Abstract
BackgroundClinical guidelines for the treatment of people experiencing psychosis have existed for over a decade, but implementation of recommended interventions is limited. Identifying influences on implementation may help to reduce this translational gap. The Structured Assessment of Feasibility (SAFE) measure is a standardised assessment of implementation blocks and enablers. The aim of this study was to characterise and compare the implementation blocks and enablers for recommended psychosis interventions.MethodsSAFE was used to evaluate and compare three groups of interventions recommended in the 2014 NICE psychosis guideline: pharmacological (43 trials testing 5 interventions), psychosocial (65 trials testing 5 interventions), and recovery (19 trials testing 5 interventions). The 127 trial reports rated with SAFE were supplemented by published intervention manuals, research protocols, trial registrations and design papers. Differences in the number of blocks and enablers across the three interventions were tested statistically, and feasibility profiles were generated.ResultsThere was no difference between psychosocial and recovery interventions in the number of blocks or enablers to implementation. Pharmacological interventions (a) had fewer blocks than both psychosocial interventions (χ2(3) = 133.77, p < 0.001) and recovery interventions (χ2(3) = 104.67, p < 0.001) and (b) did not differ in number of enablers from recovery interventions (χ2(3) = 0.74, p = 0.863) but had fewer enablers than psychosocial interventions (χ2(3) = 28.92, p < 0.001). Potential adverse events associated with the intervention tend to be a block for pharmacological interventions, whereas complexity of the intervention was the most consistent block for recovery and psychosocial interventions.ConclusionsFeasibility profiles show that pharmacological interventions are relatively easy to implement but can sometimes involve risks. Psychosocial and recovery interventions are relatively complex but tend to be more flexible and more often manualised. SAFE ratings can contribute to tackling the current implementation challenges in mental health services, by providing a reporting guideline structure for researchers to maximise the potential for implementation and by informing prioritisation decisions by clinical guideline developers and service managers.
Highlights
Clinical guidelines for the treatment of people experiencing psychosis have existed for over a decade, but implementation of recommended interventions is limited
These profiles show that psychosocial interventions and recovery interventions have a relatively broad range of blocks and enablers that partly overlap, whereas pharmacological interventions have a less varied profile
There was a significant difference in total number of blocks (χ2(6) = 161.05, p < 0.000) and enablers (χ2(6) = 33.02, p < 0.000) between the pharmacological, psychosocial and recovery intervention categories
Summary
Clinical guidelines for the treatment of people experiencing psychosis have existed for over a decade, but implementation of recommended interventions is limited. The aim of this study was to characterise and compare the implementation blocks and enablers for recommended psychosis interventions. Clinical guidelines for the treatment of people experiencing psychosis in the UK were published by the National Institute for Health and Care Excellence (NICE) in 2014 [1], updating earlier guidelines published in 2002 and 2009. A 2007 report of the Healthcare Commission and the Commission for Social Care Inspection stated that only 53 % of schizophrenia patients living in Britain received NICE-recommended family intervention, and only 46 % had access to NICE-recommended cognitive behavioural therapy [5]. A more recent survey study among 187 schizophrenia patients in North-West England showed that only 7 % of patients were offered and 5 % received cognitive behavioural therapy. The percentages for family intervention were again lower: 3 % of patients were offered family intervention and only 1 % received it [6]
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