So looking at this, you look like you've got some issues going on with your joints: Exploring case-finding in long-tern condition review consultations - the ENHANCE pilot trial

Journal article


Liddle, J., Chew-Graham, C. A., Mallen, C. D., Healey, E. L., Jinks, C. and Dikomitis, L. 2017. So looking at this, you look like you've got some issues going on with your joints: Exploring case-finding in long-tern condition review consultations - the ENHANCE pilot trial. Rheumatology. 56 (IS 2). https://doi.org/10.1093/rheumatology/kex062.181
AuthorsLiddle, J., Chew-Graham, C. A., Mallen, C. D., Healey, E. L., Jinks, C. and Dikomitis, L.
Abstract

Background: The ENHANCE pilot trial aimed to test the feasibility and acceptability of integrating case-finding for osteoarthritis, anxiety and depression within extended primary care nurse-led long-term condition (LTC) review consultations. Training was delivered to general practice nurses (PNs) to deliver ENHANCE reviews, supported by an adapted EMIS LTC computer template. This paper reports findings from a process evaluation exploring the ways in which PNs delivered ENHANCE LTC reviews, focusing on what aspects of the ENHANCE approach were delivered and how PNs integrate the ENHANCE approach within an LTC review consultation.

Methods: Twenty-four patients and seven PNs from four general practices gave consent for their ENHANCE consultations to be audio-recorded and transcribed. A checklist was developed and used to assess the extent to which each intended component was included in ENHANCE consultations. Thematic analysis of transcripts enabled a rich description of the ways in which PNs conducted ENHANCE reviews.

Results: Familiarity with the use and access of the ENHANCE template was high, and in more than half of the audio-recorded consultations PNs had integrated new ENHANCE components and not simply added them on at the end. In the majority of consultations PNs explained there would be additional questions about joint pain or mood, though this was often not prefixed with an explanation that many people with LTCs have low mood or joint pain. Although there were some inconsistencies in the wording used, the audio-recordings demonstrated that PNs were asking the initial case-finding questions. However, PNs did not always follow the intended consultation pathway to ask further questions as a result of positive answers to initial case-finding. In some cases, PNs used additional prompts that appeared to influence patients’ responses, and both patients and PNs attempted to normalize or dismiss responses to questions about anxiety and depression. Particular challenges for PNs included the involvement of family members in the consultation, patient understanding and interpretation of case-finding questions and delivering a person-centred approach that integrated standardized case-finding questions.

Conclusion: Data demonstrate variation in the ways PNs incorporated aspects of the ENHANCE approach within LTC review consultations. PNs were asked to record patient responses on a new EMIS computer template, while maintaining a patient-centred dialogue and completing an integrated ENHANCE review within the available timeframe, so it is unsurprising that there were inconsistencies in the use of case-finding questions and following the ENHANCE consultation pathway. PNs were comfortable with using and accessing the template, and there was integration during the review, suggesting that these elements of the approach were feasible. We have identified challenges around interpreting responses to case-finding questions and explaining the approach and outcomes of case-finding to patients that will need to be addressed through PN training in a future main trial.

