title: Does sharing care across the primary-specialty interface improve outcomes in chronic disease? A systematic review.
abstract: OBJECTIVE
  To determine the effectiveness of shared care interventions designed to improve the management of chronic disease across the primary-specialty care interface.
  
  
  METHODS
  Systematic review using the Cochrane Collaboration method.
  
  
  RESULTS
  Twenty studies were identified, 19 of which were randomized controlled trials. The majority of studies examined complex interventions and were of short duration. Results were mixed, with no consistent improvements in physical or mental health outcomes, psychosocial outcomes, hospital admissions, default or participation rates, recording of risk factors, and satisfaction with treatment. However, there were improvements in prescribing in the studies that considered this outcome. The methodologic quality of studies varied, with only a minority of studies of high-quality design. Cost data were limited and difficult to interpret across studies.
  
  
  CONCLUSIONS
  At present, there is insufficient evidence to support the introduction of shared care services into clinical practice. However, methodologic shortcomings, particularly inadequate length of follow-up, may account for this lack of evidence. Further research is needed to test models of collaboration across the primary-specialty care divide both in terms of effectiveness and sustainability over longer periods of time.
authors.affiliation: Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, AMNCH, Tallaght, Dublin 24, Ireland. susmith@tcd.ie
authors.forename: Susan M
authors.initials: SM
authors.lastname: Smith
authors.forename: Shane
authors.initials: S
authors.lastname: Allwright
authors.forename: Tom
authors.initials: T
authors.lastname: O'Dowd
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome