Keele Research Repository

Healey, EL ORCID: https://orcid.org/0000-0002-8356-0825, Mallen, CD ORCID: https://orcid.org/0000-0002-2677-1028, Chew-Graham, CA ORCID: https://orcid.org/0000-0002-9722-9981, Nicholls, E ORCID: https://orcid.org/0000-0001-5643-616X, Lewis, M ORCID: https://orcid.org/0000-0002-3667-132X, Lawton, SA ORCID: https://orcid.org/0000-0002-8909-2057, Finney, AG ORCID: https://orcid.org/0000-0001-7353-7480, Tan, V, Cooper, V ORCID: https://orcid.org/0000-0002-3045-8931, Dziedzic, KS ORCID: https://orcid.org/0000-0002-1168-8993, Liddle, J, Wathall, S ORCID: https://orcid.org/0000-0002-7107-5785 and Jinks, C ORCID: https://orcid.org/0000-0002-3407-2446 (2021) Integrating case-finding and initial management for osteoarthritis, anxiety, and depression into primary care long-term condition reviews: results from the ENHANCE pilot trial. Family Practice.

	Text ENHANCE pilot results FINAL.doc - Accepted Version Restricted to Repository staff only until 21 September 2022. Available under License Creative Commons Attribution Non-commercial. Download (123kB)
	Text ENHANCE paper tables final.docx - Supplemental Material Restricted to Repository staff only until 21 September 2022. Available under License Creative Commons Attribution Non-commercial. Download (27kB)
	Image Figure 1 consort diagram 28_06_21 (1).tiff - Supplemental Material Restricted to Repository staff only until 21 September 2022. Available under License Creative Commons Attribution Non-commercial. Download (1MB)
	Text Supplementary material 1 ENHANCE fidelity checklist scoring summary.docx - Supplemental Material Restricted to Repository staff only until 21 September 2022. Available under License Creative Commons Attribution Non-commercial. Download (28kB)
	Text Supplementary material 2 Patients’ views on the practice nurse.docx - Supplemental Material Restricted to Repository staff only until 21 September 2022. Available under License Creative Commons Attribution Non-commercial. Download (14kB)
	Text Supplementary material 3 Schematic of stepped wedge design.docx - Supplemental Material Restricted to Repository staff only until 21 September 2022. Available under License Creative Commons Attribution Non-commercial. Download (22kB)

Abstract

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.

Item Type:	Article
Additional Information:	The final version of this accepted manusript and all relevant information related to this article, including copyrights, can be found online at; https://academic.oup.com/fampra/advance-article/doi/10.1093/fampra/cmab113/6373370?login=true
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Medicine and Health Sciences > School of Medicine
Related URLs:	Author
Depositing User:	Symplectic
Date Deposited:	05 Oct 2021 08:39
Last Modified:	05 Oct 2021 08:39
URI:	https://eprints.keele.ac.uk/id/eprint/10061

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