Care models in the management of haemophilia: a systematic review
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BackgroundHaemophilia care is commonly provided via multidisciplinary specialized management. To date, there has been no systematic assessment of the impact of haemophilia care delivery models on patient‐important outcomes.ObjectiveTo conduct a systematic review of published studies assessing the effects of the integrated care model for persons with haemophilia (PWH).Search methodsWe searched MEDLINE, EMBASE and CINAHL up to April 22, 2015, contacted experts in the field, and reviewed reference lists.Selection criteriaRandomized and non‐randomized studies of PWH or carriers, focusing mainly on the assessment of care models on delivery.Data collection and analysisTwo investigators independently screened title, abstract, and full text of retrieved articles for inclusion. Risk of bias and overall quality of evidence was assessed using Cochrane's ACROBAT‐NRSI tool and GRADE respectively. Relative risks, mean differences, proportions, and means and their variability were calculated as appropriate.Results27 non‐randomized studies were included: eight comparative and 19 non‐comparative studies. We found low‐ to very low‐quality evidence that in comparison to other models of care, integrated care may reduce mortality, hospitalizations and emergency room visits, may lead to fewer missed days of school and work, and may increase knowledge seeking.ConclusionOur comprehensive review found low‐ to very low‐quality evidence from a limited number of non‐randomized studies assessing the impact of haemophilia care models on some patient‐important outcomes. While the available evidence suggests that adoption of the integrated care model may provide benefit to PWH, further high‐quality research in the field is needed.
