Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review
Introduction: Multimorbidity, the coexistence of two or more chronic conditions in the same individual, is a major public health problem in low-income and middle-income countries (LMICs). The use of single-disease guidelines contributes to polypharmacy, fragmented care and increased treatment burden...
| Main Authors: | , , , , |
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| Format: | Journal Article |
| Language: | English |
| Published: |
2024
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| Online Access: | https://hdl.handle.net/10356/178389 |
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| author | George, Tina Manski-Nankervis, Jo-Anne Klaic, Marlena Kang, Gagandeep Sudarsanam, Thambu David |
| author2 | Lee Kong Chian School of Medicine (LKCMedicine) |
| author_facet | Lee Kong Chian School of Medicine (LKCMedicine) George, Tina Manski-Nankervis, Jo-Anne Klaic, Marlena Kang, Gagandeep Sudarsanam, Thambu David |
| author_sort | George, Tina |
| collection | NTU |
| description | Introduction: Multimorbidity, the coexistence of two or more chronic conditions in the same individual, is a major public health problem in low-income and middle-income countries (LMICs). The use of single-disease guidelines contributes to polypharmacy, fragmented care and increased treatment burden. Health systems in LMICs are very different from those in high-income countries, and adapting interventions from one to the other may not be feasible. This review aims to systematically present the current evidence for interventions for multimorbidity in the LMIC setting. Methods and analysis: In this mixed-methods systematic review, we will include all studies of interventions for the care of adults (>18 years of age) with multimorbidity (defined as the presence of two or more chronic illnesses in an individual) in any healthcare organisation (primary, secondary or tertiary care) in an LMIC (as defined by the World Bank), published between 2000 and March 2023. All primary study designs will be included. Studies reported in languages other than English and those describing interventions classified as ‘financial’ or ‘governance arrangement’ according to the Cochrane Effective Practice and Organisation of Care classification will be excluded. MEDLINE, PubMed, Cochrane Library, TRIP, SCOPUS and the 3ie databases will be searched. The titles will be screened by one author, and two authors will independently screen all included abstracts and full texts. A third author will resolve conflicts at every stage. Studies will be reviewed for quality of evidence using appropriate tools. Epidemiological, intervention and outcome data will be extracted and summarised. Outcomes of interest for LMICs defined by the Global Alliance for Chronic Diseases research group will be analysed. Subgroup analysis according to study types and study settings will be done. Ethics and dissemination: No ethics approval is required for this systematic review. Results will be disseminated through publication in an open-access journal and presentation at conferences. PROSPERO registration number: CRD42023391897. |
| first_indexed | 2024-10-01T05:48:05Z |
| format | Journal Article |
| id | ntu-10356/178389 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T05:48:05Z |
| publishDate | 2024 |
| record_format | dspace |
| spelling | ntu-10356/1783892024-06-23T15:38:38Z Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review George, Tina Manski-Nankervis, Jo-Anne Klaic, Marlena Kang, Gagandeep Sudarsanam, Thambu David Lee Kong Chian School of Medicine (LKCMedicine) Medicine, Health and Life Sciences Multiple chronic conditions Outcome assessment Introduction: Multimorbidity, the coexistence of two or more chronic conditions in the same individual, is a major public health problem in low-income and middle-income countries (LMICs). The use of single-disease guidelines contributes to polypharmacy, fragmented care and increased treatment burden. Health systems in LMICs are very different from those in high-income countries, and adapting interventions from one to the other may not be feasible. This review aims to systematically present the current evidence for interventions for multimorbidity in the LMIC setting. Methods and analysis: In this mixed-methods systematic review, we will include all studies of interventions for the care of adults (>18 years of age) with multimorbidity (defined as the presence of two or more chronic illnesses in an individual) in any healthcare organisation (primary, secondary or tertiary care) in an LMIC (as defined by the World Bank), published between 2000 and March 2023. All primary study designs will be included. Studies reported in languages other than English and those describing interventions classified as ‘financial’ or ‘governance arrangement’ according to the Cochrane Effective Practice and Organisation of Care classification will be excluded. MEDLINE, PubMed, Cochrane Library, TRIP, SCOPUS and the 3ie databases will be searched. The titles will be screened by one author, and two authors will independently screen all included abstracts and full texts. A third author will resolve conflicts at every stage. Studies will be reviewed for quality of evidence using appropriate tools. Epidemiological, intervention and outcome data will be extracted and summarised. Outcomes of interest for LMICs defined by the Global Alliance for Chronic Diseases research group will be analysed. Subgroup analysis according to study types and study settings will be done. Ethics and dissemination: No ethics approval is required for this systematic review. Results will be disseminated through publication in an open-access journal and presentation at conferences. PROSPERO registration number: CRD42023391897. Published version TG has received a fee-offset PhD scholarship from the University of Melbourne (application number 811257); however, this review has not received any funding. 2024-06-18T01:11:44Z 2024-06-18T01:11:44Z 2024 Journal Article George, T., Manski-Nankervis, J., Klaic, M., Kang, G. & Sudarsanam, T. D. (2024). Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review. BMJ Open, 14(3), e074038-. https://dx.doi.org/10.1136/bmjopen-2023-074038 2044-6055 https://hdl.handle.net/10356/178389 10.1136/bmjopen-2023-074038 38448058 2-s2.0-85187197778 3 14 e074038 en BMJ Open © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. application/pdf |
| spellingShingle | Medicine, Health and Life Sciences Multiple chronic conditions Outcome assessment George, Tina Manski-Nankervis, Jo-Anne Klaic, Marlena Kang, Gagandeep Sudarsanam, Thambu David Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review |
| title | Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review |
| title_full | Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review |
| title_fullStr | Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review |
| title_full_unstemmed | Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review |
| title_short | Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review |
| title_sort | interventions in adult patients with multimorbidity in low income and middle income countries protocol for a mixed methods systematic review |
| topic | Medicine, Health and Life Sciences Multiple chronic conditions Outcome assessment |
| url | https://hdl.handle.net/10356/178389 |
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