Integrated models of care for diabetes and hypertension in low- and middle-income countries (LMICs) : protocol for a systematic review
Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: In low- and middle-income countries (LMICs), the burden of non-communicable diseases (NCDs) is
growing against an existing burden of other diseases such as HIV/AIDS. Integrated models of care can help address
the rising burden of multi-morbidity. Although integration of care can occur at various levels and has been defined
in numerous ways, our aim is to assess the effects of integration of service delivery at primary healthcare level in LMICs.
Methods: We will consider randomised controlled trials (RCTs), cluster RCTs, non-randomised trials, controlled beforeafter
studies and interrupted time series that examine integrated models of care among people with multi-morbidities,
of which diabetes or hypertension is one, living in LMICs. We will compare fully integrated models of care to standalone
care, partially integrated models of care to stand-alone care and fully integrated models to partially integrated
models of care. Primary outcomes include all-cause mortality, disease-specific morbidity, HbA1c, systolic blood pressure
and cholesterol levels. Secondary outcomes include access to care, retention in care, adherence, continuity of care,
quality of care and cost of care. We will conduct a comprehensive search in the following databases: MEDLINE,
EMBASE, the Cochrane Central Register of Control Trials, LILACS, Africa-Wide Information, CINAHL and Web of Science.
In addition, we will search trial registries, relevant conference abstracts and check references lists of included studies.
Selection of studies, data extraction and assessment of risk of bias will be performed independently by two review
authors. We will resolve discrepancies through discussion with a third author. We will contact study authors in case of
missing data. If included studies are sufficiently homogenous, we will pool results in a meta-analysis. Clinical
heterogeneity related to the population, intervention, outcomes and context will be documented in table
format and explored through subgroup analysis. We will assess χ²and I² tests for statistical heterogeneity. We will use
GRADE to make judgements about the certainty of evidence and present findings in a summary of findings table.
Discussion: In light of limited evidence on the provision of comprehensive care for diabetes and hypertension, and its
comorbidity in LMCIs, we believe that the findings of this systematic review will provide a synthesis of evidence on
effective models of integrated care for diabetes and hypertension and their comorbidities at primary healthcare level.
This will enable policy-makers to device policies and programs that are evidence informed.
Description
CITATION: Nicol, J. U., et al. 2018. Integrated models of care for diabetes and hypertension in low- and middle-income countries (LMICs) : protocol for a systematic review. Systematic Reviews, 7:203, doi:10.1186/s13643-018-0865-8.
The original publication is available at https://systematicreviewsjournal.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at https://systematicreviewsjournal.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
Chronic diseases -- Developing countries, Diabetes -- Developing countries, Hypertension -- Developing countries, Systematic reviews
Citation
Nicol, J. U., et al. 2018. Integrated models of care for diabetes and hypertension in low- and middle-income countries (LMICs) : protocol for a systematic review. Systematic Reviews, 7:203, doi:10.1186/s13643-018-0865-8