Abstract
Introduction: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus. Evidence suggests that physician-centred model care models alone are often unable to address all care needs of patients. To meet specific care needs of patients, there has been a shift towards incorporating multidisciplinary teams into primary care system to provide a high-quality integrated care that is patient-centred. However, the direct impact and optimal components of multidisciplinary collaborative care in CVD risk factors of diabetes in primary care remain unclear. To address the research gap, this study aimed to systematically assess the effectiveness of multidisciplinary collaboration on cardiovascular risk factors for people with diabetes in primary care settings.
Methods: Five databases (Medline, Embase, CINAHL, SCOPUS and CENTRAL) were systematically searched. Studies were eligible for inclusion if they (1) focused on adult patients with a diagnosis of type 2 diabetes; (2) evaluated an intervention implemented by a multidisciplinary team composed of at least three health disciplines; (3) were conducted in primary care settings; (4) reported cardiovascular risk factors as outcomes; (5) used a randomised controlled trial study design; and (6) published in the English language between January 1995 and March 2023. Two authors independently screened articles and extracted data from eligible studies. Random-effects model was used to calculate the pooled effects.
Results: Nineteen studies containing 6538 patients were identified. Mean age was 59.6 years and 53.4% were male. Meta-analysis demonstrated that, compared with usual care, multidisciplinary collaborative care significantly reduced CVD risk factors including mean systolic blood pressure (-3.27 mm Hg, 95% confidence interval (CI): -4.72 to -1.82, p<0.01), diastolic blood pressure (-1.4 mm Hg, 95% CI: -2.32 to -0.47, p<0.01), HbA1c (-0.42%, 95% CI: -0.59 to -0.25, p<0.01), low-density lipoprotein (-0.16 mmol/L, 95% CI: -0.26 to -0.06, p<0.01), and high-density lipoprotein (0.06 mmol/L, 95% CI: 0.01 to 0.13, p<0.05). Subgroup analysis showed multidisciplinary collaborative care were more effective in reducing cardiovascular risk factors when it comprised more different disciplines, combined pharmacological and non-pharmacological components, included both face-to-face and remote interactions, or was implemented in high-income countries.
Conclusion: This systematic review and meta-analysis found robust evidence that a multidisciplinary collaboration is an integral component of primary care and has a positive impact on reducing CVD risk in patients with diabetes. It’s essential to embed pharmacological and non-pharmacological interventions to multidisciplinary collaborative care to optimise health outcomes. Further, a greater integration of digital health technologies into collaborative care may have larger benefits of clinical outcomes. Refining the roles and responsibilities for health professionals should be an important area for future focus to achieve a consensus on the most effective team composition. Future research on cost-effectiveness of multidisciplinary collaborative care is needed before a widespread implementation.