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.

中文翻译：

---

将骨关节炎、焦虑症和抑郁症的病例发现和初始管理纳入初级保健长期状况审查：增强试验试验的结果。

背景 多发病越来越成为常态。然而，初级保健仍然专注于单一疾病。骨关节炎、焦虑和抑郁经常与其他长期疾病 (LTC) 合并，但很少被临床医生优先考虑。目的 测试一项随机对照试验 (RCT) 的可行性，该试验在 LTC 审查中整合了骨关节炎、焦虑和抑郁的病例发现和管理。方法 一项跨越 4 项一般实践的试验性阶梯楔形 RCT 招募了年龄≥45 岁的患者参加常规 LTC 审查。全科护士提供常规 LTC 审查（控制期），然后在培训后进行 ENHANCE LTC 审查（干预期）。在评估中使用了问卷、ENHANCE EMIS 嵌入式模板和咨询录音。结果 一般实践的招聘和培训出勤率达到了预先设定的成功标准。466 名受邀患者中有 318 名（68%）做出了回应；然而，在对照期间招募了更多的患者（206 名对照，112 名干预）。82% 和 78% 的人分别返回了 6 周和 6 个月的问卷。ENHANCE LTC 审查与常规 LTC 审查的整合各不相同。病例发现问题通常用于关节疼痛，但在较小程度上用于焦虑和抑郁。缺乏通过转诊和路标进行的初始管理，并且更频繁地为关节疼痛提供建议。阶梯式楔形设计意味着培训的时间安排具有挑战性，并产生了差异化的招聘。结论 该试验性试验表明，在初级保健中提供充分有力的试验是可行的。需要优化的领域包括改进培训和重新考虑阶梯式设计以及针对最需要的人的招聘方法。试用注册 ISRCTN 注册 (ISRCTN: 12154418)。注册日期：2015 年 8 月 6 日。第一个参与者注册日期：2015 年 7 月 13 日。https://www.isrctn.com/ISRCTN12154418?q=depression%20schizophrenia&filters=conditionCategory:Not%20Applicable&sort=&offset=5&totalResults=9&page=1&pageSize=20&searchType =基本搜索。12154418）。注册日期：2015 年 8 月 6 日。第一个参与者注册日期：2015 年 7 月 13 日。https://www.isrctn.com/ISRCTN12154418?q=depression%20schizophrenia&filters=conditionCategory:Not%20Applicable&sort=&offset=5&totalResults=9&page=1&pageSize=20&searchType =基本搜索。12154418）。注册日期：2015 年 8 月 6 日。第一个参与者注册日期：2015 年 7 月 13 日。https://www.isrctn.com/ISRCTN12154418?q=depression%20schizophrenia&filters=conditionCategory:Not%20Applicable&sort=&offset=5&totalResults=9&page=1&pageSize=20&searchType =基本搜索。