Healey, EL, Mallen, CD, Chew-Graham, CA, Nicholls, E, Lewis, M, Lawton, SA, Finney, AG, Tan, V, Cooper, V, Dziedzic, KS, Liddle, J, Wathall, S and Jinks, C (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. ISSN 1460-2229

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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 >= A5 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.

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
Uncontrolled Keywords: anxiety; depression; general practice; integrated care; multimorbidity; osteoarthritis
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:
Depositing User: Symplectic
Date Deposited: 05 Oct 2021 08:39
Last Modified: 21 Sep 2022 01:30
URI: https://eprints.keele.ac.uk/id/eprint/10061

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