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Papers by Andrew Finney

Annals of the Rheumatic Diseases

BackgroundThe existing EULAR Recommendations for the non-pharmacological core management of hip a... more BackgroundThe existing EULAR Recommendations for the non-pharmacological core management of hip and knee osteoarthritis (OA) were published in 2013. A considerable number of new studies on various non-pharmacological treatment modalities have been published since then. Hence, it is time to update the Recommendations for the non-pharmacological core management of hip and knee OA.ObjectivesThe objective of this project was to perform an updated systematic literature review and to update the 2013 EULAR Recommendations for the non-pharmacological core management of hip and knee osteoarthritis, accordingly.MethodsThe standardised operating procedures for EULAR-endorsed Recommendations[1]were used as a framework for this project. A multi-disciplinary Task Force (TF) including 9 physiotherapists, 6 rheumatologists, 2 orthopaedic surgeons, 2 psychologists, 2 patient research partners, 1 occupational therapist, 1 nurse, 1 general practitioner and 1 nutrition expert from 13 European countries...

Health, Jun 2, 2020

Providing self-management support as a way of meeting the challenge of the predicted rise in long... more Providing self-management support as a way of meeting the challenge of the predicted rise in long term conditions (LTCs) has been a UK policy agenda for over a decade (Ong et al. 2014b) and continues to underpin person centred NHS supported patient led care for those with LTCs (NHS England 2014). Osteoarthritis (OA) is one such LTC which is reported to lead to discomfort and disruption to individuals as well as costing state and society in terms of lost productivity and healthcare costs (Arthritis Care 2012, Dziedzic et al. 2018). Supported self-management is recommended as a way of ameliorating these problems and helping patients live with OA (NICE 2014). In response a trial intervention featuring primarily nurse-led supported self-management in general practice settings was devised and implemented (Dziedzic et al. 2018), which we detail further below. The efficacy of primary care self-management interventions has been questioned due to clinical trials demonstrating little to no effect (Sun & Guyatt 2013). A longstanding hierarchy of evidence positions trial findings as the 'gold standard' (Barton 2000) and, in part, underpins this debate. The philosophical standpoint of trial methodology emphasises identifying linear causality within a closed system between intervention and outcome (Marchal et al. 2013). It is recognised that embedding self-management support in everyday practice is not straightforward because it requires change at different levels and places additional pressures on practitioners and patients. For professionals it can conflict with external drivers, the existing organization of care, and individual ways of working (Kennedy et al 2013, Ong et al 2014a). Practitioners often experience difficulties reconciling their professional identities and relinquishing responsibilities for patients (Blakeman et al. 2006, McDonald et al. 2008).

Implementation Science, Aug 27, 2014

Background: There is as yet no evidence on the feasibility of implementing recommendations from t... more Background: There is as yet no evidence on the feasibility of implementing recommendations from the National Institute of Health and Care Excellence (NICE) osteoarthritis (OA) guidelines in primary care, or of the effect these recommendations have on the condition. The primary aim of this study is to determine the clinical and cost effectiveness of a model OA consultation (MOAC), implementing the core recommendations from the NICE OA guidelines in primary care. Secondary aims are to investigate the impact, feasibility and acceptability of the MOAC intervention; to develop and evaluate a training package for management of OA by general practitioners (GPs) and practice nurses; test the feasibility of deriving 'quality markers' of OA management using a new consultation template and medical record review; and describe the uptake of core NICE OA recommendations in participants aged 45 years and over with joint pain. Design: A mixed methods study with a nested cluster randomised controlled trial. Method: This study was developed according to a defined theoretical framework (the Whole System Informing Self-management Engagement). An overarching model (the Normalisation Process Theory) will be employed to undertake a comprehensive 'whole-system' evaluation of the processes and outcomes of implementing the MOAC intervention. The primary outcome is general physical health (Short Form-12 Physical component score [PCS]) (Ware 1996). The impact, acceptability and feasibility of the MOAC intervention at practice level will be assessed by comparing intervention and control practices using a Quality Indicators template and medical record review. Impact and acceptability of the intervention for patients will be assessed via self-completed outcome measures and semi-structured interviews. The impact, acceptability and feasibility of the MOAC intervention and training for GPs and practice nurses will be evaluated using a variety of methods including questionnaires, semi-structured interviews, and observations.

Wiener klinische Wochenschrift, 2021

Summary Background More people are living with frailty and requiring additional health and suppor... more Summary Background More people are living with frailty and requiring additional health and support services. To improve their management, the “Frailty: Core Capability Framework” in the United Kingdom recommends frailty education for older individuals, their families, carers and health professionals. We performed a systematic review of specific educational programmes for these groups. Methods Electronic databases were searched using dedicated search terms and inclusion criteria. To improve accuracy, two reviewers carried out the screening and selection of research papers. Information from included studies was collected using a tailored data extraction template, and quality appraisal tools were used to assess the rigour of the studies. The findings were analysed to identify key themes. Results A total of 11 studies met the criteria and were included in the review. The study populations ranged from 12 to 603 and the research designs were heterogeneous (6 qualitative; 2 randomised cont...

