The effects of implementing a point-of-care electronic template to prompt routine anxiety and depression screening in patients consulting for osteoarthritis (the Primary Care Osteoarthritis Trial): A cluster randomised trial in primary care

Abstract

BackgroundThis study aimed to evaluate whether prompting general practitioners (GPs) to routinely assess and manage anxiety and depression in patients consulting with osteoarthritis (OA) improves pain outcomes.Methods and findingsWe conducted a cluster randomised controlled trial involving 45 English general practices. In intervention practices, patients aged ≥45 y consulting with OA received point-of-care anxiety and depression screening by the GP, prompted by an automated electronic template comprising five questions (a two-item Patient Health Questionnaire–2 for depression, a two-item Generalized Anxiety Disorder–2 questionnaire for anxiety, and a question about current pain intensity [0–10 numerical rating scale]). The template signposted GPs to follow National Institute for Health and Care Excellence clinical guidelines for anxiety, depression, and OA and was supported by a brief training package. The template in control practices prompted GPs to ask the pain intensity question only. The primary outcome was patient-reported current pain intensity post-consultation and at 3-, 6-, and 12-mo follow-up. Secondary outcomes included pain-related disability, anxiety, depression, and general health.During the trial period, 7,279 patients aged ≥45 y consulted with a relevant OA-related code, and 4,240 patients were deemed potentially eligible by participating GPs. Templates were completed for 2,042 patients (1,339 [31.6%] in the control arm and 703 [23.1%] in the intervention arm). Of these 2,042 patients, 1,412 returned questionnaires (501 [71.3%] from 20 intervention practices, 911 [68.0%] from 24 control practices). Follow-up rates were similar in both arms, totalling 1,093 (77.4%) at 3 mo, 1,064 (75.4%) at 6 mo, and 1,017 (72.0%) at 12 mo. For the primary endpoint, multilevel modelling yielded significantly higher average pain intensity across follow-up to 12 mo in the intervention group than the control group (adjusted mean difference 0.31; 95% CI 0.04, 0.59). Secondary outcomes were consistent with the primary outcome measure in reflecting better outcomes as a whole for the control group than the intervention group. Anxiety and depression scores did not reduce following the intervention. The main limitations of this study are two potential sources of bias: an imbalance in cluster size (mean practice size 7,397 [intervention] versus 5,850 [control]) and a difference in the proportion of patients for whom the GP deactivated the template (33.6% [intervention] versus 27.8% [control]).ConclusionsIn this study, we observed no beneficial effect on pain outcomes of prompting GPs to routinely screen for and manage comorbid anxiety and depression in patients presenting with symptoms due to OA, with those in the intervention group reporting statistically significantly higher average pain scores over the four follow-up time points than those in the control group.Trial registrationISRCTN registry ISRCTN40721988

Systematic Review and Meta-analysis of the Effectiveness of Implementation Strategies for Non-communicable Disease Guidelines in Primary Health Care

“…distribution of materials applied on the meeting or e-learning sessions. 34,40,44,47,54,57,58 (3) Seven studies used diverse single approaches including audit, 25,31,43 motivational interview, 53 reminder 26,32 and patient-mediated intervention. 41 Multifaceted interventions mainly applied a combination of two methods, one of them a kind of training approach, extended by a second methodologically different method.…”

Pos1088 efficacy of Subcutaneous Tanezumab for the Treatment of Osteoarthritis of the Knee or Hip: A Post-Hoc Subgroup Analysis of Patients From a Randomized, Nsaid-Controlled Study With a History of Depression, Anxiety, or Insomnia

“…This exploratory study suggests that lipidomics is a promising field for biomarker discovery for prediction of anti-inflammatory treatment response. Indianapolis, United States of America; 4 Pfizer SAS, Paris, France; 5 Pfizer Inc., New York, United States of America; 6 Pfizer Inc., Groton, United States of America Background: Tanezumab is a monoclonal antibody directed against nerve growth factor. It is in development for the treatment of moderate to severe chronic pain associated with osteoarthritis (OA) in adult patients for whom other treatments are ineffective or not appropriate.…”

“…1,2,3,4 The efficacy of some other OA therapies can be dampened in patients with depression, anxiety, or insomnia. 5,6,7 Objectives: A post-hoc analysis to explore the efficacy of subcutaneous tanezumab after 16 weeks treatment, as compared to oral NSAID, in patients with OA and a history of depression, anxiety, or insomnia at baseline. Methods: Subgroup analysis of data from a randomized, double-blind, double-dummy, active-controlled phase 3 study of subcutaneous tanezumab (2.5 mg or 5 mg every 8 weeks) vs twice daily oral NSAID in patients (≥18 years) with radiographically-confirmed moderate to severe hip or knee OA (Kellgren-Lawrence grade ≥2; NCT02528188).…”

<p>General practitioners and management of chronic noncancer pain: a cross-sectional survey of influences on opioid deprescribing</p>

“…Although the link between POAs and depression is well supported,54,55 the specific risk associated with codeine prescriptions has only recently been highlighted 56. In contrast, a recent trial in the UK has cast doubt on the usefulness of screening for depression and anxiety, at least in patients presenting to their GP with osteoarthritis 57. It is possible that screening, in the context of more holistic care is effective, this is an area to be explored.…”