Effectiveness, implementation barriers and facilitators of shared medical appointments for chronic respiratory diseases: a mixed methods systematic review

Chronic respiratory diseases (CRDs) affect 550 million people globally and cause 4.4 million deaths each year. Despite optimal treatment, many patients continue to experience persistent respiratory symptoms, poor quality of life, and high healthcare utilization. Self-management, which involves patients’ daily management of their condition, can improve outcomes, but long-term adherence is often low. Shared medical appointments (SMAs), combining individual care with group support, have been effective in other diseases but are rarely studied in CRDs. A systematic review was conducted using MEDLINE (via PubMed), Embase, CINAHL, Web of Science, Cochrane Library, Scopus, and PsycINFO, with key terms identified and searched from inception to March 2025. Barriers and facilitators to SMA implementation were mapped using the Capability, Opportunity, and Motivation Behaviour (COM-B) model. This review followed the guidelines for mixed methods systematic reviews (MMSRs). Six studies met the inclusion criteria, involving 27 healthcare providers, 273 patients, and 97 caregivers. Overall, SMAs were associated with fewer acute exacerbations(MD = 0.44, p = 0.005), fewer emergency room visits/hospitalizations(MD = 0.28, p = 0.011), lower healthcare costs (MD = 3199.31, p = 0.005) and higher patient satisfaction(range:94%~98%). Healthcare providers reported barriers to implementing SMAs, including knowledge gaps and lack of experience, and facilitators included increased attention to patient psychology and the identification of mental health problems. For patients, barriers included some patients’ reluctance to participate in the SMA model, whereas facilitators included increased time for health education and illness consultation. Time management, health insurance, and social support were common barriers for both healthcare providers and patients, while social interaction, increased patient engagement, and reduced healthcare burden were identified as facilitators. Privacy concerns and the need for high levels of medical care were the main motivators and barriers for patients and healthcare providers, respectively. SMAs for patients with CRDs are feasible and well-accepted, and may be associated with improved self-management and more efficient use of healthcare resources. However, successful implementation requires addressing barriers at both the provider and patient levels, including workflow integration, training needs, and patient engagement. Tailored policy and operational strategies can mitigate these challenges, positioning SMAs as an efficient, sustainable care model. Given the small number and heterogeneity of the included studies, these findings should be interpreted with caution. Larger, long-term trials are needed to confirm the clinical and economic benefits of SMA implementation in CRDs.