This study cannot definitively say whether psychological or physiological changes brought about by the PEPR programme were responsible for the change in healthcare utilisation. It is clear that most of the patients in the PEPR group had frequent contact with healthcare professionals over the reporting period. A meta-analysis of smaller heterogenous randomised controlled studies reported a pooled OR for readmission of 0.13, similar to that observed here.16 The PEPR interventions included in this meta-analysis were a mixture of inpatient, outpatient and home-based interventions; interestingly, the latter did not demonstrate a reduction in readmissions.