INTRODUCTION: 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. METHOD: 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 to 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 to 0.86) and relapse prevention (OR 0.75, 95% CI 0.57 to 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.

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