PEARLS 47, November 2007, written by Brian R McAvoy

Clinical question
How effective are shared health service interventions across the interface between primary and specialty 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 (2 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 specialty 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.

Cochrane Systematic Review
Smith SM et al. Effectiveness of shared care across the interface between primary and speciality care in chronic disease management. Cochrane Reviews 2007. Issue 3 Article No. CD004910. DOI: 10.1002/14651858.CD009410.pub.2. Note: This review contains 20 studies involving 8902 participants.