Using the RE-AIM framework to evaluate the impact of shared medical appointments for diabetes mellitus: a systematic review and meta-analysis.

Abstract

Diabetes is a major global health concern. However, with proper treatment and management, individuals can lead healthy and fulfilling lives. Shared medical appointment (SMA), an integrated health service, effectively improves the clinical and behavioral outcomes of people living with diabetes (PLWD). Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this review aimed to evaluate the impact of SMA on PLWD treatment and management to inform the feasibility, sustainability, scalability, and equity of future SMA implementation. Eight electronic databases were searched for randomized controlled trials, non-randomized grouped controlled trials, pre/post studies, and interrupted time series model studies published in English and Chinese until February 2024. The information extraction was guided by the framework for outcome evaluation in implementation science, the RE-AIM framework. We performed meta-analyses for all randomized controlled trials (RCTs) using a random-effects model and presented Forrest plots and test statistics (Cochran's Q and I²) for heterogeneity analysis. Other results that did not lend themselves to quantitative analysis were summarized qualitatively. Forty-seven studies were included in the review. The studies were evaluated according to the RE-AIM framework, and most studies reported effectiveness well, while all other dimensions were poorly reported. Most studies demonstrated that SMA effectively improved patients' Hemoglobin A1c (HbA1c) and Systolic Blood Pressure (SBP) levels and reduced healthcare costs. However, the SMA was a highly resource-demanded and complex intervention package. The available evidence suggests that the SMA was beneficial in improving PLWD management and health outcomes among PLWD. However, its complexity would constrain its feasibility and scalability. Future research should assess the effect size of each intervention component and evaluate the implementation process, costs, and maintenance of SMA intervention, especially in resource-limited settings, to improve its sustainability, scalability, and equity.