A mixed-methods systematic review of nurse-led interventions for people with multimorbidity.
Chris McParland, Bridget Johnston, Mark Cooper
PMID 36065516WHAT IT FOUND
Nurse-led care for people with multiple long-term conditions improved patient-centred outcomes like satisfaction, self-management, pain, and quality of life.
However, it did not consistently reduce hospital admissions, emergency visits, costs, or mortality. Effects varied by intervention type and setting.
Key findings
01Case management improved patient-centred outcomes like quality of life and self-management but had mixed effects on healthcare use and costs.
02Transitional care interventions showed positive effects on healthcare use, but reductions in readmission were not always sustained over time.
03Self-management support did not improve mental health or self-efficacy, and achieved only cost-neutrality rather than savings.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only three randomized controlled trials were included; most studies were quasi-experimental or retrospective cohorts, which are more prone to bias. Interventions were highly complex, averaging 5.75 components, so it is impossible to tell which specific part of the nursing care drove any improvement. Heterogeneity in multimorbidity definitions and outcome measures prevented meta-analysis or formal certainty grading. Only English-language studies were included, potentially missing relevant international evidence. Qualitative studies often lacked reflexivity or theoretical grounding, limiting the transferability of those findings.
Declared interests
The study was funded by NHS Greater Glasgow and Clyde as part of the first author's PhD fellowship. No other conflicts of interest were declared.
The easy way to misread this
Do not conclude that nurse-led multimorbidity care reliably reduces hospital readmissions or costs. The review found these outcomes to be mixed or unaffected in most large studies, even where patient satisfaction and quality of life improved.