Health Care Evaluation Studies

SYSTEMATIC REVIEW CRITICAL APPRAISAL WORKSHEET

You are to respond to each question completely using the article (cited once to establish which article you have selected and put in your reference list) and using appropriately cited external resources as needed (e.g., your text books).

What question did the systematic review address?

The question this review sought to address was the significance of the impact of IPC interventions on the management of chronic patients compared to usual care.

Were important, relevant studies missed?

The study looked at studies in which Randomized Controlled Trials (RCTs) on IPC interventions on chronicity management and their impact on clinical and process outcomes were conducted. The search and inclusion criteria included the PICO domain elements: (P) Chronic condition, (I) IPC, (C) usual care and (O)impact on clinical outcomes, process outcomes and patients reported outcomes. The researchers defined their keywords as “chronic disease”, “chronic condition”, “chronic illness”, “interprofessional collaboration”, “interprofessional team”, “Outcome and Process Assessment”, “effect” and their synonymous through Boolean operators “AND” and “OR” (Pascucci et al., 2021). Exclusion criteria were also defined in the search as: Psychiatric disorders, palliative care and chronic functional pain (Pascucci et al., 2021). No language restrictions were used for the search, and the electronic databases, EMBASE, ISIWeb of Knowledge, MEDLINE, from their inception to April 2020, were used.

This paper: Yes x No Unclear

Rationale for your response:

Systematic reviews should clearly state the inclusion and exclusion criteria used to guide their search for research to ensure that only relevant studies are included in the review. This study does that, as shown above.

Were the criteria used to select articles for inclusion appropriate?

Yes, the criteria used to select articles for inclusion were appropriate. The criteria included the relevance of the article to the research topic, the quality of the research, and whether or not the article was peer reviewed. These criteria are important for ensuring that only high-quality, relevant research is included in a systematic review.

This paper: Yes x No Unclear

Rationale for your response:

The authors used a systematic approach that identified all relevant studies from the literature and then applied specific criteria to filter out lower quality studies. This approach ensured that only the most relevant and reliable studies were included, providing a comprehensive review of the available evidence. Additionally, they employed explicit criteria to evaluate study quality, which further increased the trustworthiness of their findings.

Were the included studies sufficiently valid for the type of question asked?

Yes, the included studies provided valid data and information that was relevant to the question asked. The studies were well-designed and conducted in accordance with established research protocols. Additionally, the results of the studies were adequately analyzed and interpreted in order to draw meaningful conclusions.

This paper: Yes x No Unclear

Rationale for your response:

The included studies were sufficiently valid for the type of question asked. The studies used a randomized controlled trial design which is the gold standard for testing the efficacy of interventions. Furthermore, they used a large sample size and followed up with participants over time to measure any long-term effects of the intervention. Additionally, they employed blinding techniques to reduce bias in outcome measurements. All of these factors indicate that the studies were well designed and thus their results can be trusted.

Were the results similar from study to study?

The authors noted that “the most frequently met quality criteria regarded randomization criteria, power calculation and the use of intention-to-treat analysis. A number of items were rarely reported, including those regarding adherence to treatment or avoiding other intervention” (p. 193). For instance, the authors conducted statistical analysis of results of studies looking at systolic blood pressure and found that “no statistically significant effect of the intervention of SBP was shown. Instead, a statistically significant effect of the intervention was found by including in the analysis only studies with a follow up < 12 month” (p. 194).

This paper: Yes x No Unclear

Rationale for your response:

No. Results differed depending on quality of the methodology. For example, some studies used different methods to measure the same outcome, or had different sample sizes, which could lead to varying results. Additionally, different studies had different goals or research questions that may have led to varied results.

What were the results?

The researchers found strong evidence supporting the decrease in smoking with moderate evidence documenting an improvement for clinical process outcomes: influenza vaccination coverage and diabetic foot examination. They also found insufficient evidence supporting IPC regarding mortality, incidence of ESRD, retinal examination, medication adherence, and PROs, through the application of the rating system, due to inconsistent findings (Pascucci et al., 2021, p. 199).

How are the results presented?

Results were presented in tables (5 total) and were discussed. Table 1 presented data on Meta-analysis of the reduction of blood pressure levels stratified by patient condition; study sample size; duration of the follow-up; presence of pharmacist in the team; drop-out rate at endpoint 20 % or lower; participants and providers blinded; patient education about their condition as a part of the intervention ; motivational support as a part of the intervention; Table 2 showed reduction of glycosylated hemoglobin levels stratified by patient condition; study sample size; duration of the follow-up; presence of pharmacist in the team; drop-out rate at endpoint 20 % or lower, and so on.

How can I apply the results to patient care?

Discuss whether all patient-important outcomes were considered.

Yes, insofar as the study was concerned; factors considered included medication adherence, patient-reported outcomes, mortality, etc. However, it is possible that there may be other important outcomes (e.g., quality of life, functional status) that were not considered in the study. However, the researchers did note some limitations with regard to “greater specificity about the frequency of team meetings, the mode of team communication (e.g. in person team meetings, how often teams consulted with each other, other types of contact, etc.) as well as the roles and responsibilities of the team members” and how having this data would be useful in supporting “any future decision related to staffing, reimbursement or quality assurance” (Pascucci et al., 2021, p. 199).