Integrating case-finding and initial management for osteoarthritis, anxiety, and depression into primary care long-term condition reviews: results from the ENHANCE pilot trial. (21st September 2021)

• Record Type: Journal Article
• Authors: 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
• Is Part Of: Family practice. Volume 39:Number 4(2022)
• Page Start: 592
• Page End: 602
• Publication Date: 2021-09-21
• Subjects: anxiety -- depression -- general practice -- integrated care -- multimorbidity -- osteoarthritis; Primary care (Medicine) -- Periodicals; Clinical medicine -- Periodicals; 616.005
• DOI: 10.1093/fampra/cmab113
• Languages: English
• ISSNs: 0263-2136

Abstract

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 .