Abstract
OBJECTIVES: To assess the effectiveness of community-based interventions for adults with multimorbidity on clinical and patient-centred outcomes, and to examine contextual factors influencing their impact in primary care and community settings. DESIGN: Systematic review. DATA SOURCES: PubMed/MEDLINE, Embase, Web of Science, Cochrane CENTRAL, China National Knowledge Infrastructure, WanFang Data and SinoMed were searched up to May 2025. Grey literature and trial registries were also searched. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs), quasi-experimental studies and comparative observational studies involving adults (≥18 years) with multimorbidity, defined as ≥2 chronic conditions including at least one of hypertension, diabetes or dyslipidaemia. Interventions had to be delivered in primary care or community settings and report at least one clinical or patient-centred outcome. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data and assessed risk of bias using the Cochrane RoB 2.0 and ROBINS-I tools. Due to heterogeneity in interventions and outcomes, results were synthesised narratively following the Synthesis Without Meta-analysis guidelines. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: 25 studies were included, comprising 19 RCTs and 6 quasi-experimental or observational designs. Interventions included nurse-led or multidisciplinary care (n=13), integrated or collaborative care (n=8) and digital health models (n=5). Clinical outcomes such as blood pressure, HbA1c or lipids were assessed in 10 studies, with 7 reporting significant improvements, 6 identifying subgroup-specific benefits and 3 reporting mixed or null effects. Patient-centred outcomes were reported in all studies; quality of life improved in 10 of 13 studies, self-management in 6 of 9 and healthcare use was reduced in 7 of 11. CONCLUSIONS: Community-based interventions for multimorbidity consistently improve patient-centred outcomes, while clinical effects are more variable and context-dependent. Tailored implementation for high-risk groups and attention to local delivery models may enhance effectiveness. Further research is needed to support equity-focused, long-term implementation. PROSPERO REGISTRATION NUMBER: CRD420251159790.