Influence of health-system change on treatment burden: a systematic review
Influence of health-system change on treatment burden: a systematic review
Background: Treatment burden is a patient-centred concept describing the effort required of people to look after their health and the impact this has on their functioning and wellbeing. High treatment burden is more likely for people with multiple long-term conditions (LTCs). Validated treatment burden measures exist, but have not been widely used in practice or as research outcomes.
Aim: To establish whether changes in organisation and delivery of health systems and services improve aspects contributing to treatment burden for people with multiple LTCs.
Design and setting: Systematic review of randomised controlled trials (RCTs) investigating the impact of system-level interventions on at least one outcome relevant to previously defined treatment burden domains among adults with ≥2 LTCs. Method The Embase, Ovid MEDLINE, and Web of Science electronic databases were searched for terms related to multimorbidity, system-level change, and treatment burden published between January 2010 and July 2021. Treatment burden domains were derived from validated measures and qualitative literature. Synthesis without meta-analysis (SWiM) methodology was used to synthesise results and study quality was assessed using the Cochrane risk-of-bias (version 2) tool.
Results: The searches identified 1881 articles, 18 of which met the review inclusion criteria. Outcomes were grouped into seven domains. There was some evidence for the effect of system-level interventions on some domains, but the studies exhibited substantial heterogeneity, limiting the synthesis of results. Some concern over bias gave low confidence in study results.
Conclusion: System-level interventions may affect some treatment burden domains. However, adoption of a standardised outcome set, incorporating validated treatment burden measures, and the development of standard definitions for care processes in future research would aid study comparability.
long-term conditions, multimorbidity, primary care, systematic review, treatment burden
e59-e66
Matthews, Kate S.H.
fa8b5bf2-1273-4708-ab95-796b99c9145c
Rennoldson, Susannah C.
4de697bc-6034-4662-9d51-001c0ce8c92a
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
January 2023
Matthews, Kate S.H.
fa8b5bf2-1273-4708-ab95-796b99c9145c
Rennoldson, Susannah C.
4de697bc-6034-4662-9d51-001c0ce8c92a
Fraser, Simon
135884b6-8737-4e8a-a98c-5d803ac7a2dc
Matthews, Kate S.H., Rennoldson, Susannah C. and Fraser, Simon
(2023)
Influence of health-system change on treatment burden: a systematic review.
British Journal of General Practice, 73 (726), .
(doi:10.3399/BJGP.2022.0066).
Abstract
Background: Treatment burden is a patient-centred concept describing the effort required of people to look after their health and the impact this has on their functioning and wellbeing. High treatment burden is more likely for people with multiple long-term conditions (LTCs). Validated treatment burden measures exist, but have not been widely used in practice or as research outcomes.
Aim: To establish whether changes in organisation and delivery of health systems and services improve aspects contributing to treatment burden for people with multiple LTCs.
Design and setting: Systematic review of randomised controlled trials (RCTs) investigating the impact of system-level interventions on at least one outcome relevant to previously defined treatment burden domains among adults with ≥2 LTCs. Method The Embase, Ovid MEDLINE, and Web of Science electronic databases were searched for terms related to multimorbidity, system-level change, and treatment burden published between January 2010 and July 2021. Treatment burden domains were derived from validated measures and qualitative literature. Synthesis without meta-analysis (SWiM) methodology was used to synthesise results and study quality was assessed using the Cochrane risk-of-bias (version 2) tool.
Results: The searches identified 1881 articles, 18 of which met the review inclusion criteria. Outcomes were grouped into seven domains. There was some evidence for the effect of system-level interventions on some domains, but the studies exhibited substantial heterogeneity, limiting the synthesis of results. Some concern over bias gave low confidence in study results.
Conclusion: System-level interventions may affect some treatment burden domains. However, adoption of a standardised outcome set, incorporating validated treatment burden measures, and the development of standard definitions for care processes in future research would aid study comparability.
Text
BJGP.2022.0066.full
- Accepted Manuscript
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e-pub ahead of print date: 20 July 2022
Published date: January 2023
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Publisher Copyright:
© The Authors.
Keywords:
long-term conditions, multimorbidity, primary care, systematic review, treatment burden
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Local EPrints ID: 468557
URI: http://eprints.soton.ac.uk/id/eprint/468557
ISSN: 0960-1643
PURE UUID: aa3c626d-8cc4-41ec-881d-4cc81de9f0a2
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Date deposited: 18 Aug 2022 16:30
Last modified: 17 Mar 2024 03:14
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Contributors
Author:
Kate S.H. Matthews
Author:
Susannah C. Rennoldson
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