The University of Southampton
University of Southampton Institutional Repository

Influence of health-system change on treatment burden: a systematic review

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
0960-1643
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
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), e59-e66. (doi:10.3399/BJGP.2022.0066).

Record type: Article

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
Available under License Creative Commons Attribution.
Download (601kB)

More information

e-pub ahead of print date: 20 July 2022
Published date: January 2023
Additional Information: Publisher Copyright: © The Authors.
Keywords: long-term conditions, multimorbidity, primary care, systematic review, treatment burden

Identifiers

Local EPrints ID: 468557
URI: http://eprints.soton.ac.uk/id/eprint/468557
ISSN: 0960-1643
PURE UUID: aa3c626d-8cc4-41ec-881d-4cc81de9f0a2
ORCID for Simon Fraser: ORCID iD orcid.org/0000-0002-4172-4406

Catalogue record

Date deposited: 18 Aug 2022 16:30
Last modified: 19 Dec 2023 02:45

Export record

Altmetrics

Contributors

Author: Kate S.H. Matthews
Author: Susannah C. Rennoldson
Author: Simon Fraser ORCID iD

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×