Objectives To assess the effectiveness of community-based interventions for adults with multimorbidity on clinical and patient-centred outcomes, and to examine contextual factors influencing their impact in primary care and community settings. Design Systematic review. Data sources PubMed/MEDLINE, Embase, Web of Science, Cochrane CENTRAL, China National Knowledge Infrastructure, WanFang Data and SinoMed were searched up to May 2025. Grey literature and trial registries were also searched. Eligibility criteria We included randomised controlled trials (RCTs), quasi-experimental studies and comparative observational studies involving adults (≥18 years) with multimorbidity, defined as ≥2 chronic conditions including at least one of hypertension, diabetes or dyslipidaemia. Interventions had to be delivered in primary care or community settings and report at least one clinical or patient-centred outcome. Data extraction and synthesis Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane RoB 2.0 and ROBINS-I tools. Due to heterogeneity in interventions and outcomes, results were synthesised narratively following the Synthesis Without Meta-analysis guidelines. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results 25 studies were included, comprising 19 RCTs and 6 quasi-experimental or observational designs. Interventions included nurse-led or multidisciplinary care (n=13), integrated or collaborative care (n=8) and digital health models (n=5). Clinical outcomes such as blood pressure, HbA1c or lipids were assessed in 10 studies, with 7 reporting significant improvements, 6 identifying subgroup-specific benefits and 3 reporting mixed or null effects. Patient-centred outcomes were reported in all studies; quality of life improved in 10 of 13 studies, self-management in 6 of 9 and healthcare use was reduced in 7 of 11. Conclusions Community-based interventions for multimorbidity consistently improve patient-centred outcomes, while clinical effects are more variable and context-dependent. Tailored implementation for high-risk groups and attention to local delivery models may enhance effectiveness. Further research is needed to support equity-focused, long-term implementation. PROSPERO registration number CRD420251159790.
Chen et al. (Thu,) studied this question.