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

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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

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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