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

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.

Citation

Healey, E. L., Mallen, C. D., Chew-Graham, C. A., Nicholls, E., Lewis, M., Lawton, S. A., …Jinks, C. (2022). 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, 39(4), 592–602. https://doi.org/10.1093/fampra/cmab113

• 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