Age and Ageing, 2021

Introduction With an ever-increasing, ageing population, there is inevitable increase in people l... more Introduction With an ever-increasing, ageing population, there is inevitable increase in people living with frailty with a growing demand on the NHS in the UK. Healthcare policy emphasises holistic care and a multimorbid approach to meet these needs. Frailty is seen as a measurable, complex, fluid and variable state affected by a balance of resilience versus vulnerability across domains which impact on quality of life. The FCCF positions frailty as a LTC and suggests that a holistic and person-centred approach to education is required for people living with frailty, their families, carers and health care professionals. This is a systematic review of research studies providing educational programmes or initiatives to these groups and addresses whether the content and application will compliment and support the facilitation of the FCCF. Methods Following standardised methods and guidelines, electronic databases were searched. Two reviewers were involved in the research collection proc...

Pilot and Feasibility Studies, 2021

Background People with inflammatory rheumatological conditions such as rheumatoid arthritis, psor... more Background People with inflammatory rheumatological conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polymyalgia rheumatica and giant cell arteritis are at an increased risk of common comorbidities including cardiovascular disease, osteoporosis and mood problems, leading to increased morbidity and mortality. Identifying and treating these problems could lead to improved patient quality of life and outcomes. Despite these risks being well-established, patients currently are not systematically targeted for management interventions for these morbidities. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led integrated care review in primary care to identify and manage these morbidities. Methods A pilot cluster RCT was delivered across four UK general practices. Patients with a diagnostic Read code for one of the inflammatory rheumatological conditions of interest were recruited by post. In interv...

Rheumatology, 2020

Background People with inflammatory rheumatological conditions (IRCs), including rheumatoid arthr... more Background People with inflammatory rheumatological conditions (IRCs), including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), are at an increased risk of common comorbidities, such as cardiovascular disease (CVD), osteoporosis and mood problems, which result in poorer patient outcomes. The INCLUDE study assessed the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led, holistic, integrated review in primary care. Methods A pilot cluster RCT was delivered across four general practices. Patients with a Read code for an IRC were recruited by postal invitation. In intervention practices (n = 2), eligible patients were invited to attend a nurse-delivered INCLUDE review - an integrated consultation assessing CVD risk (QRisk2), bone health (FRAX) and mood (PHQ2 and GAD2), using a study-specific computerised template. Patients received an individualized patient manageme...

Rheumatology, 2014

(65%), by manual recall arranged by administration staff. Conclusion: The keeping of a High-Risk ... more (65%), by manual recall arranged by administration staff. Conclusion: The keeping of a High-Risk Medicines Register is essential to ensure that patients on high-risk medicines are identified and receive a continuing service of high quality care. General guidance for shared care prescribing states that the doctor prescribing the medication legally assumes clinical responsibility for the patient and the consequence of the use of the high-risk drug. It is therefore important that action is taken by the GP who has undertaken this role, if test results are abnormal. It can be seen from this audit that the current recall system for drug monitoring of patients at the Nairn Healthcare Group is inefficient. GP practices should develop formal, computer-driven recall systems for the monitoring of patients receiving high-risk medicines, including a robust mechanism for recalling defaulters. Patients must be educated about the management of their disease and the potential adverse side effects of the drugs prescribed. In addition, communication between primary and secondary care must be improved to ascertain who is responsible for monitoring. Disclosure statement: The author has declared no conflicts of interest.

Rheumatology, 2014

in RA) associated with very early RA (veRA) presentation (veRA, 12 weeks). It is not known whethe... more in RA) associated with very early RA (veRA) presentation (veRA, 12 weeks). It is not known whether veRA presentation influences outcome at 1-year. In an eRA cohort, we aimed to explore: (i) baseline disease associations with veRA and (ii) veRA as predictor of 1-year outcomes. Methods: An inception cohort of eRA patients with a clinical diagnosis of RA (of symptom duration 12 months) had BMI, smoking status, symptom duration, DAS28, RF and anti-citrullinated protein antibody (ACPA) statuses, and HAQ scores recorded at baseline. All received DMARDs following a treat-to-target protocol. 1-year outcomes were: DAS28 remission DAS28 < 2.6), good EULAR response and improvement in disability (any reduction in HAQ score). Associations with veRA were explored using logistic regression, adjusting for age and gender. Results: 243 eRA patients with 1-year follow-up data were identified. Baseline mean age was 58.3 years (S.D. 15.1), 65.8% were female and 67.1% ACPA positive. History of ever-smoking was reported by 43.2%, and 28.8% were obese. VeRA presentation was observed in 100 patients (41.2%). At baseline, veRA was associated with smoking, ACPA and RF seronegativity and high DAS28 (Table 1). After 1-year of treatment, 121 patients (49.8%) achieved DAS28 remission, 142 (58%) had good EULAR response and 154 (63%) demonstrated HAQ improvement. VeRA was not predictive of these outcomes in the overall cohort, however, ACPA-stratified analyses revealed an association between veRA and HAQ improvement in ACPA-negative patients, adjusting for age, gender, DAS28, smoking and obesity (OR adj 3.3 95% CI 1.1, 10.1). Conclusion: eRA patients presenting within the window of opportunity have increased disease activity, smoking and lower rates of seropositive disease, but have similar 1-year outcomes to eRA patients presenting outside this period. In ACPA-negative patients veRA presentation is associated with improved disability at 1-year, compared with those with delayed presentation. Disclosure statement: The authors have declared no conflicts of interest.

