Evidence map›Paper›PMID 33407943›Full record

ArticlePilot and feasibility studies2021

A pilot study of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care: feasibility study findings.

Samantha L Hider, Milica Bucknall, Clare Jinks, Kelly Cooke, Kendra Cooke, Erandie Ediriweera Desilva, Andrew G Finney, Emma L Healey, Daniel Herron, Annabelle R Machin and 3 more

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Article in Pilot and feasibility studies, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Management of Rheumatoid Arthritis in Primary Care: A Scoping Review.International journal of environmental research and public health · 2024
    Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Samantha L HiderSchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK. s.hider@keele.ac.uk.ORCID https://orcid.org/0000-0002-9958-3909
Milica BucknallSchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Clare JinksSchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Kelly CookeHaywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke on Trent, Staffordshire, ST6 7AG, UK.
Kendra CookeKeele Clinical Trials Unit, Keele University, Stoke on Trent, UK.
Erandie Ediriweera DesilvaSchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Andrew G FinneySchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Emma L HealeySchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Daniel HerronSchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Annabelle R MachinSchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Christian D MallenSchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Simon WathallSchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.
Carolyn A Chew-GrahamSchool of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.

Funding

Department of Health RP_2014-04-026Department of Health RP-PG-0617-20005
6 · The paper itself

Abstract

backgroundPeople with inflammatory rheumatological conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polymyalgia rheumatica and giant cell arteritis are at an increased risk of common comorbidities including cardiovascular disease, osteoporosis and mood problems, leading to increased morbidity and mortality. Identifying and treating these problems could lead to improved patient quality of life and outcomes. Despite these risks being well-established, patients currently are not systematically targeted for management interventions for these morbidities. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led integrated care review in primary care to identify and manage these morbidities.

methodsA pilot cluster RCT was delivered across four UK general practices. Patients with a diagnostic Read code for one of the inflammatory rheumatological conditions of interest were recruited by post. In intervention practices (n = 2), eligible patients were invited to attend the INCLUDE review. Outcome measures included health-related quality of life (EQ-5D-5L), patient activation, self-efficacy and treatment burden. A sample (n = 24) of INCLUDE review consultations were audio-recorded and assessed against a fidelity checklist.

results453/789 (57%) patients responded to the invitation, although 114/453 (25%) were excluded as they either did not fulfil eligibility criteria or failed to provide full written consent. In the intervention practices, uptake of the INCLUDE review was high at 72%. Retention at 3 and 6 months both reached pre-specified success criteria. Participants in intervention practices had more primary care contacts than controls (mean 29 vs 22) over the 12 months, with higher prescribing of all relevant medication classes in participants in intervention practices, particularly so for osteoporosis medication (baseline 29% vs 12 month 46%). The intervention was delivered with fidelity, although potential areas for improvement were identified.

conclusionsThe findings of this pilot study suggest it is feasible to deliver an RCT of the nurse-led integrated care (INCLUDE) review in primary care. A significant morbidity burden was identified. Early results suggest the INCLUDE review was associated with changes in practice. Lessons have been learnt around Read codes for patient identification and refining the nurse training.

trial registrationISRCTN, ISRCTN12765345.

Indexed as

AnxietyCardiovascular diseaseComorbidityDepressionInflammatory rheumatological conditionsIntegrated careLong-term conditionsMultimorbidityOsteoporosis

Identifiers

PMID33407943
PMCPMC7786467

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.