Title:
Complex interventions that reduce urgent care use in COPD: a systematic review with meta-regression.

Abstract:
Chronic obstructive pulmonary disease is common and accounts for considerable healthcare expenditure. A large proportion of this healthcare expenditure is attributable to the use of expensive urgent healthcare. The characteristics of interventions that reduce the use of urgent healthcare remain unclear.
To examine the characteristics of complex interventions intended to reduce the use of urgent and unscheduled healthcare among people with COPD.
Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane library, from inception to 25th January 2013 were conducted. These were supplemented by hand-searching bibliographies and citation tracing identified reviews and eligible studies.
Studies were eligible for inclusion if they: i) included adults with chronic obstructive pulmonary disease, 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 the subjects recruited, trial methods used, the characteristics of complex interventions and the effects of the intervention on urgent healthcare utilisation were extracted from eligible studies.
32 independent studies were identified. Pooled effects indicated that interventions were associated with a 32% reduction in the use of urgent healthcare (OR = 0.68, 95% CI = 0.57, 0.80). When study effects were grouped according to the components of the interventions used, significant effects were seen for interventions that included general education (OR = 0.66, 95% CI = 0.55, 0.81), Exercise (OR = 0.60, 95% CI = 0.48, 0.76) and relaxation therapy (OR = 0.48, 95% CI = 0.33, 0.70).
Use of urgent healthcare in patients with COPD was significantly reduced by complex interventions. Complex interventions among people with COPD may reduce the use of urgent care, particularly those including education, exercise and relaxation.