Healthcare interventions to improve health outcomes for racially/ethnic minoritised people with multiple long-term conditions: a systematic review and narrative synthesis

Background
Racially/ethnic minoritised people with multiple long-term conditions (MLTCs) face inequalities across different dimensions of healthcare, yet little is known about how to improve their healthcare outcomes. This systematic review and narrative synthesis seeks to identify and describe healthcare interventions designed to improve health outcomes for racially/ethnic minoritised people with MLTCs and identify areas for further exploration. Given that primary care is considered the ideal setting to manage MLTCs, we focus on interventions targeted at healthcare providers/systems.

Methods
We searched 9 bibliographic databases and one website and identified 6566 studies, 15 of which met the inclusion criteria. Given the heterogeneity of interventions, health conditions and outcomes of interest, we conducted a narrative synthesis.

Results
The studies were conducted in the US (n = 13), Canada (n = 1) and Australia (n = 1). Most studies recruited racially/ethnic minoritised people mainly of African American and Hispanic/Latinx descent with comorbid Depression and a physical condition (Diabetes (n = 3), Hypertension (n = 3), Cancer (n = 2). Depression/mental health outcomes, patient-reported outcomes, clinical outcomes, medication use, and adherence were the most frequently assessed outcomes. Few studies reported on provider-related outcomes. All interventions made socio-cultural adaptations, thereby, promoting equitable and inclusive care. Community actors/assets were considered key to improving health outcomes. Of the 15 interventions, five resulted in statistically significant improvements in all outcomes of interest and nine resulted in improvements in some outcomes.

Conclusions
This review illustrates the feasibility of socio-culturally adapted interventions, many of which successfully integrate physical and mental healthcare, delivered through multidisciplinary teams working collaboratively, and leveraging community assets to improve health outcomes for racially/ethnic minoritised people with MLTCs. Future research is needed to assess the impact of these interventions beyond North America and Australia. Studies are also required to identify provider-related outcomes with the potential to improve outcomes for racially/ethnic minoritised people with MLTCs.