Effectiveness of Continuity of Care Interventions Linking Hospital Care to Primary Healthcare for Patients With...

The growing burden of cancer necessitates continuity of care interventions linking hospital and primary health care (PHC). However, optimal approaches for improving effectiveness and for enhancing care coordination of PHC integration remain unclear.

A systematic review with meta-analysis was conducted. Six databases including PubMed, Embase, Web of Science, CINAHL, CENTRAL, and PsycInfo were searched for full texts of randomized or non-randomized controlled trials (RCTs or nRCTs) from January 2000 to January 2024. Patient-reported outcomes (quality of care, psychological status), quality of care (adverse events, perceived continuity of care, and satisfaction), healthcare utilization (hospitalization, PHC use, length of stay and emergency visits), and cost evaluation were synthesized. A random-effects model was used for data analysis, and exploratory subgroup analyses based on intervention characteristics were conducted. Risk of bias was evaluated by using Cochrane Collaboration's Risk of Bias handbooks of RCTs, or Cochrane Risk of Bias Assessment Tool for nRCTs. Intervention strategies aimed at addressing the continuity of care dimensions were synthesized through a deductive approach.

Twenty eight studies from 23 unique interventions were included in the study, all conducted in high-income countries. Information continuity demonstrated the most effective practice, while management continuity received less emphasis. The overall effect size for quality of life was insignificant (standard mean difference [SMD] 0.01, 95% CI -0.04, 0.05), whereas satisfaction with care was marginally improved in intervention groups (SMD = 0.09, 95% CI 0.01, 0.18). Potential beneficial effects in reduced healthcare utilization and economic savings warrant further study.

Continuity of care interventions by integrating PHC into cancer care is overall not inferior to specialist-led care. Further efforts to enhance the management continuity dimension of intervention and extend initiatives beyond high-income countries are warranted.

PROSPERO registration number CRD42023473024.