Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis

Abstract

Background. Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with general practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study. Methods. PubMed, Embase, CINAHL, Central Register of Controlled Trials in the Cochrane Library, and MEDLINE were systematically searched in February 2024. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence, and used the rainbow model of integrated care taxonomy to describe the elements of integrated care. Outcomes included functional status, healthcare utilisation, participant satisfaction with care, health-related quality of life, mortality, nursing home admission, and adverse outcomes. Meta-analyses were performed using Review Manager 5.4. Results. Twelve trials recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD): 0.21; 95% confidence interval (CI): 0.05–0.37; low certainty evidence), hospitalisation (risk ratio (RR): 0.77; 95% CI: 0.63–0.95; very low certainty evidence), and participant satisfaction with care (SMD: 0.46; 95% CI: 0.15–0.76; low certainty evidence) from 12 to 36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, emergency department presentation, mortality, health-related quality of life, or nursing home admission were established. Conclusion. Community-based MDT integrated care with GP participation improves functional status, reduces hospitalisations, and increases patient satisfaction among community-dwelling older adults in the long term. Future research should focus on models of integrated care that respond to the needs and preferences of older adults. This trial is registered with CRD42022309744.