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

Autor:	Healey EL; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK., Mallen CD; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.; Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK., Chew-Graham CA; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.; Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK., Nicholls E; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.; Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK., Lewis M; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.; Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK., Lawton SA; Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK., Finney AG; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.; School of Nursing and Midwifery, Keele University, Keele, Staffordshire ST5 5BG, UK., Tan V; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK., Cooper V; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK., Dziedzic KS; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK., Liddle J; Population Health Sciences Institute, Newcastle University, Newcastle NE4 5TG,UK., Wathall S; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.; Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK., Jinks C; School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.
Jazyk:	angličtina
Zdroj:	Family practice [Fam Pract] 2022 Jul 19; Vol. 39 (4), pp. 592-602.
DOI:	10.1093/fampra/cmab113
Abstrakt:	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: journals.permissions@oup.com.)
Databáze:	MEDLINE
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