Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial

BMC Family Practice

Sabine Landau¹  Kirsty James¹  Meenal Patel²  Trudie Chalder²  Matthew Hotopf³  Anthony S. David⁴  Paul McCrone⁵  Rona Moss-Morris⁶  Mark Ashworth⁷  Mujtaba Husain⁸ 

[1] Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neurosciences, Psychology and Neuroscience King’s College, London, UK;Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, SE5 8AF, London, UK;Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, SE5 8AF, London, UK;UK South London and Maudsley NHS Foundation Trust, London, UK;Division of Psychiatry, Maple House, UCL Institute of Mental Health, 149 Tottenham Court Road, W1T 7NF, London, UK;Institute for Lifecourse Development, University of Greenwich, Old Royal Naval College, Park Row, Greenwich, SE10 9LS, London, UK;Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK;School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine King’s College London, London, UK;UK South London and Maudsley NHS Foundation Trust, London, UK;

关键词: Persistent physical symptoms;    Cognitive behavioural skills;    Feasibility;    General practice;    Cluster randomised controlled trial;    Transdiagnostic;   

DOI  :  10.1186/s12875-020-01269-9

来源: Springer

【 摘 要 】

BackgroundPatients continue to suffer from medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS). General practitioners (GPs) play a key role in the management of PPS and require further training. Patients are often frustrated with the care they receive. This study aims to assess the acceptability of an ‘integrated GP care’ approach which consists of offering self-help materials to patients with PPS and offering their GPs training on how to utilise cognitive behavioural skills within their consultations, as well as assessing the feasibility of conducting a future trial in primary care to evaluate its benefit.MethodsA feasibility cluster randomised controlled trial was conducted in primary care, South London, UK. GP practices (clusters) were randomly allocated to ‘integrated GP care plus treatment as usual’ or ‘treatment as usual’. Patients with PPS were recruited from participating GP practices before randomisation. Feasibility parameters, process variables and potential outcome measures were collected at pre-randomisation and at 12- and 24-weeks post-randomisation at cluster and individual participant level.ResultsTwo thousand nine hundred seventy-eight patients were identified from 18 GP practices. Out of the 424 patients who responded with interest in the study, 164 fully met the eligibility criteria. One hundred sixty-one patients provided baseline data before cluster randomisation and therefore were able to participate in the study. Most feasibility parameters indicated that the intervention was acceptable and a future trial feasible. 50 GPs from 8 GP practices (randomised to intervention) attended the offer of training and provided positive feedback. Scores in GP knowledge and confidence increased post-training. Follow-up rate of patients at 24 weeks was 87%. However estimated effect sizes on potential clinical outcomes were small.ConclusionsIt was feasible to identify and recruit patients with PPS. Retention rates of participants up to 24 weeks were high. A wide range of health services were used. The intervention was relatively low cost and low risk. This complex intervention should be further developed to improve patients’/GPs’ utilisation of audio/visual and training resources before proceeding to a full trial evaluation.Trial registrationNCT02444520 (ClinicalTrials.gov).

【 授权许可】

CC BY