Integrated healthcare services for non-COPD chronic respiratory diseases: a systematic review

Background Respiratory service integration has typically focused on chronic obstructive pulmonary disease (COPD) but may be appropriate for other chronic respiratory diseases (CRDs). Aim To investigate integrated care in asthma, bronchiectasis and interstitial lung disease (ILD). Design & setting A systematic review of interventional or observational studies published in English since 2014 from high-income countries. Integration was defined as multi-disciplinary care across two or more settings. Method Medline, Embase, CINAHL, PsycINFO, Cochrane Library and Scopus were searched. Intervention characteristics, patient-reported and healthcare utilisation outcomes were described narratively. A random-effects model was used to report standardised mean difference for asthma control and mean difference for quality of life (QOL) outcomes (mAQLQ). Results Sixteen studies (seven countries) met the inclusion criteria from 14 246 titles/abstracts: asthma=11, ILD=5. Most asthma studies targeted poorly controlled patients. Five RCTs (1096 participants) showed potentially moderate improvements in post-intervention asthma control (standardised mean difference 0.45, 95% CI -0.20 to 1.10, follow-up 3-12months). Three RCTs (1025 participants) reported small improvements in QOL at 12 months (mean difference 0.39, 95% CI 0.13 to 0.66, MCID=0.5). A reduced healthcare utilisation trend was seen. Most ILD studies included advanced care planning, reporting improvements to symptoms, care coordination and healthcare use towards end of life. No integrated care studies for bronchiectasis were identified. Conclusion Integrated care for non-COPD CRDs may improve short-term QOL, symptom control and healthcare utilisation. Heterogeneity of study populations and outcomes limited meta-analysis. There remains a paucity of real-world evidence for integrated care outside COPD.