BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial
Abstract Background Patients 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...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-10-01
|
| Series: | BMC Family Practice |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12875-020-01269-9 |
| _version_ | 1828469797380161536 |
|---|---|
| author | Meenal Patel Kirsty James Rona Moss-Morris Mark Ashworth Mujtaba Husain Matthew Hotopf Anthony S. David Paul McCrone Sabine Landau Trudie Chalder on behalf of the PRINCE Primary trial team |
| author_facet | Meenal Patel Kirsty James Rona Moss-Morris Mark Ashworth Mujtaba Husain Matthew Hotopf Anthony S. David Paul McCrone Sabine Landau Trudie Chalder on behalf of the PRINCE Primary trial team |
| author_sort | Meenal Patel |
| collection | DOAJ |
| description | Abstract Background Patients 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. Methods A 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. Results Two 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. Conclusions It 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 registration NCT02444520 (ClinicalTrials.gov). |
| first_indexed | 2024-12-11T04:44:09Z |
| format | Article |
| id | doaj.art-28eac5d4042e4b91a9b0a2727b931aa3 |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-12-11T04:44:09Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-28eac5d4042e4b91a9b0a2727b931aa32022-12-22T01:20:32ZengBMCBMC Family Practice1471-22962020-10-0121111510.1186/s12875-020-01269-9BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trialMeenal Patel0Kirsty James1Rona Moss-Morris2Mark Ashworth3Mujtaba Husain4Matthew Hotopf5Anthony S. David6Paul McCrone7Sabine Landau8Trudie Chalder9on behalf of the PRINCE Primary trial teamDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neurosciences, Psychology and Neuroscience King’s CollegePsychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s CollegeSchool of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine King’s College LondonUK South London and Maudsley NHS Foundation TrustDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonDivision of Psychiatry, Maple House, UCL Institute of Mental HealthInstitute for Lifecourse Development, University of Greenwich, Old Royal Naval CollegeDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neurosciences, Psychology and Neuroscience King’s CollegeDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonAbstract Background Patients 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. Methods A 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. Results Two 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. Conclusions It 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 registration NCT02444520 (ClinicalTrials.gov).http://link.springer.com/article/10.1186/s12875-020-01269-9Persistent physical symptomsCognitive behavioural skillsFeasibilityGeneral practiceCluster randomised controlled trialTransdiagnostic |
| spellingShingle | Meenal Patel Kirsty James Rona Moss-Morris Mark Ashworth Mujtaba Husain Matthew Hotopf Anthony S. David Paul McCrone Sabine Landau Trudie Chalder on behalf of the PRINCE Primary trial team BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial BMC Family Practice Persistent physical symptoms Cognitive behavioural skills Feasibility General practice Cluster randomised controlled trial Transdiagnostic |
| title | BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial |
| title_full | BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial |
| title_fullStr | BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial |
| title_full_unstemmed | BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial |
| title_short | BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial |
| title_sort | bmc family practice integrated gp care for patients with persistent physical symptoms feasibility cluster randomised trial |
| topic | Persistent physical symptoms Cognitive behavioural skills Feasibility General practice Cluster randomised controlled trial Transdiagnostic |
| url | http://link.springer.com/article/10.1186/s12875-020-01269-9 |
| work_keys_str_mv | AT meenalpatel bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT kirstyjames bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT ronamossmorris bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT markashworth bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT mujtabahusain bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT matthewhotopf bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT anthonysdavid bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT paulmccrone bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT sabinelandau bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT trudiechalder bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial AT onbehalfoftheprinceprimarytrialteam bmcfamilypracticeintegratedgpcareforpatientswithpersistentphysicalsymptomsfeasibilityclusterrandomisedtrial |