Systems-based care approaches consistently improved intermediate clinical outcomes, particularly systolic blood pressure and HbA1c, in adults with cardiometabolic multimorbidity.
Systematic Review
Do systems-based approaches improve clinical outcomes in adults with cardiometabolic and chronic diseases?
Systems-based care models improve risk-factor control, particularly blood pressure and HbA1c, in adults with cardiometabolic multimorbidity, though effects on hard clinical endpoints remain unclear.
Cardiometabolic and chronic diseases frequently coexist in adult clinical practice, creating complex care needs across hypertension, type 2 diabetes, cardiovascular disease, chronic kidney disease, dyslipidemia, obesity, and multimorbidity. This systematic review evaluated systems-based approaches for adult cardiometabolic and chronic disease management, including integrated care, multidisciplinary teams, chronic care management, shared medical appointments, telemonitoring, pharmacist- and nurse-supported care, and technology-assisted models. A structured search identified 252 records; after duplicate removal, title and abstract screening, and full-text eligibility assessment, 11 studies were included. Because the studies differed in design, setting, population, intervention components, follow-up duration, and outcome reporting, findings were synthesised narratively. The strongest and most consistent effects were observed for intermediate clinical outcomes, especially systolic blood pressure and HbA1c, particularly when interventions incorporated structured monitoring, medication optimisation, patient education, multidisciplinary input, and coordinated follow-up. Several studies also reported improvements in quality of life, anxiety symptoms, medication safety, provider workload, reimbursement feasibility, and care coordination. Findings for lipid control, body mass index, behavioural outcomes, and major cardiovascular, renal, or mortality endpoints were less consistent. Risk of bias varied, with randomised trials generally showing fewer concerns than retrospective, nonrandomized, and quality-improvement studies. Overall, systems-based care may improve risk-factor control and care processes in adults with cardiometabolic multimorbidity, but larger pragmatic trials with longer follow-up are needed to determine whether these benefits translate into durable reductions in complications, hospitalisation, and mortality.
G et al. (Wed,) conducted a systematic review in Cardiometabolic and chronic diseases. Systems-based approaches vs. Usual care was evaluated on Clinical outcomes including systolic blood pressure and HbA1c. Systems-based care approaches consistently improved intermediate clinical outcomes, particularly systolic blood pressure and HbA1c, in adults with cardiometabolic multimorbidity.