E059 Development of a nurse-led integrated care review based in primary care to identify and improve the management of co-morbidities in patients with inflammatory rheumatological conditions: the INCLUDE study

Machin, Annabelle R; Hider, Samantha L; Jinks, Clare; Herron, Daniel; Paskins, Zoe; Cooke, Kendra; Chew-Graham, Carolyn A

Abstract

Background: People with inflammatory rheumatological conditions (IRCs) are at an increased risk of common comorbidities such as cardiovascular disease (CVD), osteoporosis, anxiety and depression. These are often not recognised or treated and can lead to increased morbidity and mortality. INCLUDE, a pilot trial, aimed to evaluate the feasibility and acceptability of a nurse-led integrated review for people with IRCs based in primary care. The review included an assessment of CVD and fracture risk, including QRisk and FRAX calculation when appropriate, and case-finding for anxiety and depression. The idea for the study evolved from a patient and public involvement and engagement (PPIE) group linked to previous work, who also contributed to the funding application. We report on the development of the INCLUDE intervention.

Methods: An outline of the INCLUDE review was developed by the research team, based on guidelines, the team’s previous research and literature about the frequency of CVD, fracture and mood problems in people with IRCs. A PPIE meeting was held to explore patients’ priorities for the content and conduct of the review. A stakeholder group, composed of general practitioners (GPs), nurse practitioners and practice nurses was held to plan implementation of the INCLUDE review in a pilot trial. A management algorithm to support decision-making and a review template (embedded in EMIS) for completion by nurses during the review were designed. Training was developed for the nurses delivering the review. Semi-structured interviews were conducted with the nurses to explore their experiences of training.

Results: Participants at the PPIE meeting supported the study rationale and were keen to explore fatigue, a debilitating symptom associated with IRCs, which was incorporated into self-report questionnaires. Participants emphasised the need for the review to avoid repetition of recently performed tests (e.g cholesterol measurement), and contributed to the development of summary sheet to share key action points with patients as an outcome of the review. Stakeholder group participants felt the review was feasible in primary care, as aspects such as CVD risk assessment were already performed as part of chronic disease reviews. Participants suggested how investigations and follow-up as an outcome of the review could be arranged. GPs advised it would be important for the nurses delivering the review to be trained to assess suicide risk. This was included in training, which involved the use of written materials, a slide-set, role play using simulated patients and training to use EMIS software. During post-training interviews the nurses reported feeling equipped with the knowledge and skills required to deliver the review.

Conclusion: A co-design approach was used to develop a new complex intervention to help identify and manage co-morbidities in patients with IRCs. The intervention is now being tested in a feasibility trial in in primary care.

Citation

Machin, A. R., Hider, S. L., Jinks, C., Herron, D., Paskins, Z., Cooke, K., & Chew-Graham, C. A. (2019). E059 Development of a nurse-led integrated care review based in primary care to identify and improve the management of co-morbidities in patients with inflammatory rheumatological conditions: the INCLUDE study. Rheumatology, 58(Supplement_3), https://doi.org/10.1093/rheumatology/kez110.057

• Journal Article Type: Article
• Online Publication Date: Apr 12, 2019
• Publication Date: Apr 1, 2019
• Deposit Date: Jun 21, 2023
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 58
• Issue: Supplement_3
• DOI: https://doi.org/10.1093/rheumatology/kez110.057
• Keywords: Pharmacology (medical); Rheumatology