Improving the Care of People with Long Term Conditions (ENHANCE)

West MidlandsGeneric Health Relevance
Start Date: 5 Aug 2015

Study design

The design is a pilot stepped wedge cluster randomised controlled trial set in general practice. The units of randomisation are general practices and the units of observation are adults consulting for their Long Term Condition (LTC) review at participating general practices.

Primary objective

This pilot trial will examine the feasibility and acceptability of an integrated approach to LTC management by tackling the under-diagnosis and under-management of OA related pain (knee, hip, hand and foot) and anxiety and/or depression in patients aged 45 years and over with other LTCs in primary care (asthma / COPD / hypertension or ischemic heart disease / diabetes), within an ‘ENHANCE’ LTC review.


The intervention consists of trained practice nurses delivering the ‘ENHANCE’ LTC review during dedicated study clinics, supported by the ‘ENHANCE’ EMIS template. Usual practice nurse led LTC reviews will be extended by an extra 15 minutes to integrate a) Case finding for anxiety / depression / joint pain, b) Assessment of anxiety / depression / joint pain and c) Negotiation of a management plan which might include facilitating self-management support or signposting / referral to services within or outside the practice.

Prof Christian Mallen