Open Access Research article

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

Elizabeth A Barley1*, Mark Haddad2, Rosemary Simmonds3, Zoe Fortune4, Paul Walters5, Joanna Murray6, Diana Rose7 and André Tylee6

Author Affiliations

1 Florence Nightingale School of Nursing and Midwifery, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK

2 School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK

3 Research Associate, the Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK

4 Research Worker, Section of Primary Care Mental Health, Health Services and Population Research Department, Institute of Psychiatry, King’s College London, PO Box 28, De Crespigny Park, London, SE5 8AF, UK

5 Consultant Psychiatrist, Weymouth and Portland CMHT, Dorset Healthcare University Foundation NHS Trust, Radipole Lane, Weymouth, Dorset, DT4 0QE, UK

6 Section of Mental Health and Ageing, Health Services and Population Research Department, Institute of Psychiatry, King’s College London, PO Box 28, De Crespigny Park, London, SE5 8AF, UK

7 Reader in User-Led Research, Head of Section and Co-director Service User Research Enterprise (SURE), PO34 Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK

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BMC Family Practice 2012, 13:119  doi:10.1186/1471-2296-13-119

Published: 12 December 2012

Abstract

Background

Depression 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.

Methods

Using 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.

Results

We 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.

Conclusions

Application 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.

Keywords:
Complex intervention; Personalised care; Coronary heart disease; Depression; Primary care