Limited benefits from shared care in chronic disease management

Clinical question: 
How effective are shared health service interventions across the interface between primary and speciality care in chronic disease management?
Bottom line: 
Shared care had a clear effect on improving appropriate prescribing and medication adherence and use, but the pattern of results was mixed for all other outcomes.
Caveat: 
The lack of evidence may be partially due to methodological shortcomings, particularly inadequate length of follow up (two years or less). Patient or client involvement was lacking in the majority of studies. Most studies involved complex, multifaceted interventions and it was often difficult to determine the contribution of each component. Future studies need to be of adequate size and length to test the effectiveness and sustainability of shared care interventions over time and should take into account the complexity of such interventions.
Context: 
Shared care has been described as the joint participation of primary care and speciality care physicians in the planned delivery of care, informed by an enhanced information exchange over and above routine discharge and referral notices. It has the potential to improve the management of chronic diseases leading to better outcomes.
Review CD#: 
CD004910
PEARLS No: 
47
Date: 
November, 2007
Authored by: 
Brian R McAvoy