Using A RE-AIM Framework to Evaluate the Impact of Shared Medical Appointments for Diabetes Mellitus: A Systematic Review and Meta-analysis

Background Diabetes is a major global health concern and a leading cause of morbidity and mortality. Shared medical appointment (SMA), an integrated treatment and health management service, is effective in improving the clinical and behavioral outcomes of people with diabetes (PWD). Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this review aimed to evaluate the impact of SMA on PWD treatment and management to inform the feasibility, scalability, and equity of future SMA implementation. Methods 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 up to February 2024. We performed meta-analyses for all RCTs using a random-effects model and presented Forrest plots and test statistics (Cochran's Q and I ² ) for heterogeneity analysis. Other results that did not lend themselves to quantitative analysis were summarized qualitatively. Results Forty-seven studies were included in the review. The SAM was a highly resource-demanded and complex intervention package. 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’ HbA1c and SBP levels and reduced healthcare costs. Discussion The available evidence suggests that the SMA was beneficial in improving PWD management and health outcomes among PWD. 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 sustainability of SMA intervention, especially in resource-limited settings, to improve its scalability and equity. Trial registration PROSPERO CRD42019134273