Royal College of Surgeons in Ireland
Interventions for improving outcomes in patients with multimorbidity in primary care and community setting. a systematic review.pdf (1.39 MB)
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Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic review

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journal contribution
posted on 2022-08-12, 14:56 authored by Susan SmithSusan Smith, Emma WallaceEmma Wallace, Barbara ClyneBarbara Clyne, Fiona BolandFiona Boland, Martin Fortin

Background: Multimorbidity, defined as the co-existence of two or more chronic conditions, presents significant challenges to patients, healthcare providers and health systems. Despite this, there is ongoing uncertainty about the most effective ways to manage patients with multimorbidity. This review updated and narrowed the focus of a previous Cochrane review and aimed to determine the effectiveness of interventions designed to improve outcomes in people with multimorbidity in primary care and community settings, compared to usual care.

Methods: We searched eight databases and two trials registers up to 9 September 2019. Two review authors independently screened potentially eligible titles and selected studies, extracted data, evaluated study quality and judged the certainty of the evidence (GRADE). Interventions were grouped by their predominant focus into care-coordination/self-management support, self-management support and medicines management. Main outcomes were health-related quality of life (HRQoL) and mental health. Meta-analyses were conducted, where possible, but the synthesis was predominantly narrative.

Results: We included 16 RCTs with 4753 participants, the majority being older adults with at least three conditions. There were eight care-coordination/self-management support studies, four self-management support studies and four medicines management studies. There was little or no evidence of an effect on primary outcomes of HRQoL (MD 0.03, 95% CI -0.01 to 0.07, I2 = 39%) and mental health or on secondary outcomes with a small number of studies reporting that care coordination may improve patient experience of care and self-management support may improve patient health behaviours. Overall, the certainty of the evidence was graded as low due to significant variation in study participants and interventions.

Conclusions: There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity, despite the growing number of RCTs conducted in this area. Our findings suggest that future research should consider patient experience of care, optimising medicines management and targeted patient health behaviours such as exercise.


Health Research Board funded Collaborative Doctoral Award in Multimorbidity (HRB CRC-2014-1)

Health Research Board Primary Care Research Centre (HRB CDA-2018-003)

HRB Emerging Investigator Award (HRB EIA-2019-09)



The original article is available at

Published Citation

Smith SM, Wallace E, Clyne B, Boland F, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic review. Syst Rev. 2021;10(1):271.

Publication Date

20 October 2021

PubMed ID



  • Data Science Centre
  • General Practice
  • HRB Centre for Primary Care Research

Research Area

  • Population Health and Health Services


BioMed Central


  • Published Version (Version of Record)