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Meta-Analysis
. 2022 May 5;22(1):603.
doi: 10.1186/s12913-022-07838-1.

The effect of integrated health care in patients with hypertension and diabetes: a systematic review and meta-analysis

Yan Zhao  1 , Yue Ma  1 , Chongbo Zhao  2 , Jiahong Lu  2 , Hong Jiang  1 , Yanpei Cao  3 , Yafang Xu  4   5
Affiliations
Meta-Analysis

The effect of integrated health care in patients with hypertension and diabetes: a systematic review and meta-analysis

Yan Zhao et al. BMC Health Serv Res. .

Abstract

Background: A growing number of studies show that integrated health care provides comprehensive and continuous care to patients with hypertension or diabetes. However, there is still no consensus about the effect of integrated health care on patients with hypertension or diabetes. The objective of this study was to verify the effectiveness of integrated health care for patients with hypertension or diabetes by using a systematic review and meta-analysis.

Methods: The study searched multiple English and Chinese electronic databases. The search period was from database inception to 31 October 2020. Systematic reviews and meta-analyses were conducted after assessing the risk of bias of each study.

Results: Sixteen studies that involved 5231 patients were included in this study. The results of the systematic review revealed that systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and glycosylated haemoglobin (HbA1c) are commonly used indicators for patients with hypertension or diabetes. Individual models and group- and disease-specific models are the most commonly used models of integrated health care. All the studies were from high-income and middle-income countries. Meta-analysis showed that integrated health care significantly improved SBP, DBP and HbA1c but not BMI. A comparison of interventions lasting 6 and 12 months for diabetes was conducted, and HbA1c was decreased after 12 months. The changes in SBP and DBP were statistically significant after using group- and disease-specific model but not individual models. HbA1c was significantly improved after using group- and disease-specific models and individual models.

Conclusion: Integrated health care is a useful tool for disease management, and individual models and group- and disease-specific models are the most commonly used models in integrated health care. Group- and disease-specific models are more effective than individual models in the disease management of hypertension patients. The duration of intervention should be considered in the disease management of patients with diabetes, and interventions longer than 12 months are recommended. The income level may affect the model of integrated health care in selecting which disease to intervene, but this point still needs support from more studies.

Keywords: Diabetes; Hypertension; Integrated health care; Meta-analysis; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Strategies and methods in integrated health care
Fig. 2
Fig. 2
Flow of studies throughout the review
Fig. 3
Fig. 3
Funnel plot for publication bias. a Funnel plot for SBP in the patients with hypertension. b Funnel plot for DBP in the patients with hypertension. c Funnel plot for HbA1c in the patients with diabetes. *SE: standard error; MD: mean difference; SBP: systolic blood pressure; DBP: diastolic blood pressure; HbA1c: glycated haemoglobin
Fig. 4
Fig. 4
Summaries of bias. * green = low risk of bias, red = high risk of bias, yellow = unclear risk of bias
Fig. 5
Fig. 5
Meta-analysis of SBP in patients with hypertension. a The meta-analysis of SBP in patients with hypertension. b The meta-analysis of SBP in patients involved in individual model. c The meta-analysis of SBP in patients involved in Group-and disease-specific model
Fig. 6
Fig. 6
Meta-analysis of DBP in patients with hypertension. a The meta-analysis of DBP in patients with hypertension. b The meta-analysis of DBP in patients involved in individual model. c The meta-analysis of DBP in patients involved in Group-and disease-specific model
Fig. 7
Fig. 7
Meta-analysis of BMI in patients with hypertension
Fig. 8
Fig. 8
Meta-analysis of HbA1c in patients with diabetes. a The meta-analysis of HbA1c in patients with hypertension. b The meta-analysis of HbA1c in patients involved in individual model. c The meta-analysis of HbA1c in patients involved in Group-and disease-specific model
Fig. 9
Fig. 9
The meta-analysis of HbA1c after 6 and 12 months of intervention. a The meta-analysis of HbA1c after 6-months intervention. b The meta-analysis of HbA1c after 6-months intervention
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References

    1. Xu J, Yang F, Si L, Qian D. Do integrated health care interventions improve well-being among older adults with hypertension? Evidence from rural China. Social Indicators Research. 2022;160:825–843. doi: 10.1007/s11205-020-02482-w. - DOI
    1. Briggs AM, Valentijn PP, Thiyagarajan JA, Carvalho IA. Elements of integrated care approaches for older people: a review of reviews. BMJ Open. 2018;8(4):e021194. doi: 10.1136/bmjopen-2017-021194. - DOI - PMC - PubMed
    1. Organization WH . WHO global strategy on people-centred and integrated health services: interim report. World Health Organization; 2015.
    1. Piatt GA, Ches Orchard TJ, Simmons D, Songer TJ, Siminerio LM, et al. Translating the chronic care model into the community. Diabetes Care. 2006;29(4):811–817. doi: 10.2337/diacare.29.04.06.dc05-1785. - DOI - PubMed
    1. Hacihasanoğlu R, Gözüm S. The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours and BMI in a primary health care setting. J Clin Nurs. 2011;20(5–6):692–705. doi: 10.1111/j.1365-2702.2010.03534.x. - DOI - PubMed

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