their caregiver. | NR |
[i] The common themes between the studies reported regarding the multidisciplinary team meetings that took place within the intervention, sorted by the factors that contribute to an efficient multidisciplinary team meeting for patients with multimorbidity, based in primary care [22]. Abbreviations: NR; not reported.