HealthDay News — Care coordination strategies can be beneficial for older patients with multiple chronic diseases, according to a review published in the Aug. 27 issue of CMAJ, the journal of the Canadian Medical Association.
Monika Kastner, Ph.D., from North York General Hospital in Toronto, and colleagues conducted a systematic review of randomized controlled trials evaluating interventions for managing multiple chronic diseases. Data were included for 25 studies with 12,579 older adults (mean age, 67.3 years).
The researchers found that care coordination strategies significantly improved depressive symptoms (standardized mean difference, −0.41; 95 percent confidence interval, −0.59 to −0.22) in patients with depression and chronic obstructive pulmonary disease (COPD) and in patients with cardiovascular disease (CVD) and diabetes mellitus (DM); in addition, the strategies decreased glycosylated hemoglobin levels (mean difference, −0.51; 95 percent confidence interval −0.9 to −0.11) but not mortality (relative risk, 0.79; 95 percent confidence interval, 0.53 to 1.17). In secondary outcomes, care coordination significantly reduced functional impairment in patients with arthritis and depression or DM and depression; improved cognitive functioning in patients with DM and depression or heart failure and COPD; and increased mental health service use in those with DM and either CVD or depression.
“Care coordination interventions with one or a combination of case management, care pathways, self-management, and education appear to have the greatest potential for impact,” the authors write.