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The UPBEAT nurse-delivered personalized care intervention for people with coronary heart disease who report current chest pain and depression: A randomised controlled pilot study

Barley, Elizabeth A., Walters, Paul, Haddad, Mark, Phillips, Rachel, Achilla, Evanthia, McCrone, Paul, Van Marwijk, Harm, Mann, Anthony and Tylee, Andre (2014) The UPBEAT nurse-delivered personalized care intervention for people with coronary heart disease who report current chest pain and depression: A randomised controlled pilot study PLoS ONE, 9 (6), e98704.

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Background: Depression is common in people with coronary heart disease (CHD) and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression. Methods: Multi-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC) or treatment as usual (TAU) for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables. Result: 1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years) were randomized. PC participants (n = 41) identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%), high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up). Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03). Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9) and illness perceptions (mean scale increase of 7.8 vs 2.5) had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000. Conclusions: Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU. Trial Registration: ISRCTN21615909. © 2014 barley et al.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Health Sciences
Authors :
Barley, Elizabeth
Walters, Paul
Haddad, Mark
Phillips, Rachel
Achilla, Evanthia
McCrone, Paul
Van Marwijk, Harm
Mann, Anthony
Tylee, Andre
Date : 5 June 2014
DOI : 10.1371/journal.pone.0098704
Copyright Disclaimer : �Copyright 2014 barley et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Uncontrolled Keywords : adult, aged, article, controlled study, cost effectiveness analysis, depression, evaluation study, feasibility study, female, health care delivery, Hospital Anxiety and Depression Scale, hospital cost, hospital service, human, illness perception, ischemic heart disease, major clinical study, male, mental health, multicenter study, nurse delivered personalized care, outcome assessment, perception, pilot study, quality adjusted life year, randomized controlled trial, self concept, thorax pain, United Kingdom, Chest Pain, clinical trial, complication, Coronary Disease, cost benefit analysis, depression, middle aged, nurse attitude, personalized medicine, primary health care, risk factor, time, Aged, Chest Pain, Coronary Disease, Cost-Benefit Analysis, Depression, Female, Humans, Individualized Medicine, London, Male, Middle Aged, Nurse's Role, Patient Outcome Assessment, Pilot Projects, Primary Health Care, Risk Factors, Time Factors
Depositing User : Diane Maxfield
Date Deposited : 19 Jul 2019 13:56
Last Modified : 19 Jul 2019 13:56

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