Introduction Task-shifting and task-sharing strategies show promise for managing chronic diseases especially in low-income and middle-income countries(LMICs),though their effectiveness in multimorbidity management rem...Introduction Task-shifting and task-sharing strategies show promise for managing chronic diseases especially in low-income and middle-income countries(LMICs),though their effectiveness in multimorbidity management remains unclear.This study synthesised evidence on task-shifting and task-sharing strategies globally and assessed the impact on core health outcomes in multimorbidity management.Methods We conducted a systematic review and meta-analysis of global studies evaluating task-shifting and sharing interventions for individuals with multimorbidity.Six databases,including PubMed,Embase,Web of Science,Ovid(Medline),CINAHL and Cochrane Library,were searched for studies reporting the core outcomes of multimorbidity management in quality of life,mortality,hospitalisation,emergency department visits and symptoms of depression and anxiety.Random-effects models were used to calculate pooled effect sizes with heterogeneity assessed through subgroup and meta-regression analyses.Results From 8471 records,36 studies from 14 countries were included,with only 5 conducted in LMICs.Twenty-one studies,encompassing 20989 participants,were eligible for meta-analysis.More than half of the studies involved nurses as delegates,with some sharing the tasks with health professionals and about 10%of studies involved non-health professionals,including community healthcare workers as delegates to share the responsibility in caring for individuals with multimorbidity.Most studies were multicomponent,with 16.7%addressing all guideline-recommended aspects of multimorbidity management.By pooling the findings,task-shifting and task-sharing interventions were associated with a 27%reduction in mortality(OR:0.73,95%CI:0.55 to 0.97,I2=0%),a modest improvement in quality of life(standardised mean difference(SMD):0.1,95%CI:0.03 to 0.17,I2=47%)and reduced symptoms of depression(SMD:0.27,95%CI:−0.52 to–0.02,I2=90%),but showed no significant effect on hospitalisation,emergency visits or anxiety-related symptoms.展开更多
基金supported by the National Key R&D programprogramme of China(Grant No.2023 YFC 3605002)Noncommunicable Chronic Disease National Science and Technology Major Project(Grant No.2023ZD0506001)+1 种基金the CAMS Innovation Fund for Medical Sciences(ClFMS)(Grant No.2025-I2M-KJ-029)the non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(Grant No.2022-ZHCH330-01).
文摘Introduction Task-shifting and task-sharing strategies show promise for managing chronic diseases especially in low-income and middle-income countries(LMICs),though their effectiveness in multimorbidity management remains unclear.This study synthesised evidence on task-shifting and task-sharing strategies globally and assessed the impact on core health outcomes in multimorbidity management.Methods We conducted a systematic review and meta-analysis of global studies evaluating task-shifting and sharing interventions for individuals with multimorbidity.Six databases,including PubMed,Embase,Web of Science,Ovid(Medline),CINAHL and Cochrane Library,were searched for studies reporting the core outcomes of multimorbidity management in quality of life,mortality,hospitalisation,emergency department visits and symptoms of depression and anxiety.Random-effects models were used to calculate pooled effect sizes with heterogeneity assessed through subgroup and meta-regression analyses.Results From 8471 records,36 studies from 14 countries were included,with only 5 conducted in LMICs.Twenty-one studies,encompassing 20989 participants,were eligible for meta-analysis.More than half of the studies involved nurses as delegates,with some sharing the tasks with health professionals and about 10%of studies involved non-health professionals,including community healthcare workers as delegates to share the responsibility in caring for individuals with multimorbidity.Most studies were multicomponent,with 16.7%addressing all guideline-recommended aspects of multimorbidity management.By pooling the findings,task-shifting and task-sharing interventions were associated with a 27%reduction in mortality(OR:0.73,95%CI:0.55 to 0.97,I2=0%),a modest improvement in quality of life(standardised mean difference(SMD):0.1,95%CI:0.03 to 0.17,I2=47%)and reduced symptoms of depression(SMD:0.27,95%CI:−0.52 to–0.02,I2=90%),but showed no significant effect on hospitalisation,emergency visits or anxiety-related symptoms.
