The UPBEAT depression and coronary heart disease programme: using the UK medical research council framework to design a nurse-led complex intervention for use in primary care
Open accessAbstract
BACKGROUND: Depression is common in coronary heart disease (CHD) and increases the incidence of coronary symptoms and death in CHD patients. Interventions feasible for use in primary care are needed to improve both mood and cardiac outcomes. The UPBEAT-UK programme of research has been funded by the NHS National Institute for Health Research (NIHR) to explore the relationship between CHD and depression and to develop a new intervention for use in primary care. METHODS: Using the Medical Research Council (MRC) guidelines for developing and evaluating complex interventions, we conducted a systematic review and qualitative research to develop a primary care-based nurse-led intervention to improve mood and cardiac outcomes in patients with CHD and depression. Iterative literature review was used to synthesise our empirical work and to identify evidence and theory to inform the intervention. RESULTS: We developed a primary care-based nurse-led personalised care intervention which utilises elements of case management to promote self management. Following biopsychosocial assessment, a personalised care plan is devised. Nurses trained in behaviour change techniques facilitate patients to address the problems important to them. Identification and utilisation of existing resources is promoted. Nurse time is conserved through telephone follow up. CONCLUSIONS: Application of the MRC framework for complex interventions has allowed us to develop an evidence based intervention informed by patient and clinician preferences and established theory. The feasibility and acceptability of this intervention is now being tested further in an exploratory trial.
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Fourteen included studies explored the acceptability and/or feasibility of the intervention to different stakeholders, including providers, recipients or policy makers and service commissioners.
“Fourteen studies explored the acceptability and/or feasibility of the intervention to different stakeholders, including providers, recipients or policy makers and service commissioners [27, 29–32, 34, 36, 37, 39, 40, 42, 43, 47, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [30]
17 of the 27 included studies used the MRC 2000 framework, the updated 2008 version, or a combination of the two.
“In particular, 17 of the 27 studies included in this review used the MRC 2000 framework, the updated 2008 version or a combination of the two [24–40].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [30]
Interventions were delivered in a variety of settings (e.g. inpatient, outpatient clinics and home-based settings) and targeted a wide range of conditions, such as mental health conditions, stroke, cancer and other chronic illnesses.
“Interventions were delivered in a variety of settings (e.g. inpatient, outpatient clinics and home-based settings) and targeted a wide range of conditions, such as mental health conditions [28, 30, 35, 40, 47], stroke [31, 36, 39], cancer [29, 32, 33, 37, 42] and other chronic illnesses [25, 34, 38].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [30]
The involvement of stakeholders was identified as a strength by several studies, as stakeholders play a key role in the implementation of interventions into practice.
“The involvement of stakeholders was identified as a strength by several studies, as stakeholders play a key role in the implementation of interventions into practice [30, 32, 33, 42, 43, 45].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [30]
Optimisation strategies applying qualitative methods tended to explore acceptability and feasibility issues.
“Optimisation strategies applying qualitative methods tended to explore acceptability and feasibility issues [26, 30, 32, 34, 39, 47, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [30]
The majority of included studies (n = 16) subsequently refined the intervention to then test the optimised version within pilot studies or full-scale RCTs.
“The majority of studies (n = 16) subsequently refined the intervention to then test the optimised version of the intervention within pilot studies or full-scale RCTs [24–32, 34, 38–40, 43, 47, 48].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [30]
Several included studies employed well-established qualitative methods including interviews or focus groups with providers and recipients or relevant stakeholders, and observations and consensus processes including researchers, patients and clinical experts.
“Several studies employed well-established qualitative methods including interviews or focus groups with providers and recipients or relevant stakeholders [26, 30, 32, 34, 39, 47, 48] and observations and consensus processes including researchers, patients and clinical experts [31].”
From Optimisation of complex health interventions prior to a randomised controlled trial: a scoping review of strategies used (2016) · cites this paper as [30]
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- Authors
- Barley, E. A., Haddad, M., Simmonds, R., Fortune, Z., Walters, P., Murray, J., Rose, D., & Tylee, A.
- Affiliations
- King's College London (GB)
- City, University of London (GB)
- University of Bristol (GB)
- Dorset HealthCare University NHS Foundation Trust (GB)
- Corresponding author
- Barley, Elizabeth A
- Venue
- BMC Family Practice
- Published
- 2012-12
- Volume
- 13
- Issue
- 1
- Pages
- 119-119
- ISSN
- 1471-2296 (ISSN-L)
- PMC
- PMC3538052
- OpenAlex
- W2089937334
- Cited by
- 19
- References
- 42
- Citations by year
- 2024: 3 · 2023: 1 · 2022: 1 · 2021: 2 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 2 · 2015: 4 · 2014: 1
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Family Practice (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- City Research Online (City University London) (acceptedVersion)
- Open Research (University of Surrey) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Funders
- South London and Maudsley NHS Foundation Trust
- National Institute for Health and Care Research (RP-PG-0606-1048)
- King's College London
- Programme Grants for Applied Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Education › Health Education and Validation
- Keywords
- depression, coronary artery disease, nurse-led intervention, complex intervention development, MRC framework, primary care, case management, self-management, behaviour change techniques, individualized care plans, biopsychosocial assessment, telephone follow-up, feasibility and acceptability
- MeSH terms
- Aged, Aged, 80 and over, Attitude of Health Personnel, Coronary Disease, Delivery of Health Care, Depression, Female, United Kingdom, Health Services Accessibility, Humans, Male, Middle Aged, Patient Care Planning, Patient Education as Topic, Primary Health Care, Self Care, Cohort Studies, Program Development, Patient-Centered Care, Case Management, Practice Patterns, Nurses', General Practice
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