Managing Multimorbidity In Internal Medicine: A Meta-Analysis Of Interventions And Outcomes

Abstract

The existence of two or more chronic conditions at the same time is known as multimorbidity, and it poses a significant clinical and health system challenge globally. This meta-analysis evaluates the efficacy of interventions to improve outcomes for adults with multimorbidity by combining data from 25 high-quality studies published between 2001 and 2022. The selected studies included 18,764 participants and addressed digital health interventions, integrated care models, pharmacotherapy optimisation, and lifestyle and behavioural interventions. The findings show that lifestyle changes significantly reduced symptom burden (SMD = -0.29; 95% CI: -0.45 to -0.13), enhanced functional status (SMD = 0.30; 95% CI: 0.16 to 0.44), and enhanced health-related quality of life (Standardised Mean Difference [SMD] = 0.35; 95% Confidence Interval [CI]: 0.22 to 0.48).

Drug adverse events (OR = 0.55; 95% CI: 0.38 to 0.79), polypharmacy (Odds Ratio [OR] = 0.60; 95% CI: 0.45 to 0.80), and medication adherence (SMD = 0.40; 95% CI: 0.25 to 0.55) were all reduced by pharmacological interventions, particularly deprescribing and medication review. Hospitalisations (OR = 0.72; 95% CI: 0.58 to 0.90) and emergency visits (OR = 0.70; 95% CI: 0.55 to 0.89) significantly decreased when multidisciplinary care models were incorporated into treatment. Additionally, patient satisfaction (SMD = 0.38; 95% CI: 0.20 to 0.56) increased. The effects of digital health interventions on self-management (SMD = 0.37) and patient engagement (SMD = 0.33) were modest but encouraging. Subgroup analyses revealed higher intervention efficacy among older populations and in low- and middle-income nations. The consistency of these findings was confirmed using sensitivity and publication bias analyses.