Faculty of Medicine, University of Southampton, Southampton.
Br J Gen Pract. 2022 Dec 21;73(726):e59-e66. doi: 10.3399/BJGP.2022.0066. Print 2023 Jan.
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.
To establish whether changes in organisation and delivery of health systems and services improve aspects contributing to treatment burden for people with multiple LTCs.
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.
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.
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.
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.
治疗负担是一个以患者为中心的概念，描述了人们照顾自己健康所需的努力，以及这对他们的功能和幸福感的影响。患有多种慢性疾病（LTCs）的人更有可能面临高治疗负担。现已有经过验证的治疗负担衡量标准，但尚未在实践中或作为研究结果广泛使用。
确定卫生系统和服务组织和提供方式的改变是否改善了对患有多种 LTCs 的人治疗负担产生影响的方面。
系统评价随机对照试验（RCTs），调查系统层面干预对成年人中至少一个与先前定义的治疗负担领域相关的结果的影响，这些成年人患有≥2 种 LTCs。
使用 Embase、Ovid MEDLINE 和 Web of Science 电子数据库，搜索与多疾病、系统层面变化和治疗负担相关的术语，这些术语的文献发表时间为 2010 年 1 月至 2021 年 7 月。治疗负担领域来自经过验证的衡量标准和定性文献。采用无荟萃分析的综合方法（SWiM）来综合结果，并使用 Cochrane 偏倚风险（第 2 版）工具评估研究质量。
检索共确定了 1881 篇文章，其中 18 篇符合综述纳入标准。结果被分为七个领域。有一些证据表明系统层面干预对某些领域有影响，但研究存在很大的异质性，限制了结果的综合。对偏倚的一些担忧降低了对研究结果的信心。
系统层面的干预措施可能会影响一些治疗负担领域。然而，在未来的研究中采用标准化的结果集，纳入经过验证的治疗负担衡量标准，并为护理过程制定标准定义，将有助于提高研究的可比性。
