Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions

BMC Medicine

Research Article

Annemarie Edwards¹  Trudy Van der Weijden²  Brenda R. Hemmelgarn³  Henry T. Stelfox⁴  France Legare⁵  Paul P. Glasziou⁶  Patricia Rios⁷  Yonda Lai⁷  Lisa Strifler⁷  Marco Ghassemi⁷  Heather MacDonald⁷  Vera Nincic⁷  Paul A. Khan⁷  Christine Fahim⁷  Fatemeh Yazdi⁷  Wanrudee Isaranuwatchai⁷  Andrea C. Tricco⁸  Charlene Soobiah⁹  Areti Angeliki Veroniki⁹  Sharon E. Straus^1,10  Lisa R. Dolovich^1,11  David A. Chambers^1,12  Ross C. Brownson^1,13  Jessie McGowan^1,14  Janet E. Squires^1,15  Ian D. Graham^1,16  Justin Presseau^1,16  Bev J. Holmes^1,17 

[1] Canadian Partnership Against Cancer, 1 University Avenue, Toronto, ON, Canada;Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Debeyeplein 1, Maastricht, The Netherlands;Department of Medicine, University of Alberta, C MacKenzie Health Sciences Centre, 2J2.00, WalterEdmonton, AB, Canada;Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB, Canada;Département de Médecine Familiale Et Médecine d’urgenceFaculté de Médecine, Université Laval Pavillon Ferdinand-Vandry1050, Avenue de La Médecine, Local 2431, Québec, QC, Canada;Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec 1050, Chemin Sainte-Foy, Local K0-03, Québec, QC, Canada;Faculty of Health Sciences and Medicine, Bond University, 4226, Robina, QLD, Australia;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, M5B 1T8, Toronto, ON, Canada;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, M5B 1T8, Toronto, ON, Canada;Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, M5B 1T8, Toronto, ON, Canada;Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada;Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, M5B 1T8, Toronto, ON, Canada;Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada;Department of Geriatric Medicine, University of Toronto, Toronto, ON, Canada;Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, Canada;Department of Family Medicine David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON, Canada;National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA;Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA;Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, USA;School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, Canada;School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, Canada;School of Nursing, University of Ottawa, 451 Smyth Road, K1H 8M5, Ottawa, ON, Canada;School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, Canada;The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, Canada;The Michael Smith Foundation for Health Research (MSFHR), 200 - 1285 West Broadway, Vancouver, BC, Canada;

关键词: Sustainability;    Knowledge translation;    Chronic disease management;    Older adults;    Integrated knowledge translation;    Patient and public involvement;   

DOI  :  10.1186/s12916-023-02966-9

 received in 2022-12-25, accepted in 2023-06-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundChronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults.MethodsDesign: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT.Eligibility criteria: Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care).Information sources: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database’s inception to March 2020.Outcome measures: Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC).Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate. Data synthesis: We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data.ResultsWe included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [− 1.25, 3.47], 14 RCTs, 5876 participants, I2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [− 0.01, 0.02], 15 RCTs, 6628 participants, I2 = 25%; St George’s Respiratory Questionnaire: MD − 2.12, 95% CI [− 3.72, − 0.51] 44 12 RCTs, 2893 participants, I2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I2 = 21%).ConclusionsKT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age.Systematic review registrationPROSPERO CRD42018084810.

【 授权许可】

CC BY   
© The Author(s) 2023

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