Musculoskeletal Care, 2013

Background: There is as yet no evidence on the feasibility of implementing recommendations from t... more Background: There is as yet no evidence on the feasibility of implementing recommendations from the National Institute of Health and Care Excellence (NICE) osteoarthritis (OA) guidelines in primary care, or of the effect these recommendations have on the condition. The primary aim of this study is to determine the clinical and cost effectiveness of a model OA consultation (MOAC), implementing the core recommendations from the NICE OA guidelines in primary care. Secondary aims are to investigate the impact, feasibility and acceptability of the MOAC intervention; to develop and evaluate a training package for management of OA by general practitioners (GPs) and practice nurses; test the feasibility of deriving 'quality markers' of OA management using a new consultation template and medical record review; and describe the uptake of core NICE OA recommendations in participants aged 45 years and over with joint pain. Design: A mixed methods study with a nested cluster randomised controlled trial. Method: This study was developed according to a defined theoretical framework (the Whole System Informing Self-management Engagement). An overarching model (the Normalisation Process Theory) will be employed to undertake a comprehensive 'whole-system' evaluation of the processes and outcomes of implementing the MOAC intervention. The primary outcome is general physical health (Short Form-12 Physical component score [PCS]) (Ware 1996). The impact, acceptability and feasibility of the MOAC intervention at practice level will be assessed by comparing intervention and control practices using a Quality Indicators template and medical record review. Impact and acceptability of the intervention for patients will be assessed via self-completed outcome measures and semi-structured interviews. The impact, acceptability and feasibility of the MOAC intervention and training for GPs and practice nurses will be evaluated using a variety of methods including questionnaires, semi-structured interviews, and observations.

Rheumatology, Mar 14, 2018

Objectives. The aim of this study was to estimate the cost-effectiveness of a model OA consultati... more Objectives. The aim of this study was to estimate the cost-effectiveness of a model OA consultation for OA to support self-management compared with usual care. Methods. An incremental costutility analysis using patient responses to the three-level EuroQoL-5D (EQ-5D) questionnaire was undertaken from a UK National Health Service perspective alongside a two-arm cluster-randomized controlled trial. Uncertainty was explored through the use of cost-effectiveness acceptability curves. Results. Differences in health outcomes between the model OA consultation and usual care arms were not statistically significant. On average, visits to the orthopaedic surgeon were lower in the model OA consultation arm by À0.28 (95% CI: À0.55, À0.06). The costutility analysis indicated that the model OA consultation was associated with a non-significant incremental cost of £À13.11 (95% CI: À81.09 to 54.85) and an incremental quality adjusted life year (QALY) of À0.003 (95% CI: À0.03 to 0.02), with a 44% chance of being cost-effective at a threshold of £20 000 per QALY gained. The percentage of participants who took time off and the associated productivity cost were lower in the model OA consultation arm. Conclusion. Implementing National Institute for Health and Care Excellence guidelines using a model OA consultation in primary care does not appear to lead to increased costs, but health outcomes remain very similar to usual care. Even though the intervention seems to reduce the demand for orthopaedic surgery, overall it is unlikely to be cost-effective.

British Journal of General Practice, 2021

BackgroundGroup consultations are a relatively new concept in UK primary care and are a suggested... more BackgroundGroup consultations are a relatively new concept in UK primary care and are a suggested solution to current workload pressures in general practice. Little is known about the experience of implementing and delivering this approach from staff and organisational perspectives.AimTo explore the experience of implementing and delivering group consultations in general practice.Design and settingQualitative telephone interview study.MethodTopic guides explored the perspectives and experiences of general practice staff on the implementation and delivery of group consultations. Data analysis adopted principles of the Framework Method underpinned by Normalisation Process Theory.ResultsInterviews were conducted with 8 GPs, 8 practice nurses, 1 nurse associate, 1 practice pharmacist, 1 deputy practice manager, and 1 healthcare assistant. Four themes were identified: sense making of group consultations; the work associated with initiating group consultations; the experiences of operatio...

