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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 2022; 39:592-602. [PMID: 34546341 DOI: 10.1093/fampra/cmab113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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.
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Affiliation(s)
- Emma L Healey
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Christian D Mallen
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK
| | - Elaine Nicholls
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Martyn Lewis
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Sarah A Lawton
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Andrew G Finney
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,School of Nursing and Midwifery, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Valerie Tan
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Vince Cooper
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Krysia S Dziedzic
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
| | - Jennifer Liddle
- Population Health Sciences Institute, Newcastle University, Newcastle NE4 5TG,UK
| | - Simon Wathall
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.,Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK
| | - Clare Jinks
- School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK
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2
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Barnett LA, Pritchard MG, Edwards JJ, Afolabi EK, Jordan KP, Healey EL, Finney AG, Chew-Graham CA, Mallen CD, Dziedzic KS. Relationship of anxiety with joint pain and its management: A population survey. Musculoskeletal Care 2018; 16:353-362. [PMID: 29675943 DOI: 10.1002/msc.1243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/11/2018] [Accepted: 03/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The aims of the present study was to examine the associations between the severity of pain and anxiety in a community population reporting joint pain, and to investigate the management of joint pain in the presence of comorbid anxiety. METHODS A population survey was carried out of people aged ≥45 years, registered with eight general practices in Cheshire, Shropshire and Staffordshire, UK. Respondents were asked to report pain intensity in their hands, hips, knees and feet (on a numerical rating scale), anxiety symptoms (Generalized Anxiety Disorder seven-item [GAD-7] scale) and guideline-recommended treatments used to manage pain. Clinical anxiety was defined by a GAD-7 score of 10 or more. RESULTS A total of 11,222 respondents with joint pain were included in the analysis, with 1,802 (16.1%) reporting clinical anxiety. Respondents reporting more severe pain were more likely to report clinical anxiety (severe versus mild pain, odds ratio [OR] 5.36, 95% confidence interval [CI] 4.56 to 6.31). The number of pain sites was also positively associated with clinical anxiety (four versus one site; OR 3.64, 95% CI 3.09 to 4.30). Those with clinical anxiety were less likely to undertake general fitness exercises (OR 0.60, 95% CI 0.52 to 0.70), but more likely to diet (OR 1.43, 95% CI 1.21 to 1.69), use walking aids (OR 1.53, 95% CI 1.32 to 1.77) and assistive devices (OR 1.24, 95% CI 1.04 to 1.49), and more likely to use opioids (OR 1.34, 95% CI 1.18 to1.52). CONCLUSIONS Anxiety is common among patients presenting to primary care with joint pain. Patients with anxiety are likely to manage their joint pain differently to those without. Case-finding to identify and treat anxiety would be appropriate in this population, with caution about opioid prescribing and consideration of exercise as an intervention.
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Affiliation(s)
- Lauren A Barnett
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Mark G Pritchard
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire
| | - John J Edwards
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Ebenezer K Afolabi
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Kelvin P Jordan
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Emma L Healey
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Andrew G Finney
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Carolyn A Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Collaboration for Leadership in Applied Health Research and Care, West Midlands
| | - Christian D Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
- Collaboration for Leadership in Applied Health Research and Care, West Midlands
| | - Krysia S Dziedzic
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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3
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Bachmann MO, Bateman ED, Stelmach R, Cruz ÁA, Pacheco de Andrade M, Zonta R, Zepeda J, Natal S, Cornick R, Wattrus C, Anderson L, Lombard C, Fairall LR. Integrating primary care of chronic respiratory disease, cardiovascular disease and diabetes in Brazil: Practical Approach to Care Kit (PACK Brazil): study protocol for randomised controlled trials. J Thorac Dis 2018; 10:4667-4677. [PMID: 30174920 PMCID: PMC6105957 DOI: 10.21037/jtd.2018.07.34] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multimorbidity is increasing common in Brazilian adults. Comorbid chronic lung disease, cardiovascular disease and diabetes are often inaccurately diagnosed or ineffectively treated. The Global Alliance against Chronic Respiratory Diseases (GARD) aims to strengthen health systems to prevent and control non-communicable diseases through primary health care. The Practical Approach to Care Kit (PACK Adult) is a clinical decision support tool that provides evidence-supported algorithmic guidelines for screening, diagnosis and treatment of chronic diseases, and is widely used in South Africa. It was adapted for Brazil by family physicians in the Florianopolis City Health Department, which trains clinic doctors and nurses to use it. METHODS Effectiveness of PACK Adult training will be evaluated in two pragmatic cluster randomised trials, one enrolling adults with chronic lower respiratory diseases and the other enrolling adults with cardiovascular disease or diabetes. Forty-eight municipal clinics in Florianopolis were randomly allocated to intervention or control arms. In intervention arm clinics, doctors and nurses will receive educational outreach training and the PACK Adult clinical decision support tool. In control arm clinics, doctors and nurses will receive only the tool. Trial outcomes will be measured using patients' electronic medical records during 12 months after completion of basic training. Primary outcomes for the respiratory trial are appropriate prescribing, spirometry and diagnosis rates. Primary outcomes for the cardiovascular trial are testing for cardiovascular risk and diabetes, and systolic blood pressure. Educational outreach to primary care professionals could improve respiratory, cardiovascular and diabetes care in Brazil. TRIAL REGISTRATION NCT02786030 and NCT02795910 (https://clinicaltrials.gov/).
