identifying the barriers and facilitators of rolling out ... wright... · identifying the barriers...
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Identifying the barriers
and facilitators of
rolling out cCBT at
scale in Scotland
through the EU Project
MasterMind
Chris Wright
NHS 24 Service Development Manager
MasterMind, cCBT in Scotland
About MasterMind
2
Implementation study, not clinical research
Using a range of products and service models
Implement at scale computerised Cognitive
Behavioural Therapy (cCBT )
1. Identify the barriers and success factors to implement cCBT on a large scale in different political, social, economic and technical health care contexts
2. Recommend successful strategies for implementing cCBT in these different contexts/settings
MasterMind consortium: 22 members including 14 trials
sites in 9 EU member states.
MasterMind, cCBT in Scotland
Countries Involved MasterMind
3
MasterMind, cCBT in Scotland
Evaluation Process
4
Evaluated using: MAST (Model for assessment of telemedicine applications)
1. Health problem and characteristics of the application2. Safety3. Clinical Effectiveness4. Patient perspective5. Economic aspects6. Organisational aspects7. Socio-cultural, ethical and legal aspects
Pretest-posttest design using quantitative data to understand what has been
achieved and qualitative to find reasons of success or failure
MasterMind, cCBT in Scotland
Identifying the barriers
5
Domain 1: Health problem and general characteristics: patient and healthcare professional profiles (cCBT)Domain 2: Patient safety (cCBT)Domain 3: Clinical effectiveness (cCBT)Domain 4: Patient and Healthcare professional perspectives (cCBT)Domain 5: Economic aspects (cCBT)Domain 6: Organisational aspects (cCBT)Domain 7: Socio, ethical and legal aspects (cCBT)
PATIENT
Demographics Patient
Patient safety
Depressive symptoms
Quality of life
Treatment access
Drop-out
Patient perceived satisfaction
Patient perceived usability
HEALTH PROFESSIONAL
Demographics Healthcare professional
Professional experience
Healthcare professional case load
Healthcare professional perceived satisfaction
Healthcare professional perceived usability
Perceived patient safety by healthcare professional
Perspective on drop-out
Leadership engagement (commitment)
Resources (time)
Knowledge and beliefs about intervention
Self efficacy
State of change
Identification with organisation
Support
Rewards
Priority
Professional liability
ORGANISATION
Implementation costs
Operational costs
Demographics organisation
Maintenance
Implementation strategy
Perspective on implementation
Guidelines
Public image / benchmarking
Over 90 Indicators
MasterMind, cCBT in Scotland
MasterMind in Scotland
6
BOARDS POPULATION
NHS Lanarkshire 652,580
NHS Fife 366,910
NHS Grampian 579,220
NHS Shetland 23,200
MasterMind Total 1,621,910
Total population including existing services in Tayside and Forth Valley equals 2,333,750
approximately 44% of national population.
SHETLAND
GRAMPIAN
FIFE
LANARKSHIRE
TAYSIDE
FORTH VALLEY
MasterMind, cCBT in Scotland
Nationally Supported Implementation
7
Referrals processed for Home users
Existing services feed into national expertise
and directly into implementing boards
Expertise and support offered to Health Boards includes
policies, key documentation
advice and guidance
Implementing Boards in
MasterMind able to pass on knowledge and experience to
other remaining Health Boards
4 Health Boards
MasterMind, cCBT in Scotland
Local Implementation of Existing Model
8
Central Coordination of service from within
psychology
All referrals come to one central point using
same process
Run with minimal clinical input but
support is there when needed
Co-ordinator supports home and community
users
Co-ordinator arranges initial appointments across all locations
and deals with initial patient issues
Patients complete treatment in their
homes or community locations such as
Libraries
Referrers maintain clinical responsibility and respond to suicide alerts
MasterMind, cCBT in Scotland
Progress to Date
9
Number of Community Locations = 28
Numer of Referrers = 328
Number of Referral Sources = 11
• GPs, Psychology, Community Mental Health Teams, NHS Occupational Health, OTs, Psychiatry, Integrated Day Care, Primary Care Mental Health Workers, Audiology, Unplanned Care Assessment Team (UCAT), Rehabilitation–MSK
Lowest Age = 17
Highest Age = 80
BOARDS STARTED TREATMENT
REFERRALS AVG COMMENCERS PER MONTH
AVG REFERRALSPER MONTH
NHS Lanarkshire 172 418 34 84
NHS Fife 103 252 21 50
NHS Grampian 147 252 29 50
NHS Shetland 16 21 3 5
Total So Far 438 943 88 189
MasterMind, cCBT in Scotland
Issues, Positives & Lessons Learnt
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• Patients not starting treatment after initial referral/contact
• Program not running well on iPads and Tablets
• Adapting national model to local requirements due to variations in local psychology services
• Engaging with referrers in particular GPs
• Internet bandwidth an issue in remote and rural health
• Having a GP directly involved in the early stages and having GPs involved in policy development from the outset has proven to be invaluable
• Maintaining effective communications with referrers
• Have a dedicated team with right individuals to implement and then run service
• Allow focus to remain on patient by ensuring efficiency of process and administration
• Get the right clinical and managerial support structures in place before you start
Positives/Lesson Learnt
Issues