BMC Musculoskeletal Disorders, 2017

Background: Research into musculoskeletal conditions often focusses on pain at single sites, such... more Background: Research into musculoskeletal conditions often focusses on pain at single sites, such as the knee, yet several studies have previously reported the high prevalence of multiple sites of musculoskeletal pain. The most common form of musculoskeletal condition is arthritis, with osteoarthritis (OA) the most common cause of joint pain in adults 45 years and over. However, there is limited recognition of the prevalence of multisite peripheral joint pain in those either living with or at risk of OA, therefore this study set out to estimate the prevalence of multisite peripheral joint pain in adults 45 years and older, and its impact on several dimensions of health. Methods: A cross-sectional population survey was mailed to adults (n = 28,443) aged 45 years and over from eight general practices in the North West Midlands, United Kingdom (UK). Prevalence rates were established for multisite peripheral joint pain (pain in two or more sites; hands, hips, knees, feet). Impact was measured for general health (SF-12 MCS & PCS), QoL (EQ-5D), pain intensity (0-10 numerical ratings scale) and the number of consultations with a range of health care professionals. Results: Of 15,083 responders (53%), multisite peripheral joint pain was reported by 54%. Peripheral joint pain was present in n = 11,928, of which 68% reported pain in multiple sites. Multisite peripheral joint pain was shown to be significantly associated with reduced physical (Mean difference = −5.9 95% CI-6.3,-5.5) and mental (−2.8 95% CI-3. 2,-2.4) components of the SF-12, reduced QoL (−0.14 95% CI-0.15, −0.13), increased pain (+0.70 95% CI 0.62, 0.79) and increased odds of consultations with GPs (OR 2.4 95% CI 2.2, 2.6) and practice nurses (OR 2.6 (95% CI 2.1, 3.2) when compared to single site pain. Conclusions: Multisite peripheral joint pain is prevalent in the population in adults 45 years and over and has a significant negative impact on several dimensions of health. Health care professionals should consider joint pain beyond the index site in order to address holistic management.

Journal of comorbidity, 2018

Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumat... more Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed. To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care. A ...

BMJ open, Dec 29, 2017

To determine common patterns of recorded primary care for osteoarthritis (OA), and patient and pr... more To determine common patterns of recorded primary care for osteoarthritis (OA), and patient and provider characteristics associated with the quality of recorded care. An observational study nested within a cluster-randomised controlled trial. Eight UK general practices who were part of the Management of Osteoarthritis in Consultations study. Patients recorded as consulting within the eight general practices for clinical OA. Achievement of seven quality indicators of care (pain/function assessment, information provision, exercise/weight advice, analgesics, physiotherapy), recorded through an electronic template or routinely recorded in the electronic healthcare records, was identified for patients aged ≥45 years consulting over a 6-month period with clinical OA. Latent class analysis was used to cluster patients based on care received. Clusters were compared on patient and clinician-level characteristics. 1724 patients (median by practice 183) consulted with clinical OA. Common patter...

Rheumatology (Oxford, England), Jun 14, 2018

The aim of this study was to estimate the cost-effectiveness of a model OA consultation for OA to... more The aim of this study was to estimate the cost-effectiveness of a model OA consultation for OA to support self-management compared with usual care. An incremental cost-utility analysis using patient responses to the three-level EuroQoL-5D (EQ-5D) questionnaire was undertaken from a UK National Health Service perspective alongside a two-arm cluster-randomized controlled trial. Uncertainty was explored through the use of cost-effectiveness acceptability curves. Differences in health outcomes between the model OA consultation and usual care arms were not statistically significant. On average, visits to the orthopaedic surgeon were lower in the model OA consultation arm by -0.28 (95% CI: -0.55, -0.06). The cost-utility analysis indicated that the model OA consultation was associated with a non-significant incremental cost of £-13.11 (95% CI: -81.09 to 54.85) and an incremental quality adjusted life year (QALY) of -0.003 (95% CI: -0.03 to 0.02), with a 44% chance of being cost-effective ...

Musculoskeletal care, Sep 20, 2018

The aims of the present study was to examine the associations between the severity of pain and an... more The aims of the present study was to examine the associations between the severity of pain and anxiety in a community population reporting joint pain, and to investigate the management of joint pain in the presence of comorbid anxiety. A population survey was carried out of people aged ≥45 years, registered with eight general practices in Cheshire, Shropshire and Staffordshire, UK. Respondents were asked to report pain intensity in their hands, hips, knees and feet (on a numerical rating scale), anxiety symptoms (Generalized Anxiety Disorder seven-item [GAD-7] scale) and guideline-recommended treatments used to manage pain. Clinical anxiety was defined by a GAD-7 score of 10 or more. A total of 11,222 respondents with joint pain were included in the analysis, with 1,802 (16.1%) reporting clinical anxiety. Respondents reporting more severe pain were more likely to report clinical anxiety (severe versus mild pain, odds ratio [OR] 5.36, 95% confidence interval [CI] 4.56 to 6.31). The n...

Osteoarthritis and cartilage, Jan 14, 2017

To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, ... more To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, on physical function and uptake of National Institute for Health and Care Excellence (NICE) osteoarthritis recommendations, in adults ≥45 years consulting with peripheral joint pain in UK general practice. Two-arm cluster-randomised controlled trial with baseline health survey. Eight general practices in England. 525 adults ≥45 years consulting for peripheral joint pain, amongst 28,443 population survey recipients. Four intervention practices delivered the model osteoarthritis consultation to patients consulting with peripheral joint pain; four control practices continued usual care. The primary clinical outcome of the trial was the SF-12 physical component score (PCS) at 6 months; the main secondary outcome was uptake of NICE core recommendations by 6 months, measured by osteoarthritis quality indicators. A Linear Mixed Model was used to analyse clinical outcome data (SF-12 PCS). Differ...

