'Mind the gaps': the accessibility and implementation of an effective depression relapse prevention programme in UK NHS services: learning from mindfulness-based cognitive therapy through a mixed-methods study.
BMJ Open
; 9(9): e026244, 2019 09 08.
Article
em En
| MEDLINE
| ID: mdl-31501097
ABSTRACT
OBJECTIVES:
Mindfulness-based cognitive therapy (MBCT) is an evidence-based approach for people at risk of depressive relapse to support their long-term recovery. However, despite its inclusion in guidelines, there is an 'implementation cliff'. The study objective was to develop a better explanation of what facilitates MBCT implementation.SETTING:
UK primary and secondary care mental health services. DESIGN, PARTICIPANTS ANDMETHODS:
A national two-phase, multi-method qualitative study was conducted, which was conceptually underpinned by the Promoting Action on Research Implementation in Health Services framework. Phase I involved interviews with stakeholders from 40 service providers about current provision of MBCT. Phase II involved 10 purposively sampled case studies to obtain a more detailed understanding of MBCT implementation. Data were analysed using adapted framework analysis, refined through stakeholder consultation.RESULTS:
Access to MBCT is variable across the UK services. Where available, services have adapted MBCT to fit their context by integrating it into their care pathways. Evidence was often important to implementation but took different forms the NICE depression guideline, audits, evaluations, first person accounts, experiential taster sessions and pilots. These were used to build a platform from which to develop MBCT services. The most important aspect of facilitation was the central role of the MBCT implementers. These were generally self-designated individuals who 'championed' grass-roots implementation. Our explanatory framework mapped out a prototypical implementation journey, often over many years with a balance of bottom-up and top-down factors influencing the fit of MBCT into service pathways. 'Pivot points' in the implementation journey provided windows of either challenge or opportunity.CONCLUSIONS:
This is one of the largest systematic studies of the implementation of a psychological therapy. While access to MBCT across the UK is improving, it remains patchy. The resultant explanatory framework about MBCT implementation provides a heuristic that informed an implementation resource.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Temas:
Atencao_primaria_forma_integrada
Contexto em Saúde:
11_ODS3_cobertura_universal
/
1_ASSA2030
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2_ODS3
Base de dados:
MEDLINE
Assunto principal:
Terapia Cognitivo-Comportamental
/
Transtorno Depressivo
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Atenção Plena
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Implementação de Plano de Saúde
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Acessibilidade aos Serviços de Saúde
Tipo de estudo:
Guideline
/
Qualitative_research
/
Sysrev_observational_studies
Aspecto:
Determinantes_sociais_saude
/
Implementation_research
/
Patient_preference
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Revista:
BMJ Open
Ano de publicação:
2019
Tipo de documento:
Article