Does anxiety predict the use of urgent care by people with long term conditions? A systematic review with meta-analysis

Claire Blakeley,Amy Blakemore,Cheryl Hunter,Else Guthrie,Barbara Tomenson,Chris Dickens

doi:10.1016/j.jpsychores.2014.06.010

Abstract

ObjectiveThe 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. MethodsElectronic 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. Results8 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. ConclusionsAnxiety 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.

Highlights

Long term conditions (LTCs) are common and are associated with high healthcare costs
Four non-communicable, exemplar LTCs were chosen for the purposes of the review: chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), asthma and diabetes
Included adults with one or more of the following LTCs: diabetes, asthma, COPD, or CHD, presenting results independently to any further LTMCs not included in the review criteria

Summary

Introduction

Long term conditions (LTCs) are common and are associated with high healthcare costs. 50–80% of all healthcare spending is related to LTCs [1] with approximately 78% of the entire healthcare budget of the United States of America spent on providing healthcare for people with LTCs [2] and 69% of the healthcare budget in England allocated to the care of individuals with LTCs [3]. A disproportionate amount of healthcare costs are spent on urgent healthcare, some of which may be avoidable [4,5,6]. In the UK, there has been an increase in the use of urgent care over the last decade with an ever increasing number of patients presenting to Emergency Departments [7,8,9].

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Results

Conclusion