Annals of the Rheumatic Diseases

BackgroundThe existing EULAR Recommendations for the non-pharmacological core management of hip a... more BackgroundThe existing EULAR Recommendations for the non-pharmacological core management of hip and knee osteoarthritis (OA) were published in 2013. A considerable number of new studies on various non-pharmacological treatment modalities have been published since then. Hence, it is time to update the Recommendations for the non-pharmacological core management of hip and knee OA.ObjectivesThe objective of this project was to perform an updated systematic literature review and to update the 2013 EULAR Recommendations for the non-pharmacological core management of hip and knee osteoarthritis, accordingly.MethodsThe standardised operating procedures for EULAR-endorsed Recommendations[1]were used as a framework for this project. A multi-disciplinary Task Force (TF) including 9 physiotherapists, 6 rheumatologists, 2 orthopaedic surgeons, 2 psychologists, 2 patient research partners, 1 occupational therapist, 1 nurse, 1 general practitioner and 1 nutrition expert from 13 European countries...

Health, Jun 2, 2020

Providing self-management support as a way of meeting the challenge of the predicted rise in long... more Providing self-management support as a way of meeting the challenge of the predicted rise in long term conditions (LTCs) has been a UK policy agenda for over a decade (Ong et al. 2014b) and continues to underpin person centred NHS supported patient led care for those with LTCs (NHS England 2014). Osteoarthritis (OA) is one such LTC which is reported to lead to discomfort and disruption to individuals as well as costing state and society in terms of lost productivity and healthcare costs (Arthritis Care 2012, Dziedzic et al. 2018). Supported self-management is recommended as a way of ameliorating these problems and helping patients live with OA (NICE 2014). In response a trial intervention featuring primarily nurse-led supported self-management in general practice settings was devised and implemented (Dziedzic et al. 2018), which we detail further below. The efficacy of primary care self-management interventions has been questioned due to clinical trials demonstrating little to no effect (Sun & Guyatt 2013). A longstanding hierarchy of evidence positions trial findings as the 'gold standard' (Barton 2000) and, in part, underpins this debate. The philosophical standpoint of trial methodology emphasises identifying linear causality within a closed system between intervention and outcome (Marchal et al. 2013). It is recognised that embedding self-management support in everyday practice is not straightforward because it requires change at different levels and places additional pressures on practitioners and patients. For professionals it can conflict with external drivers, the existing organization of care, and individual ways of working (Kennedy et al 2013, Ong et al 2014a). Practitioners often experience difficulties reconciling their professional identities and relinquishing responsibilities for patients (Blakeman et al. 2006, McDonald et al. 2008).

Implementation Science, Aug 27, 2014

Background: There is as yet no evidence on the feasibility of implementing recommendations from t... more Background: There is as yet no evidence on the feasibility of implementing recommendations from the National Institute of Health and Care Excellence (NICE) osteoarthritis (OA) guidelines in primary care, or of the effect these recommendations have on the condition. The primary aim of this study is to determine the clinical and cost effectiveness of a model OA consultation (MOAC), implementing the core recommendations from the NICE OA guidelines in primary care. Secondary aims are to investigate the impact, feasibility and acceptability of the MOAC intervention; to develop and evaluate a training package for management of OA by general practitioners (GPs) and practice nurses; test the feasibility of deriving 'quality markers' of OA management using a new consultation template and medical record review; and describe the uptake of core NICE OA recommendations in participants aged 45 years and over with joint pain. Design: A mixed methods study with a nested cluster randomised controlled trial. Method: This study was developed according to a defined theoretical framework (the Whole System Informing Self-management Engagement). An overarching model (the Normalisation Process Theory) will be employed to undertake a comprehensive 'whole-system' evaluation of the processes and outcomes of implementing the MOAC intervention. The primary outcome is general physical health (Short Form-12 Physical component score [PCS]) (Ware 1996). The impact, acceptability and feasibility of the MOAC intervention at practice level will be assessed by comparing intervention and control practices using a Quality Indicators template and medical record review. Impact and acceptability of the intervention for patients will be assessed via self-completed outcome measures and semi-structured interviews. The impact, acceptability and feasibility of the MOAC intervention and training for GPs and practice nurses will be evaluated using a variety of methods including questionnaires, semi-structured interviews, and observations.

Wiener klinische Wochenschrift, 2021

Summary Background More people are living with frailty and requiring additional health and suppor... more Summary Background More people are living with frailty and requiring additional health and support services. To improve their management, the “Frailty: Core Capability Framework” in the United Kingdom recommends frailty education for older individuals, their families, carers and health professionals. We performed a systematic review of specific educational programmes for these groups. Methods Electronic databases were searched using dedicated search terms and inclusion criteria. To improve accuracy, two reviewers carried out the screening and selection of research papers. Information from included studies was collected using a tailored data extraction template, and quality appraisal tools were used to assess the rigour of the studies. The findings were analysed to identify key themes. Results A total of 11 studies met the criteria and were included in the review. The study populations ranged from 12 to 603 and the research designs were heterogeneous (6 qualitative; 2 randomised cont...

