Background Shared medical appointments (SMAs) are a care delivery model that involves a group of patients with a shared long-term condition (LTC) meeting with their health professional for routine care, e.g. annual review. SMAs typically last between 60–120 minutes and are co-delivered by a physician (usually doctor, nurse or pharmacist) and a facilitator (non-clinician). SMAs have the potential to address interlinked challenges of limited capacity in primary healthcare and rising prevalence of patients with multiple LTCs. This review aimed to examine the effectiveness of SMAs compared to one-to-one appointments in primary care at improving health outcomes and reducing demand on healthcare services.
Methods We searched for randomised controlled trials (RCTs) of SMAs from 2013 involving patients with LTCs in primary care across six databases (MEDLINE, EMBASE, Science Citation Index, Social Science Citation Index, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library including Central Register of Controlled Trials) and added eligible papers identified from previous relevant reviews. Data were extracted and outcomes measures categorised into health outcomes (biomedical indicators, psychological and well-being measures), behavioural outcomes, and resource use. Data from studies that were sufficiently similar were meta-analysed else were narratively synthesised.
Results Twenty-three unique trials were included. Nineteen were conducted in United States, two in China and one each in Australia, Germany and UK. Studies were published between 2001 and 2020. SMA models varied in terms of components, mode of delivery and target population. Most trials recruited patients with a single LTC, mostly commonly diabetes (n=13), although eight trials selected patients with multiple LTCs. There was substantial heterogeneity in outcome measures reported. Meta-analysis showed that participants in SMA groups had lower diastolic blood pressure than those in usual care (d=-0.123, 95%CI = -0.22, -0.03, k=8). No statistically significant differences were found across other outcomes. Where individual studies showed significant differences (patient self-efficacy), these trended in favour of SMAs. Compared with usual care, SMAs had no significant effect on healthcare service use.
Conclusion SMAs were at least as effective as usual care in terms of health outcomes and did not lead to increased healthcare service use in the short-term. They show some potential in improving self-efficacy which may boost self-care. To strengthen the evidence base, future studies should target standardised behavioural and health outcomes and clearly report SMA components so key behavioural ingredients can be identified. Similarly, transparent approaches to measuring costs would improve comparability between studies.
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