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Affiliation(s)
- Max O. Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | | | | | | | | | - Sonia Natal
- Federal University of Santa Catarina, Florianopolis, Brazil
| | - Ruth Cornick
- University of Cape Town, Cape Town, South Africa
| | | | | | - Carl Lombard
- Medical Research Council, Cape Town, South Africa
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4
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Babatunde OO, Tan V, Jordan JL, Dziedzic K, Chew-Graham CA, Jinks C, Protheroe J, van der Windt DA. Evidence flowers: An innovative, visual method of presenting "best evidence" summaries to health professional and lay audiences. Res Synth Methods 2018; 9:273-284. [PMID: 29439286 DOI: 10.1002/jrsm.1295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/03/2017] [Accepted: 01/25/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND & AIMS Barriers to dissemination and engagement with evidence pose a threat to implementing evidence-based medicine. Understanding, retention, and recall can be enhanced by visual presentation of information. The aim of this exploratory research was to develop and evaluate the accessibility and acceptability of visual summaries for presenting evidence syntheses with multiple exposures or outcomes to professional and lay audiences. METHODS "Evidence flowers" were developed as a visual method of presenting data from 4 case scenarios: 2 complex evidence syntheses with multiple outcomes, Cochrane reviews, and clinical guidelines. Petals of evidence flowers were coloured according to the GRADE evidence rating system to display key findings and recommendations from the evidence summaries. Application of evidence flowers was observed during stakeholder workshops. Evaluation and feedback were conducted via questionnaires and informal interviews. RESULTS Feedback from stakeholders on the evidence flowers collected from workshops, questionnaires, and interviews was encouraging and helpful for refining the design of the flowers. Comments were made on the content and design of the flowers, as well as the usability and potential for displaying different types of evidence. CONCLUSIONS Evidence flowers are a novel and visually stimulating method for presenting research evidence from evidence syntheses with multiple exposures or outcomes, Cochrane reviews, and clinical guidelines. To promote access and engagement with research evidence, evidence flowers may be used in conjunction with other evidence synthesis products, such as (lay) summaries, evidence inventories, rapid reviews, and clinical guidelines. Additional research on potential adaptations and applications of the evidence flowers may further bridge the gap between research evidence and clinical practice.
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Affiliation(s)
- O O Babatunde
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - V Tan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J L Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - K Dziedzic
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,West Midlands CLAHRC and South Staffs and Shropshire Foundation Trust, UK
| | - C Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - D A van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
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5
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Healey EL, Jinks C, Foster NE, Chew-Graham CA, Pincus T, Hartshorne L, Cooke K, Nicholls E, Proctor J, Lewis M, Dent S, Wathall S, Hay EM, McBeth J. The feasibility and acceptability of a physical activity intervention for older people with chronic musculoskeletal pain: The iPOPP pilot trial protocol. Musculoskeletal Care 2017; 16:118-132. [PMID: 29218808 DOI: 10.1002/msc.1222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION This pilot trial will inform the design and methods of a future full-scale randomized controlled trial (RCT) and examine the feasibility, acceptability and fidelity of the Increasing Physical activity in Older People with chronic Pain (iPOPP) intervention, a healthcare assistant (HCA)-supported intervention to promote walking in older adults with chronic musculoskeletal pain in a primary care setting. METHODS AND ANALYSIS The iPOPP study is an individually randomized, multicentre, three-parallel-arm pilot RCT. A total of 150 participants aged ≥65 years with chronic pain in one or more index sites will be recruited and randomized using random permuted blocks, stratified by general practice, to: (i) usual care plus written information; (ii) pedometer plus usual care and written information; or (iii) the iPOPP intervention. A theoretically informed mixed-methods approach will be employed using semi-structured interviews, audio recordings of the HCA consultations, self-reported questionnaires, case report forms and objective physical activity data collection (accelerometry). Follow-up will be conducted 12 weeks post-randomization. Collection of the quantitative data and statistical analysis will be performed blinded to treatment allocation, and analysis will be exploratory to inform the design and methods of a future RCT. Analysis of the HCA consultation recordings will focus on the use of a checklist to determine the fidelity of the iPOPP intervention delivery, and the interview data will be analysed using a constant comparison approach in order to generate conceptual themes focused around the acceptability and feasibility of the trial, and then mapped to the Theoretical Domains Framework to understand barriers and facilitators to behaviour change. A triangulation protocol will be used to integrate quantitative and qualitative data and findings.
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Affiliation(s)
- E L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - N E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - C A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - T Pincus
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Department of Psychology, Royal Holloway, University of London, Egham, UK
| | - L Hartshorne
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - K Cooke
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E Nicholls
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J Proctor
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - M Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Dent
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - S Wathall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - E M Hay
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - J McBeth
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK.,Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, UK
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