Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis

This systematic review and meta-analysis included 10 randomised controlled trials from 11 publications, enrolling 4864 participants from six SSA countries. Studies featured integrated care models with at least two elements of Wagner's chronic care model. A random-effects meta-analysis of six studies with 1754 participants found integrated care conferred a moderately lower mean systolic blood pressure compared with standard care, with a mean difference of −4.85 mm Hg (95% CI −7.37 to −2.34) and a Hedges' g of −0.25 (95% CI −0.39 to −0.11). The overall GRADE evidence quality was moderate. Structured synthesis of the remaining studies showed mixed results for HbA1c, depression, medication adherence, and quality of life. Limitations included heterogeneity in multimorbidity definitions, interventions, follow-up periods, and outcome assessment, which restricted meta-analysis to only 6 of 10 studies. Most included studies implemented two to three CCM elements, which may partly explain inconsistent effects on secondary outcomes.