Integrating case-finding and initial management for osteoarthritis, anxiety, and depression into primary care long-term condition reviews : results from the ENHANCE pilot trial
© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
BACKGROUND: Multimorbidity is increasingly the norm; however, primary care remains focused on single diseases. Osteoarthritis, anxiety, and depression are frequently comorbid with other long-term conditions (LTCs), but rarely prioritized by clinicians.
OBJECTIVES: To test the feasibility of a randomized controlled trial (RCT) of an intervention integrating case-finding and management for osteoarthritis, anxiety, and depression within LTC reviews.
METHODS: A pilot stepped-wedge RCT across 4 general practices recruited patients aged ≥45 years attending routine LTC reviews. General practice nurses provided usual LTC reviews (control period), then, following training, delivered the ENHANCE LTC review (intervention period). Questionnaires, an ENHANCE EMIS-embedded template and consultation audio-recordings, were used in the evaluation.
RESULTS: General practice recruitment and training attendance reached prespecified success criteria. Three hundred and eighteen of 466 (68%) of patients invited responded; however, more patients were recruited during the control period (206 control, 112 intervention). Eighty-two percent and 78% returned their 6-week and 6-month questionnaires, respectively. Integration of the ENHANCE LTC review into routine LTC reviews varied. Case-finding questions were generally used as intended for joint pain, but to a lesser extent for anxiety and depression. Initial management through referrals and signposting were lacking, and advice was more frequently provided for joint pain. The stepped-wedge design meant timing of the training was challenging and yielded differential recruitment.
CONCLUSION: This pilot trial suggests that it is feasible to deliver a fully powered trial in primary care. Areas to optimize include improving the training and reconsidering the stepped-wedge design and the approach to recruitment by targeting those with greatest need.
TRIAL REGISTRATION: ISRCTN registry (ISRCTN: 12154418). Date registered: 6 August 15. Date first participant was enrolled: 13 July 2015. https://www.isrctn.com/ISRCTN12154418?q=depression%20schizophrenia&filters=conditionCategory:Not%20Applicable&sort=&offset=5&totalResults=9&page=1&pageSize=20&searchType=basic-search.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
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| Enthalten in: |
Family practice - 39(2022), 4 vom: 19. Juli, Seite 592-602 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Healey, Emma L [VerfasserIn] |
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| Links: |
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| Themen: |
Anxiety |
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| Anmerkungen: |
Date Completed 20.07.2022 Date Revised 15.10.2022 published: Print ISRCTN: ISRCTN2154418 Citation Status MEDLINE |
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| doi: |
10.1093/fampra/cmab113 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM330881752 |
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| 100 | 1 | |a Healey, Emma L |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Integrating case-finding and initial management for osteoarthritis, anxiety, and depression into primary care long-term condition reviews |b results from the ENHANCE pilot trial |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 20.07.2022 | ||
| 500 | |a Date Revised 15.10.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a ISRCTN: ISRCTN2154418 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: Multimorbidity is increasingly the norm; however, primary care remains focused on single diseases. Osteoarthritis, anxiety, and depression are frequently comorbid with other long-term conditions (LTCs), but rarely prioritized by clinicians | ||
| 520 | |a OBJECTIVES: To test the feasibility of a randomized controlled trial (RCT) of an intervention integrating case-finding and management for osteoarthritis, anxiety, and depression within LTC reviews | ||
| 520 | |a METHODS: A pilot stepped-wedge RCT across 4 general practices recruited patients aged ≥45 years attending routine LTC reviews. General practice nurses provided usual LTC reviews (control period), then, following training, delivered the ENHANCE LTC review (intervention period). Questionnaires, an ENHANCE EMIS-embedded template and consultation audio-recordings, were used in the evaluation | ||
| 520 | |a RESULTS: General practice recruitment and training attendance reached prespecified success criteria. Three hundred and eighteen of 466 (68%) of patients invited responded; however, more patients were recruited during the control period (206 control, 112 intervention). Eighty-two percent and 78% returned their 6-week and 6-month questionnaires, respectively. Integration of the ENHANCE LTC review into routine LTC reviews varied. Case-finding questions were generally used as intended for joint pain, but to a lesser extent for anxiety and depression. Initial management through referrals and signposting were lacking, and advice was more frequently provided for joint pain. The stepped-wedge design meant timing of the training was challenging and yielded differential recruitment | ||
| 520 | |a CONCLUSION: This pilot trial suggests that it is feasible to deliver a fully powered trial in primary care. Areas to optimize include improving the training and reconsidering the stepped-wedge design and the approach to recruitment by targeting those with greatest need | ||
| 520 | |a TRIAL REGISTRATION: ISRCTN registry (ISRCTN: 12154418). Date registered: 6 August 15. Date first participant was enrolled: 13 July 2015. https://www.isrctn.com/ISRCTN12154418?q=depression%20schizophrenia&filters=conditionCategory:Not%20Applicable&sort=&offset=5&totalResults=9&page=1&pageSize=20&searchType=basic-search | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a anxiety | |
| 650 | 4 | |a depression | |
| 650 | 4 | |a general practice | |
| 650 | 4 | |a integrated care | |
| 650 | 4 | |a multimorbidity | |
| 650 | 4 | |a osteoarthritis | |
| 700 | 1 | |a Mallen, Christian D |e verfasserin |4 aut | |
| 700 | 1 | |a Chew-Graham, Carolyn A |e verfasserin |4 aut | |
| 700 | 1 | |a Nicholls, Elaine |e verfasserin |4 aut | |
| 700 | 1 | |a Lewis, Martyn |e verfasserin |4 aut | |
| 700 | 1 | |a Lawton, Sarah A |e verfasserin |4 aut | |
| 700 | 1 | |a Finney, Andrew G |e verfasserin |4 aut | |
| 700 | 1 | |a Tan, Valerie |e verfasserin |4 aut | |
| 700 | 1 | |a Cooper, Vince |e verfasserin |4 aut | |
| 700 | 1 | |a Dziedzic, Krysia S |e verfasserin |4 aut | |
| 700 | 1 | |a Liddle, Jennifer |e verfasserin |4 aut | |
| 700 | 1 | |a Wathall, Simon |e verfasserin |4 aut | |
| 700 | 1 | |a Jinks, Clare |e verfasserin |4 aut | |
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