将骨关节炎、焦虑和抑郁的病例发现和初步管理纳入初级保健慢性病评估：ENHANCE 试点试验的结果。

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

机构信息

School of Medicine, Keele University, Keele, Staffordshire ST5 5BG, UK.

Midlands Partnership Foundation Trust, Staffordshire ST16 3SR, UK.

出版信息

Fam Pract. 2022 Jul 19;39(4):592-602. doi: 10.1093/fampra/cmab113.

DOI:10.1093/fampra/cmab113

PMID:34546341

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.

摘要

背景

多种疾病日益成为常态；然而，基层医疗仍然专注于单一疾病。骨关节炎、焦虑症和抑郁症常与其他长期疾病（LTC）同时发生，但很少被临床医生优先考虑。

目的

测试在 LTC 审查中整合病例发现和管理骨关节炎、焦虑症和抑郁症的干预措施的随机对照试验（RCT）的可行性。

方法

在 4 家普通诊所进行的一项试点阶梯式 RCT 招募了年龄≥45 岁接受常规 LTC 审查的患者。普通诊所护士提供常规 LTC 审查（对照期），然后在接受培训后提供 ENHANCE LTC 审查（干预期）。评估中使用了问卷、ENHANCE EMIS 嵌入式模板和咨询录音。

结果

普通诊所的招募和培训出席达到了预定的成功标准。466 名受邀患者中有 318 名（68%）做出回应；然而，在对照期招募了更多的患者（206 名对照，112 名干预）。分别有 82%和 78%的患者在 6 周和 6 个月时返回了他们的问卷。将 ENHANCE LTC 审查纳入常规 LTC 审查的方式各不相同。关节疼痛的病例发现问题通常按预期使用，但对焦虑症和抑郁症的使用程度较低。初始管理通过转介和引导缺乏，更多地提供了关节疼痛的建议。阶梯式设计意味着培训的时间安排具有挑战性，并导致了不同的招募情况。