关键词: 糖尿病, 高血压, 全专结合, 随机对照实验, 系统评价

Abstract: Background While the effectiveness of multidisciplinary team-based care in chronic care management has been well-documented in high-income countries, evidence from China is limited. Objective To systematically evaluate the effect of multidisciplinary team-based care, collaboratively provided by hospital-based specialists and community-based generalists, on hypertension and diabetic outcomes in primary care settings in China. Methods A comprehensive literature search was conducted across nine databases, including both English and Chinese language journals, covering publications from July 2011 to October 2024. Two independent reviewers performed literature screening and data extraction, with consensus. The risk of bias and publication bias were assessed, and heterogeneity was evaluated using the Q-test and I² statistic. Fixed-effect and random-effect models were applied for meta-analysis. Subgroup analyses were conducted based on the participants’ mean age, gender ratio, disease duration, and intervention length. Statistical analysis was conducted using RevMan 5.4.1 and Stata 17.0 software. Results Seventeen randomized clinical trials (RCTs) with 21 591 patients were included, with 12 focusing on diabetes and 5 on hypertension. Meta-analysis results showed that, for diabetic patients, collaborative care significantly improved patient outcomes, including glycated hemoglobin (MD = -0.72, 95%CI = -0.96 to -0.48, P < 0.001), fasting blood glucose (MD = -0.84, 95%CI = -1.04 to -0.65, P < 0.001), and 2-hour postprandial blood glucose (MD = -1.12, 95%CI = -1.52 to -0.72, P < 0.001) compared to the control group. Similarly, hypertensive patients in the intervention group also showed significant improvements in systolic blood pressure (MD = -6.49, 95%CI = -7.53 to -5.44, P < 0.001) and diastolic blood pressure (MD = -6.00, 95%CI = -8.89 to -3.12, P < 0.001). However, except for systolic blood pressure, the I² values exceeded 50%. Subgroup analyses suggested that heterogeneity across studies due to variations in gender ratio, mean age, and intervention lengths. Egger's test indicates that there may be publication bias in glycated hemoglobin (P=0.003) and fasting blood glucose (P=0.002). Discussion The collaborative care provided by hospital-based specialists and community-based generalists significantly improved hypertension and diabetic patient outcomes in China’s primary care settings. Interprofessional collaborative care, especially between primary care physicians and hospital specialists, is crucial for optimal management of chronic diseases. High-quality and large community trials are needed to identify strategies to enhance an in-depth collaboration between hospital-based specialists and community-based generalists, thereby further improving population health and enhancing the efficiency of healthcare utilization.

Key words: Diabetes, Hypertension, General practitioner-specialty collaborative care, Randomized control trial, Systematic review