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Healey EL, Mallen CD, Chew-Graham CA, et al. Integrating case-finding and initial management for osteoarthritis, anxiety, and depression into primary care long-term condition reviews: results from the ENHANCE pilot trial. Fam Pract. 2021;doi: 10.1093/fampra/cmab113.
Healey, E. L., Mallen, C. D., Chew-Graham, C. A., Nicholls, E., Lewis, M., Lawton, S. A., Finney, A. G., Tan, V., Cooper, V., Dziedzic, K. S., Liddle, J., Wathall, S., & 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, . https://doi.org/10.1093/fampra/cmab113
Healey, Emma L, et al. "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 vol. (2021). doi: https://doi.org/10.1093/fampra/cmab113
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, Jinks C. Integrating case-finding and initial management for osteoarthritis, anxiety, and depression into primary care long-term condition reviews: results from the ENHANCE pilot trial. Fam Pract. 2021 Sep 21; doi: 10.1093/fampra/cmab113. Epub 2021 Sep 21. PMID: 34546341.
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Fam Pract. 2021 Sep 21; doi: 10.1093/fampra/cmab113. Epub 2021 Sep 21.

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

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

Affiliations

  1. School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.
  2. Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK.
  3. Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK.
  4. School of Nursing and Midwifery, Keele University, Keele, Staffordshire ST5 5BG, UK.
  5. Population Health Sciences Institute, Newcastle University, Newcastle NE4 5TG,  UK.

PMID: 34546341 DOI: 10.1093/fampra/cmab113

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.

© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [email protected].

Keywords: anxiety; depression; general practice; integrated care; multimorbidity; osteoarthritis

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