title: Complex interventions reduce use of urgent healthcare in adults with asthma: systematic review with meta-regression.
abstract: BACKGROUND
  Asthma accounts for considerable healthcare expenditure, a large proportion of which is attributable to use of expensive urgent healthcare. This review examines the characteristics of complex interventions that reduce urgent healthcare use in adults with asthma.
  
  
  METHODS
  Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane library, from inception to January 2013 were conducted. Studies were eligible for inclusion if they: i) included adults with asthma ii) assessed the efficacy of a complex intervention using randomised controlled trial design, and iii) included a measure of urgent healthcare utilisation at follow-up. Data on participants recruited, methods, characteristics of complex interventions and the effects of the intervention on urgent healthcare use were extracted.
  
  
  RESULTS
  33 independent studies were identified resulting in 39 comparisons altogether. Pooled effects indicated that interventions were associated with a reduction in urgent healthcare use (OR = 0.79, 95% CI = 0.67, 0.94). When study effects were grouped according to the components of the interventions used, significant effects were seen for interventions that included general education (OR = 0.77, 95% CI = 0.64, 0.91), skills training (OR = 0.64, 95% CI = 0.48, 0.86) and relapse prevention (OR = 0.75, 95% CI = 0.57, 0.98). In multivariate meta-regression analysis, only skills training remained significant.
  
  
  CONCLUSIONS
  Complex interventions reduced the use of urgent healthcare in adults with asthma by 21%. Those complex interventions including skills training, education and relapse prevention may be particularly effective in reducing the use of urgent healthcare in adults with asthma.
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK; National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK. Electronic address: amy.blakemore@manchester.ac.uk.
authors.forename: Amy
authors.initials: A
authors.lastname: Blakemore
authors.affiliation: Institute of Health Research, University of Exeter Medical School and Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), University of Exeter, Veysey Building, Room 007, Salmon Pool Lane, Exeter, EX2 4SG, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Dickens
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Anderson
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: Institution of Inflammation and Repair, University of Manchester, 2nd Floor Education and Research Centre, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Woodcock
authors.affiliation: Department of Psychiatry, Manchester Mental Health and Social Care Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
authors.forename: Else
authors.initials: E
authors.lastname: Guthrie
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001249:Asthma / Q000628:therapy*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male
keywords: Asthma; Complex interventions; Long-term conditions; Urgent healthcare