Age and Ageing, 2021

Introduction With an ever-increasing, ageing population, there is inevitable increase in people l... more Introduction With an ever-increasing, ageing population, there is inevitable increase in people living with frailty with a growing demand on the NHS in the UK. Healthcare policy emphasises holistic care and a multimorbid approach to meet these needs. Frailty is seen as a measurable, complex, fluid and variable state affected by a balance of resilience versus vulnerability across domains which impact on quality of life. The FCCF positions frailty as a LTC and suggests that a holistic and person-centred approach to education is required for people living with frailty, their families, carers and health care professionals. This is a systematic review of research studies providing educational programmes or initiatives to these groups and addresses whether the content and application will compliment and support the facilitation of the FCCF. Methods Following standardised methods and guidelines, electronic databases were searched. Two reviewers were involved in the research collection proc...

Pilot and Feasibility Studies, 2021

Background People with inflammatory rheumatological conditions such as rheumatoid arthritis, psor... more Background People with inflammatory rheumatological conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polymyalgia rheumatica and giant cell arteritis are at an increased risk of common comorbidities including cardiovascular disease, osteoporosis and mood problems, leading to increased morbidity and mortality. Identifying and treating these problems could lead to improved patient quality of life and outcomes. Despite these risks being well-established, patients currently are not systematically targeted for management interventions for these morbidities. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led integrated care review in primary care to identify and manage these morbidities. Methods A pilot cluster RCT was delivered across four UK general practices. Patients with a diagnostic Read code for one of the inflammatory rheumatological conditions of interest were recruited by post. In interv...

Rheumatology, 2020

Background People with inflammatory rheumatological conditions (IRCs), including rheumatoid arthr... more Background People with inflammatory rheumatological conditions (IRCs), including rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), are at an increased risk of common comorbidities, such as cardiovascular disease (CVD), osteoporosis and mood problems, which result in poorer patient outcomes. The INCLUDE study assessed the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led, holistic, integrated review in primary care. Methods A pilot cluster RCT was delivered across four general practices. Patients with a Read code for an IRC were recruited by postal invitation. In intervention practices (n = 2), eligible patients were invited to attend a nurse-delivered INCLUDE review - an integrated consultation assessing CVD risk (QRisk2), bone health (FRAX) and mood (PHQ2 and GAD2), using a study-specific computerised template. Patients received an individualized patient manageme...

Rheumatology, 2014

(65%), by manual recall arranged by administration staff. Conclusion: The keeping of a High-Risk ... more (65%), by manual recall arranged by administration staff. Conclusion: The keeping of a High-Risk Medicines Register is essential to ensure that patients on high-risk medicines are identified and receive a continuing service of high quality care. General guidance for shared care prescribing states that the doctor prescribing the medication legally assumes clinical responsibility for the patient and the consequence of the use of the high-risk drug. It is therefore important that action is taken by the GP who has undertaken this role, if test results are abnormal. It can be seen from this audit that the current recall system for drug monitoring of patients at the Nairn Healthcare Group is inefficient. GP practices should develop formal, computer-driven recall systems for the monitoring of patients receiving high-risk medicines, including a robust mechanism for recalling defaulters. Patients must be educated about the management of their disease and the potential adverse side effects of the drugs prescribed. In addition, communication between primary and secondary care must be improved to ascertain who is responsible for monitoring. Disclosure statement: The author has declared no conflicts of interest.

Rheumatology, 2014

in RA) associated with very early RA (veRA) presentation (veRA, 12 weeks). It is not known whethe... more in RA) associated with very early RA (veRA) presentation (veRA, 12 weeks). It is not known whether veRA presentation influences outcome at 1-year. In an eRA cohort, we aimed to explore: (i) baseline disease associations with veRA and (ii) veRA as predictor of 1-year outcomes. Methods: An inception cohort of eRA patients with a clinical diagnosis of RA (of symptom duration 12 months) had BMI, smoking status, symptom duration, DAS28, RF and anti-citrullinated protein antibody (ACPA) statuses, and HAQ scores recorded at baseline. All received DMARDs following a treat-to-target protocol. 1-year outcomes were: DAS28 remission DAS28 < 2.6), good EULAR response and improvement in disability (any reduction in HAQ score). Associations with veRA were explored using logistic regression, adjusting for age and gender. Results: 243 eRA patients with 1-year follow-up data were identified. Baseline mean age was 58.3 years (S.D. 15.1), 65.8% were female and 67.1% ACPA positive. History of ever-smoking was reported by 43.2%, and 28.8% were obese. VeRA presentation was observed in 100 patients (41.2%). At baseline, veRA was associated with smoking, ACPA and RF seronegativity and high DAS28 (Table 1). After 1-year of treatment, 121 patients (49.8%) achieved DAS28 remission, 142 (58%) had good EULAR response and 154 (63%) demonstrated HAQ improvement. VeRA was not predictive of these outcomes in the overall cohort, however, ACPA-stratified analyses revealed an association between veRA and HAQ improvement in ACPA-negative patients, adjusting for age, gender, DAS28, smoking and obesity (OR adj 3.3 95% CI 1.1, 10.1). Conclusion: eRA patients presenting within the window of opportunity have increased disease activity, smoking and lower rates of seropositive disease, but have similar 1-year outcomes to eRA patients presenting outside this period. In ACPA-negative patients veRA presentation is associated with improved disability at 1-year, compared with those with delayed presentation. Disclosure statement: The authors have declared no conflicts of interest.

