Interprofessional Collaboration and Diabetes Management in Primary Care: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes
, Giorgio Sessa 1,†, Domenico Pascucci 1,2,*, Michele Sassano 1,3, Linda Lombi 4 and Gianfranco Damiani 1,2
Round 1
Reviewer 1 Report
This study has the appropriate methodology.
PICO has utility and increased its quality based on the meta-analysis.
The authors could discuss more about the follow-up in the selected studies, in addition to the duration, similarity or differences in the results at the measurement or evaluation cut-off points of the patients, what trends were observed during those follow-ups and perhaps factors at which that these variations were attributed during the follow-ups. In table S2 in which the 13 quality criteria that give clarity to the
results can be added.
|
Author, Year, Country |
Source |
Intervention team |
Setting |
Type of Interventions |
Target of Intervention |
Population |
Follow-up |
PROMs Analyzed |
Results |
|
Thankappan K.R. 2018, India |
PLoS Medicine |
- Nurse with a PhD in public health |
Outpatient clinics |
- Community engagement |
Community-based |
- 500 intervention group |
24 months |
- SF-36 converted in Short Form 6 Dimension (SF-6D) |
A community-based program didn’t result in a nonsignificant reduction in diabetes incidence. However, there were significant improvements in some cardiovascular risk factors and physical functioning score of the HRQoL scale. |
|
Penckofer S.M. 2012, USA |
Annals of Behavioral Medicine |
- Nurse |
Outpatient clinics |
- Psychological (psychoeducational) |
Group-based |
- 38 intervention group |
6 months |
- SF-12 |
SWEEP program provides evidence that group-therapy was more effective than usual care for treating depressed women with type 2 diabetes. |
|
Chaveepojnkamjorn W. 2009, Thailand |
Southeast Asian Journal of Tropical Medicine and Public Health |
- Psychologist |
Community Health Centers |
- Educational (self-management) |
Group-based |
- 80 intervention group |
6 months |
-WHOQOL-BREF (THAI version) |
This program, focused on enhancement of experience sharing among group members and participation in problem-solving, shows it is effective for improving perceived quality of life. |
|
Piette J.D. 2011, USA |
Medical Care |
- Nurses with psychiatric and primary care training and experience, trained in CBT |
Primary Care Clinics |
- Psychological (Cognitive-Behavioural Therapy) |
Person-based |
- 172 intervention group |
12 months |
- SF-12 |
This program of telephone delivered CBT combined with a pedometer-based walking program did not improve A1c values but significantly decreased patients’ blood pressure, increased physical activity, and decreased depressive symptoms. The intervention also improved patients’ functioning and quality of life. |
|
Cezaretto A 2012, Brazil |
Quality of Life Research |
-Endocrinologist |
Primary Care Clinics |
- Psychological (psychoeducational) |
Person-based |
- 97 intervention group |
9 months |
- SF-36 |
An intensive intervention on lifestyle with interdisciplinary approach for individuals at risk for type 2DM induced greater improvements in QoL than a traditional one, in parallel to better benefits on cardiometabolic profile. |
|
Miklavcic J.J. 2020, Canada |
BMC Geriatrics |
- Nurse |
Primary Care Clinics |
- Educational (self-management) |
Community-based |
- 70 intervention group |
6 months |
- SF-12 |
This pragmatic trial of a self-management intervention for older adults with T2DM and multimorbidity demonstrated inconclusive results for improving QoL. |
|
Blackberry I.D. 2013, Australia |
BMJ Online |
- Practice nurses |
General practices |
- Psychological (coaching) |
Person-based |
- 30 intervention group |
18 months |
- AQoL |
A telephone coaching by existing generalist practice nurses without prescribing rights found no evidence that was effective compared with usual primary care, either in reaching treatment targets or achieving more intensive treatment. |
|
Du Pon E. 2019, Netherlands |
BMC Endocrine Disorders |
- Practice Nurses |
General practices |
- Educational (self-management) |
Group-based |
- 101 intervention group |
12 months |
- EQ-5D-3L |
PRISMA did not improve self-reported outcomes in patients with type 2 diabetes treated in primary care.It was not possible to make a statement about the clinical effects. |
|
Vadstrup E.S. 2011, Denmark |
Health Qual Life Outcomes |
- Nurse |
Outpatient Clinics and |
- Educational (self-management) |
Group-based |
- 70 intervention group |
6 months |
- SF-36 |
After 6 months this study suggests that a group-based rehabilitation programme is not superior to an individual counselling programme in changing patients' HRQOL and self-rated health. |
|
Pauley T. 2016, Canada |
Home Health Care Services Quarterly |
- Nurse |
Home |
- Psychological (coaching) |
Person-based |
- 47 intervention group |
1 month |
- DSES |
A PSW-led coaching intervention to improve diabetes self-efficacy shows no differences compared to nurse-led traditional standard of care. However, the results do demonstrate it may be sufficient to improve depression. Furthermore all subjects demonstrated significant improvements in self-efficacy measures. |
