ENHANCE - Improving care for people with long term conditions

Chief Investigator:

Principal Investigator:

Study Co-ordinator:

Funder name / reference number: Arthritis Research UK Primary Care Centre of Excellence, a NIHR Research Professorship (NIHR-RP-2014-04-026) and the National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands (NIHR CLAHRC WM)
UKCRN Study portfolio: 19369
Year 2014-2016

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

Improving care for people with long term conditions 

To 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 long term conditions (LTCs) in primary care (asthma / COPD / hypertension or ischemic heart disease / diabetes), within what we have called an ‘ENHANCE’ long term condition (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.