KeywordsConsultation; Case-finding
Year2017
JournalRheumatology
Journal citation56 (IS 2)
PublisherOxford University Press
ISSN1462-0324
1462-0332
Digital Object Identifier (DOI)https://doi.org/10.1093/rheumatology/kex062.181
Official URLhttps://academic.oup.com/rheumatology/article/56/suppl_2/kex062.181/4106684
Publication dates
OnlineApr 2017
Publication process dates
Deposited18 Jul 2024
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Chris Littlewood, Marcus Bateman, Kendra Cooke, Susie Hennnings, Tina Cookson, Kieran Bromley, Martyn Lewis, Lennard Funk, Jean Denton, Maria Moffatt, Rachel Winstanley, Saurabh Mehta, Gareth Stephens, Lisa Dikomitis, Linda Chesterton and Nadine E. Foster 2019. Protocol for a multi-centre pilot and feasibility randomised controlled trial with a nested qualitative study: rehabilitation following rotator cuff repair (the RaCeR study). Trials. 20 (328). https://doi.org/10.1186/s13063-019-3407-3
Exploring differences in individual and group judgements in standard setting
Peter Yeates, Natalie Cope, Eva Luksaite, Andrew Hassell and Lisa Dikomitis 2019. Exploring differences in individual and group judgements in standard setting. Medical Education. 53 (9), pp. 941-962. https://doi.org/10.1111/medu.13915
Images depicting headache pain – a tool to aid the diagnosis of cluster headache: a pilot study
Dikomitis, L. 2019. Images depicting headache pain – a tool to aid the diagnosis of cluster headache: a pilot study. Journal of Multidisciplinary Healthcare. 2019 (12), pp. 691-698. https://doi.org/10.2147/JMDH.S207128
Images depicting pain: a screening tool for cluster headache
Buture, A., Dikomitis, L., Boland, L. and Ahmed, F. 2018. Images depicting pain: a screening tool for cluster headache. Cephalalgia. 38 (Supp 1), pp. 114-115. https://doi.org/10.1177/0333102418789865
Delays in the diagnosis and misdiagnosis of cluster headache – a systematic literature review
Buture, A., Boland, J. W., Dikomitis, L. and Ahmed, F. 2018. Delays in the diagnosis and misdiagnosis of cluster headache – a systematic literature review. Cephalalgia. 38 (Supp 1), pp. MTIS2018-145.
Systematic literature review on the delays in the diagnosis and misdiagnosis of cluster headache
Buture, A., Boland, J. W., Dikomitis, L. and Ahmed, F. 2018. Systematic literature review on the delays in the diagnosis and misdiagnosis of cluster headache. Neurological Sciences. 40, pp. 25-39. https://doi.org/10.1007/s10072-018-3598-5
Visual images: an additional tool for the screening of cluster headache
Buture, A., Dikomitis, L., Boland, J. W. and Ahmed, F. 2017. Visual images: an additional tool for the screening of cluster headache. Cephalalgia. 37, p. 219.
'"The man who closed the asylums": Franco Basaglia and the revolution in mental health care', by John Foot (Verso, 2015)
Dikomitis, L. 2016. '"The man who closed the asylums": Franco Basaglia and the revolution in mental health care', by John Foot (Verso, 2015). Durham University Institute for Medical Humanities.
How do clinicians think about cluster headache
Dikomitis, L., Paemeleire, K., Goadsby, P. J. and Ahmed, F. 2016. How do clinicians think about cluster headache. Cephalalgia. 36 (S 1).
Developing a diagnostic tool for the early diagnosis of cluster headache
Buture, A., Dikomitis, L. and Ahmed, F. 2016. Developing a diagnostic tool for the early diagnosis of cluster headache. Cephalalgia.
Perceptions, understandings and experiences of cluster headache patients in the north of England: a qualitative study
Dikomitis, L., Quarshie, V., Paemeleire, K., Goadsby, P. J. and Ahmed, F. 2015. Perceptions, understandings and experiences of cluster headache patients in the north of England: a qualitative study. Cephalalgia. 25 (S6).
[Review of] The Past in Pieces: Belonging in the New Cyprus, by Rebecca Bryant. Contemporary Ethnography series. Philadelphia: University of Pennsylvania Press, 2010. 224 pp.
Dikomitis, L. 2014. [Review of] The Past in Pieces: Belonging in the New Cyprus, by Rebecca Bryant. Contemporary Ethnography series. Philadelphia: University of Pennsylvania Press, 2010. 224 pp. American Anthropologist. 116 (1), pp. 194-195. https://doi.org/10.1111/aman.12085_9
Perceptions and experiences of cluster headache among patients, general practitioners and neurologists in the north of england: A qualitative study
Ahmed, F., Dikomitis, L., Zafar, H. W., Goadsby, P. and Paemeliere, P. 2014. Perceptions and experiences of cluster headache among patients, general practitioners and neurologists in the north of england: A qualitative study. Journal of Headache and Pain. 15 (S1).
Patients perceptions of the causes of migraine in Flanders (Belgium): A qualitative study
Dikomitis, L., Bonte, M., Willems, S. and Paemeleire, K. 2013. Patients perceptions of the causes of migraine in Flanders (Belgium): A qualitative study. Cephalalgia. 33 (S 8), p. 198. https://doi.org/10.1177/0333102413490487