|
Siaw M.Y.L. 2017, Singapore |
Journal of Clinical Pharmacy and Therapeutics |
- Physicians |
Outpatient clinics |
- Medication control |
Person-based |
- 214 intervention group |
6 months |
- DTSQ |
After 6 months a multidisciplinary collaborative care for Asian diabetic patients there was an increased QoL and satisfaction towards diabetes care, lightened the physicians’ workload and cost saving. This study shows the effectiveness of this approach through an improvement of positive clinical, humanistic and economic outcomes. |
|
Kulzer B. 2018, Germany |
Diabetes Research and Clinical Practice |
- Physicians received training based on a structured curriculum |
General practices |
- Educational (self-management) |
Person-based |
- 440 intervention group |
12 months |
- DTSQ |
The iPDM process improved the use of diagnostic data leading to better glycemic control, more timely treatment adjustments (indicating reduced clinical inertia), and increased patient adherence and treatment satisfaction among patients and physicians. |
|
Browning C. 2016, China |
BMJ Open |
- Community Doctors trained in coaching |
Community health Centers |
- Psychological (health coaching - motivational intervention) |
Person-based |
- 372 intervention group |
12 months |
- SDSCA |
In this study, although a differential treatment effect was not observed for HbA1c, numerous outcomes (including HbA1c) improved in both groups, supporting the establishment of regular, free clinical health checks for people with T2DM in Chinese CHSs. |
|
Markle-Reid M. 2017, Canada |
Journal of the American Geriatrics Society |
- Nurse |
Primary Care Clinics |
- Educational (self-management) |
Community-based and Group-based |
- 80 intervention group |
6 months |
- SF‐12 |
This study provide evidence that participation in a 6-month community-based intervention improved quality of life and self-management and reduced depressive symptoms in older adults with T2DM and comorbidity without increasing total healthcare costs. |
|
van der Wulp I. 2012, Netherlands |
Diabetic Medicine |
- Expert patients trained in motivational interviewing |
General practices |
- Peer support |
Person-based |
- 59 intervention group |
6 months |
- CES-D |
A peer-led self-management coaching programme for recently diagnosed patients with Type 2 diabetes improved self-efficacy of patients experiencing low self-efficacy shortly after diagnosis |
|
Davies M.J. 2008, UK |
BMJ |
- Dieticians |
General practices |
- Educational |
Group-based |
- 437 intervention group |
12 months |
- WHOQOL-BREF |
A structured group education programme for patients with newly diagnosed type 2 diabetes resulted in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A(1c) levels up to 12 months after diagnosis. |
|
Cortez D.N. 2017, Brazil |
BMC Public Health |
- Lead researcher as a facilitator and an instigator of discussions |
Primary Care Clinics |
- Educational |
Group-based |
- 127 intervention group |
12 months |
- SLC |
The empowerment program based on individualized goals was effective in improving self-care practices and metabolic control of type 2 diabetes in Brazilian users |
|
Kinmonth A.L. 1998, UK |
BMJ |
- Nurse |
General practices |
- Psychological |
Person-based |
- 142 intervention group |
12 months |
- ADDQoL |
A training programme in patient centred care for practitioners led to patients with newly diagnosed diabetes reporting better communication with doctors, greater wellbeing, and greater treatment satisfaction at one year, without loss of glycaemic control. |
|
Lamers F. 2011, Netherlands |
Journal of Advanced Nursing |
- Nurses |
General practices |
- Psychological (Cognitive Behavioral Therapy) |
Person-based |
- 105 intervention group |
9 months |
- DSC-R |
The nurse-administered intervention had limited effects on diabetes-specific quality of life. |
Abbreviations: SF-36, short form health survey 36; SF-12, short form health survey 12; CES-D, The Center for Epidemiologic Studies Depression Tool; QLI Diabetes version, Diabetes version of the Ferrans and Powers Quality of Life Index; WHOQOL-BREF (THAI version), Thai abbreviated version of World Health Organization Quality of Life; BDI, Beck Depression Inventory; SEM-CD, Self-Efficacy for Managing Chronic Disease scale; SDSCA, Summary of Diabetes Self-Care Activities scale; AQoL, Assessment of Quality of Life Mark 2 instrument; PHQ-9, Major depressive syndrome; DMSES, 20-item Diabetes Management Self-Efficacy Scale; DSES, Diabetes Self-Efficacy Scale; EQ-5D-3L, EuroQol Five Dimensions scale, HADS, Hospital Anxiety and Depression Scale; DTSQ, Diabetes Satisfaction and Treatment Questionnaire; PAID, Problem Areas in Diabetes questionnaire; WHOQOL-BREF, short version of the World Health Organization Quality of Life instrument; SLC, Self-care for type 2 diabetes; ADDQoL, audit of diabetes dependent quality of life; DSC-R, DiabetesSymptom Checklist – Revised.
