BMC family practice integrated GP care for patients with persistent physical symptoms, 2020, Chalder et al

Full title: BMC family practice integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial
[Worth noting that the intended study title was probably "Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial", i.e. the title minus the name of the journal, BMC family practice, it was printed in.]

Part of the PRINCE gobbledegook.

Open access, https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-020-01269-9

ETA: Added note about the title of the study.

 

A quick look at whether there was outcome switching.

The planned primary outcome measures

1. Willingness of clinicians to participate in the study
   
2. Willingness of patients to use the provided material given in 'integrated GP care' (self-help material).
   
3. Willingness of practices and participants to be contacted about the study
   
4. Willingness of practices to be randomised
   
5. Willingness of GP practices to be consent and be randomized as assessed
   
6. Follow-up rates and response rates to questionnaires
   
7. Rate of eligible trial participants (Consort). The number of patients per practice that are initially screened for eligibility and the number per practice meeting the inclusion and exclusion criteria.
   
8. Availability of data required and the usefulness and limitations of GP databases assessed qualitatively
   
9. Willingness of participants to be consented and randomised

The published primary outcome measures

1. Willingness of GP practices to be contacted about PRINCE Primary
2. Willingness of GP practices to consent and be randomised
3. Availability of data needed and the usefulness and limitations of the general practice databases
4. Interest of patients to be contacted about the study
5. Rate of eligible participants
6. Willingness of patients to consent to participate in PRINCE Primary
7. Willingness of participants to complete baseline measures before randomisation
8. Interest of GPs to attend the GP training (intervention arm only)
9. Participants follow-up rates to questionnaires per group

Several of these outcomes appear to have been split or eliminated or reworded in a confusing way. If I was a reviewer I would demand clarification.

Some examples

This appears to have been split into two outcomes "Willingness of GP practices to be contacted about PRINCE Primary" and "Interest of patients to be contacted about the study".

In the publication this is now referred to as "Participants follow-up rates to questionnaires per group" which no longer mentions response rates.

This appears to have been dropped.

That said to be sure one would have to do a more careful analysis looking at the published data to make sure that there was a substantial deviation and not merely a confusing change in wording.

The secondary outcomes seem to have changed substantially as well. The registered trial lists 10, in the publication there are only 6.

 

No benefits for patients
Doubtless benefits for others

 

Looking at use of health services by trial arm there don't seem to be important difference between the groups. If anything the control group seems to receive less testing (wasn't the idea to reduce healthcare costs?) and has better work outcomes (but am not sure if this is statistically significant). The intervention also appears to make people more likely to see a mental health care professional.

 

The fact that these people are still doing feasibility trials for things that have been used in practice, uselessly, for years is beyond absurd. It's a complete failure of oversight. They basically just keep doing the first few steps, then back again. Over and over and over again. It's a level of failure that simply should not exist and in fact does not exist in most professions.

This money needs to be reimbursed, taken off the future budgets of whoever made the absurd decision to spend money on yet another copy-paste piece of useless study. And all oversight decision-makers frankly need to account for why they keep allowing for identical copy-paste tripe of zero usefulness to be done over and over for years, identical, always the first few tentative steps, always on things that have long been used in practice, without oversight or accountability of course, thanks to these very people.

This is a jobs program. Nothing else. It serves no purpose other than providing easy jobs for people who can't actually do it.

 

I wish I did. I wanted to write more and find out if the primary outcomes were really switched or not but ran out of stamina and then lost motivation.

 

This must be one of my brain fog days. I don't even understand the title.

 

Ha! I was going to look at this over the weekend. someone sent it to me yesterday and I've been tied up. Sounds like another Chalder clunker. How many can one person have?

 

As I see the problem of how this gets funding: too many privileged people with little (if any) real experience using a 'top-down' model for thinking about how to approach health issues.

 

MUS is not one problem, it's a hundred or a thousand problems put into the same category for no other reason than being unexplained and difficult. It needs many solutions.

 

It might genuinely be worth quantifying and creating some sort of visualization of just how many of these things they churn out.

If you have the real Tabasco there is no need to disgorge the same paper every six weeks about the same 'breakthrough' in treatment and the same 'need' for more research. Even just a list of all the spam that they've put out should shock anybody with two discerning brain cells.

 

Okay, this is annoying me and I want to understand the hodgepodge of nouns and verbs in the following title to try and make sense of it.

Title of article : "BMC family practice integrated GP care for patients with persistent physical symptoms"

"BMC Family Practice" is the name of the journal this was published in. BMC appears to be the initials of "BioMedCentral" - another meaningless mess.

So, my translation has come up with the following :

1) The article referred to is published in a journal with a name containing some meaningless initials.

2) GP care for patients with persistent physical symptoms was integrated with something but I don't know what.

3) I think there should be a colon between practice and integrated in the title. But it is still meaningless. So my final attempt at understanding this is :

4) Change the title to "BMC Family Practice : GP Care For Persistent Physical Symptoms Has Been Integrated With Something But I Don't Know What"

 

Agree completely though I would add that the people who fund this stuff need to also be held to account.

Absolutely nothing of any concrete value in terms of recovering from illness and going back to one's previous life come out of this (and the anecdotes that get sponsored as such need investigating). The hallmark of good medicine here is returning to full health (that's what the BPS model promised initially--not coping strategies). So why fund endless papers that fail to provide any real life benefits.