Thirty-two studies were included (3,941 patients, range 26 to 544). Eight studies were judged to be of high methodological quality. Mean length of follow-up was 10.1 months (range one to 24 months).
Complex interventions were associated with a reduction in urgent healthcare use (OR 0.68, 95% CI 0.57 to 0.80; 32 studies; Ι²=37.4% indicating moderate heterogeneity). Subgroup analyses found that complex interventions that included education (OR 0.66, 95% CI 0.55 to 0.81; 28 studies; Ι² not reported), exercise (OR 0.60, 95% CI 0.48 to 0.76; 11 studies; Ι² not reported) and relaxation therapy (OR 0.48, 95% CI 0.33 to 0.70; four studies; Ι² not reported) were associated with a reduction in healthcare use.
Component effects were reported to be comparable in the subgroup analysis of studies with high methodological quality. Meta-regression found that the reductions in use of urgent care could not be attributed to any single intervention. Further subgroup analysis results were reported in the paper. Funnel plot analysis suggested a relative absence of small studies in which interventions showed an increase in urgent care use.