A Systematic Review of Interventions that Use Multidisciplinary Team Meetings to Manage Multimorbidity in Primary Care

Introduction: Multidisciplinary team (MDT) meetings could facilitate coordination of care for individuals living with multimorbidity, yet there is limited evidence on their effectiveness. We hence explored the common characteristics of MDT meetings in primary care and assessed the effectiveness of interventions that include such meetings, designed to improve outcomes for adults living with multimorbidity. Methods: A systematic review of literature was conducted using MEDLINE and EMBASE. A narrative synthesis was performed, extracting study and MDT meeting characteristics, in addition to any outcomes reported. Results: Four randomised controlled trials that were conducted in the United States of America were identified as eligible, recruiting a total of 3,509 adults living with multimorbidity. Common MDT meeting themes include regular frequency of discussion, the absence of patient involvement and the participation of three or four multiprofessionals. Significant improvements were observed in response to interventions with an MDT component across most measures, yet this trend did not extend to physical health outcomes. Discussion: It is unclear if the results in this review are sufficient to support the widespread implementation of MDT meetings in primary care, for adults living with multimorbidity. Due to the paucity of studies collated, further research is required to inform widespread implementation.

Specify all databases, registers, websites, organisations, reference lists and other sources search or consulted to identify studies. Specify the date when each source was last searched or consulted.

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Search Strategy 7 Present the full search strategies for all databases, registers, and websites, including any fillers and limits used.

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Selection process 8 Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screed each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.

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Data collection process 9 Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.

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Data items 10a List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome in each study were sought (e.g., for all measures, time points, analyses), and if not, the methods used to decide which results to collect 5 10b List and define all other variables for which data were sought (e.g., participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear data.

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Study risk of bias assessment 11 Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they voted independently, and if applicable, details of automation tools used in the process.

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Effect measures 12 Specify for each outcome the effect measure(s) (e.g., risk ratio, mean difference) used in the synthesis or presentation of results

Synthesis methods
13a Describe the processes used to decide which studies were eligible for each synthesis (e.g., tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)) 5 13b Describe any methods required to prepare the data for presentation or synthesis such as handling of missing summary statistics, or data conversions 5 13c Describe any methods used to tabulate or visually display results of individual studies and syntheses 5 13d Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed, describe the mode(s), method(s) to identify the presence and extent of statistical heterogeneity, and software 5/6 package(s) used. 13e Describe any methods used to explore the probable causes of heterogeneity among study results (e.g., subgroup analysis, meta-regression) -13f Describe any sensitivity analyses conducted to assess robustness of synthesised results

Reporting bias assessment
14 Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases) -Certainty assessment 15 Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome -

Results
16a Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram

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16b Cite studies that might appear to meet the inclusion criteria, but which were excluded 6 Study characteristics 17 Cite each included study and present its characteristics 6 Risk of bias in studies 18 Present assessments of risk of bias for each included study 4/5

Results of individual studies
19 For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (B) an effect estimates and its precision (e.g., confidence/credible interval) , ideally using structured tables or plots 9/10/11

Results of syntheses
20a For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies

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20b Present results of all statistical syntheses conducted. If meta-analysis was done, present for each the summary estimate and its precision (e.g. confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction of the effect. 24a Provide registration information for the review, including register name and registration number, or state that the review was not registered -24b Indicate where the review protocol can be accessed or state that the protocol was not prepared -24c Describe and explain any amendments to information provided at registration or in the protocol. Availability of data, code, and other materials 27 Report which of the following are publicly available and where they can be found template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review