Musculoskeletal Care, 2013

Background: There is as yet no evidence on the feasibility of implementing recommendations from t... more Background: There is as yet no evidence on the feasibility of implementing recommendations from the National Institute of Health and Care Excellence (NICE) osteoarthritis (OA) guidelines in primary care, or of the effect these recommendations have on the condition. The primary aim of this study is to determine the clinical and cost effectiveness of a model OA consultation (MOAC), implementing the core recommendations from the NICE OA guidelines in primary care. Secondary aims are to investigate the impact, feasibility and acceptability of the MOAC intervention; to develop and evaluate a training package for management of OA by general practitioners (GPs) and practice nurses; test the feasibility of deriving 'quality markers' of OA management using a new consultation template and medical record review; and describe the uptake of core NICE OA recommendations in participants aged 45 years and over with joint pain. Design: A mixed methods study with a nested cluster randomised controlled trial. Method: This study was developed according to a defined theoretical framework (the Whole System Informing Self-management Engagement). An overarching model (the Normalisation Process Theory) will be employed to undertake a comprehensive 'whole-system' evaluation of the processes and outcomes of implementing the MOAC intervention. The primary outcome is general physical health (Short Form-12 Physical component score [PCS]) (Ware 1996). The impact, acceptability and feasibility of the MOAC intervention at practice level will be assessed by comparing intervention and control practices using a Quality Indicators template and medical record review. Impact and acceptability of the intervention for patients will be assessed via self-completed outcome measures and semi-structured interviews. The impact, acceptability and feasibility of the MOAC intervention and training for GPs and practice nurses will be evaluated using a variety of methods including questionnaires, semi-structured interviews, and observations.

Rheumatology, Mar 14, 2018

Objectives. The aim of this study was to estimate the cost-effectiveness of a model OA consultati... more Objectives. The aim of this study was to estimate the cost-effectiveness of a model OA consultation for OA to support self-management compared with usual care. Methods. An incremental costutility analysis using patient responses to the three-level EuroQoL-5D (EQ-5D) questionnaire was undertaken from a UK National Health Service perspective alongside a two-arm cluster-randomized controlled trial. Uncertainty was explored through the use of cost-effectiveness acceptability curves. Results. Differences in health outcomes between the model OA consultation and usual care arms were not statistically significant. On average, visits to the orthopaedic surgeon were lower in the model OA consultation arm by À0.28 (95% CI: À0.55, À0.06). The costutility analysis indicated that the model OA consultation was associated with a non-significant incremental cost of £À13.11 (95% CI: À81.09 to 54.85) and an incremental quality adjusted life year (QALY) of À0.003 (95% CI: À0.03 to 0.02), with a 44% chance of being cost-effective at a threshold of £20 000 per QALY gained. The percentage of participants who took time off and the associated productivity cost were lower in the model OA consultation arm. Conclusion. Implementing National Institute for Health and Care Excellence guidelines using a model OA consultation in primary care does not appear to lead to increased costs, but health outcomes remain very similar to usual care. Even though the intervention seems to reduce the demand for orthopaedic surgery, overall it is unlikely to be cost-effective.

British Journal of General Practice, 2021

BackgroundGroup consultations are a relatively new concept in UK primary care and are a suggested... more BackgroundGroup consultations are a relatively new concept in UK primary care and are a suggested solution to current workload pressures in general practice. Little is known about the experience of implementing and delivering this approach from staff and organisational perspectives.AimTo explore the experience of implementing and delivering group consultations in general practice.Design and settingQualitative telephone interview study.MethodTopic guides explored the perspectives and experiences of general practice staff on the implementation and delivery of group consultations. Data analysis adopted principles of the Framework Method underpinned by Normalisation Process Theory.ResultsInterviews were conducted with 8 GPs, 8 practice nurses, 1 nurse associate, 1 practice pharmacist, 1 deputy practice manager, and 1 healthcare assistant. Four themes were identified: sense making of group consultations; the work associated with initiating group consultations; the experiences of operatio...

