Nurse-Led Interventions to Improve Health, Adherence, and Functional Outcomes in Adults and Older Adults With Multimorbidity: A Systematic Review of Randomized and Quasiexperimental Studies

Abstract

Objective: To synthesize evidence from randomized controlled trials (RCTs) and quasiexperimental studies evaluating the effectiveness of nurse-led interventions on health outcomes in adults and older adults with multimorbidity. Background: Multimorbidity presents complex healthcare challenges and worsened outcomes, especially in older adults. Nurse-led interventions are emerging as a strategic model to address these needs. Evaluating their effectiveness is essential for advancing evidence-based chronic care. Design: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Methods: Two reviewers independently screened studies according to refined inclusion criteria. Risk of bias was assessed using the Risk of Bias 2 tool for RCTs and the ROBINS-I tool for quasiexperimental studies. Data were synthesized using a convergent integrated approach, following the Joanna Briggs Institute methodology. Data Sources: Nursing & Allied Health Collection (ProQuest), PubMed, MEDLINE, ScienceDirect, and Scopus. Results: Thirteen studies met the inclusion criteria. Nurse-led interventions, delivered in person, via telephone, or through digital platforms, were effective in improving care quality, medication adherence, self-management, self-efficacy, and select biophysical indicators such as blood pressure and glucose levels. Some studies also reported reductions in hospital readmissions and mortality. Thematic synthesis revealed four major domains of benefit: health outcomes, self-management and adherence, health functioning, and support and healthcare utilization. Conclusion: Nurse-led interventions contribute to improved health outcomes in adults with multimorbidity by supporting adherence, self-care, and key clinical indicators. These findings highlight the crucial role of nurses in delivering integrated, patient-centered care, supporting their inclusion in chronic disease management strategies. Implications for the Profession or Patient Care: The results highlight nurses’ key role in coordinating and delivering effective care. By promoting self-management and adherence, nurse-led models serve as a foundation for managing complex chronic conditions. Broader implementation can improve outcomes and reduce healthcare burdens.