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

Abstract

BackgroundDepression 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.MethodsUsing 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.ResultsWe 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.ConclusionsApplication 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.

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

“…The key themes and how they translate across the included studies are detailed in Table 2. Both tables were also published Barley et al 2 In summary, we identified seven key themes, which were all supported by at least one good-quality study and by both qualitative and quantitative data. The first theme concerned professionals' understanding of depression; depression was either seen as a normal response to life events, or biomedical explanations were given.…”

“…GPs and PNs appeared to have similar views. We have published the findings of this study, including illustrative quotes and participant details, in open access journal papers by Barley et al 2,59 in 2012. The identified themes and topics discussed are listed in Box 1 and the main findings are summarised below.…”

“…3 This chapter opens with a statement on patient and public involvement (see Patient and public involvement). We have then summarised the introductory sections of the published introductory papers [1][2][3] (see Background), which has been updated with references to more recent literature. In Aims and objectives of the programme, the key objectives of the four work packages are outlined.…”

“…This is detailed in Table 5 (first published in our RCT development paper). 2 We discussed the meaning of these findings in the context of UK primary care, where an established component of chronic disease management is the provision of self-management support; this means enabling patients to take better care of themselves, for instance by providing information and helping them to change unhealthy behaviours.…”

“…Barley et al 2 published a full account of the process that we used to develop the intervention in an open access journal in 2012. The key steps of the process, which followed MRC guidelines for developing complex interventions, 30 are summarised here.…”