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Integrating case-finding and initial management for osteoarthritis, anxiety, and depression into primary care long-term condition reviews: results from the ENHANCE pilot trial.

Healey, Emma L; Mallen, Christian D; Chew-Graham, Carolyn A; Nicholls, Elaine; Lewis, Martyn; Lawton, Sarah A; Finney, Andrew G; Tan, Valerie; Cooper, Vince; Dziedzic, Krysia S; Liddle, Jennifer; Wathall, Simon; Jinks, Clare

Authors

Valerie Tan

Vince Cooper

Jennifer Liddle



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.

Journal Article Type Article
Acceptance Date Sep 21, 2021
Online Publication Date Sep 21, 2021
Publication Date 2022-08
Journal Family Practice
Print ISSN 0263-2136
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 39
Issue 4
Pages 592–602
DOI https://doi.org/10.1093/fampra/cmab113
Keywords anxiety; depression; general practice; integrated care; multimorbidity; osteoarthritis
Publisher URL https://academic.oup.com/fampra/advance-article/doi/10.1093/fampra/cmab113/6373370?login=true

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