The ENHANCE study aims to improve the management of people with long-term conditions (LTCs) in primary care and is part of the National Institute for Health Research (NIHR) West Midlands Collaborations for Leadership in Applied Health Research and Care (CLAHRC). Anxiety, depression, and pain due to osteoarthritis (OA) often appear alongside LTCs and can be neglected in consultations when LTCs such as diabetes, COPD, asthma and heart disease are reviewed. Anxiety and depression worsens the outcomes for people with LTCs, and increase health service use and costs. Co-morbid pain leads to poor quality of life for these patients.
We developed training for Practice Nurses to identify (case-find) pain due to OA, anxiety and depression in review consultations for people with LTCs (diabetes, COPD, asthma, CHD). Once anxiety or depression are recognised, patients may be referred to primary care mental health services (or ‘Improving Access to Psychological Therapies’, IAPT) for further management, as outlined in NICE Clinical Guideline 91.
Because of the impact of anxiety and depression on people with LTCs, IAPT services are tasked by the Department of Health to ensure that they offer appropriate interventions, which take account of the LTC. As part of our discussions with IAPT, we offered to deliver training to IAPT therapists, focussed on the management of depression and anxiety in people with LTCs. This training was developed within the Greater Manchester CLAHRC by Karina Lovell (Professor of Mental Health), Linda Gask (Emerita Professor of Primary Care Psychiatry) and myself, and delivered as part of the COINCIDE trial.
Karina and I delivered the training in two days, at the request of the local IAPT services (normally we deliver over 4 or 5 days) a couple of weeks ago. We think the training went well – therapists were keen to ask questions, participated in the skills practice exercises, and given us good feedback.