title: Does anxiety predict the use of urgent care by people with long term conditions? A systematic review with meta-analysis.
abstract: OBJECTIVE
  The role of anxiety in the use of urgent care in people with long term conditions is not fully understood. A systematic review was conducted with meta-analysis to examine the relationship between anxiety and future use of urgent healthcare among individuals with one of four long term conditions: diabetes; coronary heart disease, chronic obstructive pulmonary disease and asthma.
  
  
  METHODS
  Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane Library were conducted These searches were supplemented by hand-searching bibliographies, citation tracing eligible studies and asking experts within the field about relevant studies. Studies were eligible for inclusion if they: a) used a standardised measure of anxiety, b) used prospective cohort design, c) included adult patients diagnosed with coronary heart disease (CHD), asthma, diabetes or chronic obstructive pulmonary disease (COPD), d) assessed urgent healthcare use prospectively. Data regarding participants, methodology, and association between anxiety and urgent care use was extracted from studies eligible for inclusion. Odds ratios were calculated for each study and pooled using random effects models.
  
  
  RESULTS
  8 independent studies were identified for inclusion in the meta-analysis, with a total of 28,823 individual patients. Pooled effects indicate that anxiety is not associated with an increase in the use of urgent care (OR=1.078, p=0.476), regardless of the type of service, or type of medical condition.
  
  
  CONCLUSIONS
  Anxiety is not associated with increased use of urgent care. This finding is in contrast to similar studies which have investigated the role of depression as a risk factor for use of urgent care.
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, UK. Electronic address: claire.blakeley@mhsc.nhs.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Blakeley
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, UK; NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Sciences Centre, University of Manchester, Williamson Building, Oxford Road, M13 9WL, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Blakemore
authors.affiliation: Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Oxford OX3 7LF, UK.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Hunter
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, UK.
authors.forename: Else
authors.initials: E
authors.lastname: Guthrie
authors.affiliation: Biostatistics Unit, Institute of Population Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.affiliation: Mental Health Research Group, University of Exeter Medical School, UK; National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research & Care (CLAHRC) for the South West Peninsula (PenCLAHRC), UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Dickens
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001007:Anxiety / Q000150:complications*; D001249:Asthma / Q000628:therapy*; D002908:Chronic Disease; D003327:Coronary Disease / Q000628:therapy*; D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012307:Risk Factors
keywords: Anxiety; Chronic obstructive pulmonary disease; Coronary heart disease; Diabetes' asthma; Long term conditions; Urgent care