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.
Highlights
Depression is common in coronary heart disease (CHD) and increases the incidence of coronary symptoms and death in CHD patients
Our review, which included 7 qualitative and 10 quantitative studies, indicated that practice nurses (PNs) and general practitioners (GPs) are unsure of the nature of the relationship between low mood and social problems and of their role in managing it
The PNs in particular expressed a lack of confidence in dealing with depression
Summary
Depression is common in coronary heart disease (CHD) and increases the incidence of coronary symptoms and death in CHD patients. The Medical Research Council (MRC) published a framework first in 2000 [5], revised in 2008 [6,7] to inform intervention development, feasibility/piloting, evaluation and implementation. The final modelling phase involves using research to progressively refine the design prior to intervention evaluation [7]
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