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

Chronic disease management Integrated knowledge translation Knowledge translation Older adults Patient and public involvement Sustainability

Journal

BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723

Informations de publication

Date de publication:
24 07 2023
Historique:
received: 25 12 2022
accepted: 27 06 2023
medline: 26 7 2023
pubmed: 25 7 2023
entrez: 24 7 2023
Statut: epublish

Résumé

Chronic 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. Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT. 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). We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020. 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. We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data. We 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, I KT 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. PROSPERO CRD42018084810.

Sections du résumé

BACKGROUND
Chronic 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.
METHODS
Design: 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.
RESULTS
We 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, I
CONCLUSIONS
KT 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 REGISTRATION
PROSPERO CRD42018084810.

Identifiants

pubmed: 37488589
doi: 10.1186/s12916-023-02966-9
pii: 10.1186/s12916-023-02966-9
pmc: PMC10367354
doi:

Types de publication

Meta-Analysis Systematic Review Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

269

Subventions

Organisme : CIHR
ID : 154334
Pays : Canada

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2023. The Author(s).

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Auteurs

Areti Angeliki Veroniki (AA)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada. areti-angeliki.veroniki@unityhealth.to.
Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada. areti-angeliki.veroniki@unityhealth.to.

Charlene Soobiah (C)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.
Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada.

Vera Nincic (V)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

Yonda Lai (Y)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

Patricia Rios (P)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

Heather MacDonald (H)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

Paul A Khan (PA)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

Marco Ghassemi (M)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

Fatemeh Yazdi (F)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

Ross C Brownson (RC)

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.

David A Chambers (DA)

National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, USA.

Lisa R Dolovich (LR)

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.

Annemarie Edwards (A)

Canadian Partnership Against Cancer, 1 University Avenue, Toronto, ON, Canada.

Paul P Glasziou (PP)

Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, 4226, Australia.

Ian D Graham (ID)

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.

Brenda R Hemmelgarn (BR)

Department of Medicine, University of Alberta, C MacKenzie Health Sciences Centre, WalterEdmonton, AB, 2J2.00, Canada.

Bev J Holmes (BJ)

The Michael Smith Foundation for Health Research (MSFHR), 200 - 1285 West Broadway, Vancouver, BC, Canada.

Wanrudee Isaranuwatchai (W)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

France Legare (F)

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.

Jessie McGowan (J)

School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, Canada.

Justin Presseau (J)

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.

Janet E Squires (JE)

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, Ottawa, ON, K1H 8M5, Canada.

Henry T Stelfox (HT)

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.

Lisa Strifler (L)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

Trudy Van der Weijden (T)

Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Debeyeplein 1, Maastricht, The Netherlands.

Christine Fahim (C)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.

Andrea C Tricco (AC)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.
Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Sharon E Straus (SE)

Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, 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.

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