BMC Musculoskeletal Disorders, 2017

Background: Research into musculoskeletal conditions often focusses on pain at single sites, such... more Background: Research into musculoskeletal conditions often focusses on pain at single sites, such as the knee, yet several studies have previously reported the high prevalence of multiple sites of musculoskeletal pain. The most common form of musculoskeletal condition is arthritis, with osteoarthritis (OA) the most common cause of joint pain in adults 45 years and over. However, there is limited recognition of the prevalence of multisite peripheral joint pain in those either living with or at risk of OA, therefore this study set out to estimate the prevalence of multisite peripheral joint pain in adults 45 years and older, and its impact on several dimensions of health. Methods: A cross-sectional population survey was mailed to adults (n = 28,443) aged 45 years and over from eight general practices in the North West Midlands, United Kingdom (UK). Prevalence rates were established for multisite peripheral joint pain (pain in two or more sites; hands, hips, knees, feet). Impact was measured for general health (SF-12 MCS & PCS), QoL (EQ-5D), pain intensity (0-10 numerical ratings scale) and the number of consultations with a range of health care professionals. Results: Of 15,083 responders (53%), multisite peripheral joint pain was reported by 54%. Peripheral joint pain was present in n = 11,928, of which 68% reported pain in multiple sites. Multisite peripheral joint pain was shown to be significantly associated with reduced physical (Mean difference = −5.9 95% CI-6.3,-5.5) and mental (−2.8 95% CI-3. 2,-2.4) components of the SF-12, reduced QoL (−0.14 95% CI-0.15, −0.13), increased pain (+0.70 95% CI 0.62, 0.79) and increased odds of consultations with GPs (OR 2.4 95% CI 2.2, 2.6) and practice nurses (OR 2.6 (95% CI 2.1, 3.2) when compared to single site pain. Conclusions: Multisite peripheral joint pain is prevalent in the population in adults 45 years and over and has a significant negative impact on several dimensions of health. Health care professionals should consider joint pain beyond the index site in order to address holistic management.

Journal of comorbidity, 2018

Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumat... more Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed. To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care. A ...

BMJ open, Dec 29, 2017

To determine common patterns of recorded primary care for osteoarthritis (OA), and patient and pr... more To determine common patterns of recorded primary care for osteoarthritis (OA), and patient and provider characteristics associated with the quality of recorded care. An observational study nested within a cluster-randomised controlled trial. Eight UK general practices who were part of the Management of Osteoarthritis in Consultations study. Patients recorded as consulting within the eight general practices for clinical OA. Achievement of seven quality indicators of care (pain/function assessment, information provision, exercise/weight advice, analgesics, physiotherapy), recorded through an electronic template or routinely recorded in the electronic healthcare records, was identified for patients aged ≥45 years consulting over a 6-month period with clinical OA. Latent class analysis was used to cluster patients based on care received. Clusters were compared on patient and clinician-level characteristics. 1724 patients (median by practice 183) consulted with clinical OA. Common patter...

Rheumatology (Oxford, England), Jun 14, 2018

The aim of this study was to estimate the cost-effectiveness of a model OA consultation for OA to... more The aim of this study was to estimate the cost-effectiveness of a model OA consultation for OA to support self-management compared with usual care. An incremental cost-utility analysis using patient responses to the three-level EuroQoL-5D (EQ-5D) questionnaire was undertaken from a UK National Health Service perspective alongside a two-arm cluster-randomized controlled trial. Uncertainty was explored through the use of cost-effectiveness acceptability curves. Differences in health outcomes between the model OA consultation and usual care arms were not statistically significant. On average, visits to the orthopaedic surgeon were lower in the model OA consultation arm by -0.28 (95% CI: -0.55, -0.06). The cost-utility analysis indicated that the model OA consultation was associated with a non-significant incremental cost of £-13.11 (95% CI: -81.09 to 54.85) and an incremental quality adjusted life year (QALY) of -0.003 (95% CI: -0.03 to 0.02), with a 44% chance of being cost-effective ...

Musculoskeletal care, Sep 20, 2018

The aims of the present study was to examine the associations between the severity of pain and an... more The aims of the present study was to examine the associations between the severity of pain and anxiety in a community population reporting joint pain, and to investigate the management of joint pain in the presence of comorbid anxiety. A population survey was carried out of people aged ≥45 years, registered with eight general practices in Cheshire, Shropshire and Staffordshire, UK. Respondents were asked to report pain intensity in their hands, hips, knees and feet (on a numerical rating scale), anxiety symptoms (Generalized Anxiety Disorder seven-item [GAD-7] scale) and guideline-recommended treatments used to manage pain. Clinical anxiety was defined by a GAD-7 score of 10 or more. A total of 11,222 respondents with joint pain were included in the analysis, with 1,802 (16.1%) reporting clinical anxiety. Respondents reporting more severe pain were more likely to report clinical anxiety (severe versus mild pain, odds ratio [OR] 5.36, 95% confidence interval [CI] 4.56 to 6.31). The n...

Osteoarthritis and cartilage, Jan 14, 2017

To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, ... more To determine the effectiveness of a model osteoarthritis consultation, compared with usual care, on physical function and uptake of National Institute for Health and Care Excellence (NICE) osteoarthritis recommendations, in adults ≥45 years consulting with peripheral joint pain in UK general practice. Two-arm cluster-randomised controlled trial with baseline health survey. Eight general practices in England. 525 adults ≥45 years consulting for peripheral joint pain, amongst 28,443 population survey recipients. Four intervention practices delivered the model osteoarthritis consultation to patients consulting with peripheral joint pain; four control practices continued usual care. The primary clinical outcome of the trial was the SF-12 physical component score (PCS) at 6 months; the main secondary outcome was uptake of NICE core recommendations by 6 months, measured by osteoarthritis quality indicators. A Linear Mixed Model was used to analyse clinical outcome data (SF-12 PCS). Differ...