Summary of findings for the main comparison. Patient‐initiated appointment systems compared with consultant‐led appointment systems for people with chronic conditions.

Patient‐initiated appointment systems compared with consultant‐led appointment systems for people with chronic conditions
Patient or population: adults with a chronic or recurrent condition Settings: secondary care Intervention: patient‐initiated appointment systems Comparison: consultant‐led appointment systems
Outcomes	Relative effect (95% CI)	No of participants (studies)	Certainty of the evidence (GRADE)	Comments
Patient outcomes: anxiety (HADS)a 12–24 months	OR 0.87 (0.68 to 1.12)	1019 (5)	⊕⊕⊝⊝ Lowb	7 studies reported anxiety, 2 could not be included in the analysis due to data available, but findings appeared consistent. Heterogeneity in health condition (cancer, psoriasis and RA), participants and follow‐up.
Patient outcomes: depression (HADS)a 9–24 months	OR 0.79 (0.51 to 1.23)	1835 (6)	⊕⊕⊝⊝ Lowb	7 studies reported depression, 1 could not be included in the analysis due to data available, but findings appeared consistent. Heterogeneity in health condition (cancer, RA, psoriasis and IBD), participants and follow‐up.
Patient outcomes: quality of life (different scales used across studies) 12–18 months	SMD 0.12 (0.00 to 0.25)	1486 (7)	⊕⊕⊝⊝ Lowb	12 studies reported quality of life, 5 could not be included due to data available, but where some data were available findings appeared consistent. Heterogeneity in health condition (asthma, IBD, psoriasis, RA and cancer) and tools used to measure quality of life.
Service utilisation (contacts) 12 months	Contact rate ratio ranged from 0.68 to 3.83 (median rate ratio 1.11, IQR 0.93 to 1.37)	3348 (15)	⊕⊕⊝⊝ Lowc	Studies included different elements of service contact in their data, and may expect contact to vary across health condition.
Service utilisation (costs) per patient per year	Studies reported the intervention group may have had higher or lower costs than the control group.	2235 (8)	⊕⊝⊝⊝ Very lowd	Studies included different elements of service costs in their data, data were presented in different currencies and it may be expected that service costs vary across health condition.
Adverse events – relapse 12–60 months	MD –0.20 (–0.54 to 0.14)	888 (3)	⊕⊕⊝⊝ Lowe	5 studies reported adverse events as relapse or recurrence, 2 could not be included in the analysis due to data available but findings appeared consistent. Each study used different questions/definitions to collect their data at difference time points and across different health conditions (inflammatory bowel disease and cancer).
Patient satisfaction 6–72 months	SMD 0.05 (–0.41 to 0.52)	375 (2)	⊕⊕⊝⊝ Lowf	12 studies reported patient satisfaction, 10 could not be included in the analysis due to data available but findings appeared broadly consistent. Each study used different questions to collect their data at different time points and across different health conditions. No studies reported on clinician satisfaction.
CI: confidence interval; HADS: Hospital Anxiety and Depression Scale; IBD: inflammatory bowel disease; IQR: interquartile range; MD: mean difference; OR: odds ratio; RA: rheumatoid arthritis; SMD: standardised mean difference.
GRADE Working Group grades of evidence High‐certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate‐certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low‐certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low‐certainty: we are very uncertain about the estimate.

^aAnxiety and depression (HADS) was pooled as dichotomous data using the score of 10 as the cut point as identified in two of the papers, continuous data were converted to dichotomous data as no other data could be retrieved from the papers presenting dichotomous data for these outcomes.
 ^bDowngraded two levels due serious risk of bias (lack of blinding, incomplete and selective reporting) and serious imprecision (wide confidence intervals).
 ^cDowngraded two levels due to serious risk of bias (lack of blinding) and serious indirectness (different levels of contact reported across studies); consistency and precision difficult to assess.
 ^dDowngraded three levels due to serious risk of bias (due to incomplete data), serious indirectness (as different currencies and levels of costs reported across studies) and serious imprecision.
 ^eDowngraded two levels due to serious risk of bias (lack of blinding, selective reporting) and serious imprecision (wide confidence intervals).
 ^fDowngraded two levels due to serious risk of bias (lack of blinding) and serious indirectness as satisfaction was measured and reported differently across studies; consistency and precision difficult to assess.