Table S2. Results of quality assessment process of Controlled Intervention studies.
|
Author, Year, Country |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
14 |
Quality Rating |
|
Thankappan K.R. 2018, India |
yes |
yes |
yes |
yes |
no |
yes |
yes |
yes |
yes |
yes |
yes |
yes |
yes |
yes |
good |
|
Penckofer S.M. 2012, USA |
yes |
yes |
yes |
no |
no |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
yes |
good |
|
Chaveepojnkamjorn W. 2009, Thailand |
yes |
yes |
yes |
NR |
NR |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
NR |
fair |
|
Piette J.D. 2011, USA |
yes |
yes |
yes |
NR |
NR |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
yes |
good |
|
Cezaretto A 2012, Brazil |
yes |
yes |
NR |
NR |
NR |
yes |
no |
yes |
yes |
NR |
yes |
no |
yes |
NR |
poor |
|
Markle-Reid M. 2017, Canada |
yes |
yes |
yes |
no |
yes |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
yes |
good |
|
Miklavcic J.J. 2020, Canada |
yes |
yes |
yes |
no |
yes |
no |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
yes |
good |
|
Blackberry I.D. 2013, Australia |
yes |
yes |
yes |
no |
yes |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
NR |
good |
|
van der Wulp I. 2012, Netherlands |
yes |
yes |
yes |
NR |
NR |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
NR |
fair |
|
Davies M.J. 2008, UK |
yes |
yes |
yes |
NR |
NR |
yes |
no |
yes |
yes |
NR |
yes |
yes |
yes |
yes |
fair |
|
Du Pon E. 2019, Netherlands |
yes |
yes |
yes |
NR |
NR |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
yes |
good |
|
Cortez D.N. 2017, Brazil |
yes |
yes |
yes |
NR |
NR |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
NR |
fair |
|
Vadstrup E.S. 2011, Denmark |
yes |
yes |
yes |
no |
yes |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
yes |
good |
|
Pauley T. 2016, Canada |
yes |
yes |
yes |
no |
yes |
yes |
yes |
yes |
yes |
NR |
yes |
NR |
yes |
yes |
good |
|
Siaw M.Y.L. 2017, Singapore |
yes |
yes |
yes |
NR |
NR |
yes |
yes |
no |
no |
NR |
yes |
yes |
yes |
yes |
fair |
|
Kulzer B. 2018, Germany |
yes |
yes |
yes |
NR |
NR |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
yes |
good |
|
Browning C. 2016, China |
yes |
yes |
yes |
no |
yes |
yes |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
NR |
good |
|
Kinmonth A.L. 1998, UK |
yes |
yes |
yes |
no |
yes |
yes |
no |
yes |
yes |
NR |
yes |
yes |
yes |
yes |
good |
|
Lamers F. 2011, Netherlands |
yes |
yes |
yes |
NR |
yes |
yes |
yes |
no |
yes |
NR |
yes |
yes |
yes |
yes |
good |
Abbreviation: NR, not reported.
Author-derived key for standardization: ≤ 5 POOR, 6-7 FAIR, ≥ 8 GOOD.
Author Response
We thank the reviewer for the valuable comments.
Reviewer 1
The authors could discuss more about the follow-up in the selected studies, in addition to the duration, similarity or differences in the results at the measurement or evaluation cut-off points of the patients, what trends were observed during those follow-ups and perhaps factors at which that these variations were attributed during the follow-ups. In table S2 in which the 13 quality criteria that give clarity to the results can be added.
We thank the reviewer for the valuable insights. We proceeded to discuss about the follow-up time and about the quality assessment results. Please, see lines 328-337.
Reviewer 2 Report
- need to include table for included studies before meta analysis
- how many studies were in Italian language ? and included in the final analysis
- can add table for quality assessment
Author Response
We thank the reviewer for the valuable comments.
Reviewer 2
Need to include table for included studies before meta analysis
Thank you for the suggestion. However, due to formatting restrictions, we put the table of the summary characteristics of the included studies in the supplementary file (Table S1).
How many studies were in Italian language ? and included in the final analysis
Among the included studies, there were not papers written in Italian.
Can add table for quality assessment
The table for quality assessment was put in a supplementary file (Table S2).
Reviewer 3 Report
Introduction: Some references are too old such as Wagnre 1998 , which should be converted to number! Please replace any references older than 2005 from Introduction and discussion…
Methods: The PROSPERO registration ID was not provided… The search strategies for all included databases should be provided in the supplementary materials...
Author Response
We thank the reviewer for the valuable comments.
Reviewer 3
Introduction: Some references are too old such as Wagnre 1998 , which should be converted to number! Please replace any references older than 2005 from Introduction and discussion…
We thank the reviewer for the valuable comment. We replaced most of the older references with newest ones. However, we cannot substitute the reference of Professor Edward Wagner since it developed the model we are referring to.
Methods: The PROSPERO registration ID was not provided… The search strategies for all included databases should be provided in the supplementary materials...
Thank you for the precious suggestion. We did not provide the PROSPERO registration ID since we did not register the systematic review in the PROSPERO database.
The search strategy for all the databases is now available in a new supplementary file.
