Limits...
Immediate versus sustained effects: interrupted time series analysis of a tailored intervention.

Hanbury A, Farley K, Thompson C, Wilson PM, Chambers D, Holmes H - Implement Sci (2013)

Bottom Line: The intervention was associated with a significant, immediate, positive effect upon percentage referral rates for psychological treatments.However, an understanding that psychological treatment can have long-term benefits was also cited.Combined with qualitative interviews, this provided insight into intervention effectiveness.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK. katherine.farley@york.ac.uk.

ABSTRACT

Background: Detailed intervention descriptions and robust evaluations that test intervention impact--and explore reasons for impact--are an essential part of progressing implementation science. Time series designs enable the impact and sustainability of intervention effects to be tested. When combined with time series designs, qualitative methods can provide insight into intervention effectiveness and help identify areas for improvement for future interventions. This paper describes the development, delivery, and evaluation of a tailored intervention designed to increase primary health care professionals' adoption of a national recommendation that women with mild to moderate postnatal depression (PND) are referred for psychological therapy as a first stage treatment.

Methods: Three factors influencing referral for psychological treatment were targeted using three related intervention components: a tailored educational meeting, a tailored educational leaflet, and changes to an electronic system data template used by health professionals during consultations for PND. Evaluation comprised time series analysis of monthly audit data on percentage referral rates and monthly first prescription rates for anti-depressants. Interviews were conducted with a sample of health professionals to explore their perceptions of the intervention components and to identify possible factors influencing intervention effectiveness.

Results: The intervention was associated with a significant, immediate, positive effect upon percentage referral rates for psychological treatments. This effect was not sustained over the ten month follow-on period. Monthly rates of anti-depressant prescriptions remained consistently high after the intervention. Qualitative interview findings suggest key messages received from the intervention concerned what appropriate antidepressant prescribing is, suggesting this to underlie the lack of impact upon prescribing rates. However, an understanding that psychological treatment can have long-term benefits was also cited. Barriers to referral identified before intervention were cited again after the intervention, suggesting the intervention had not successfully tackled the barriers targeted.

Conclusion: A time series design allowed the initial and sustained impact of our intervention to be tested. Combined with qualitative interviews, this provided insight into intervention effectiveness. Future research should test factors influencing intervention sustainability, and promote adoption of the targeted behavior and dis-adoption of competing behaviors where appropriate.

Show MeSH

Related in: MedlinePlus

Time series plot of percentage of PND cases receiving first prescription for antidepressants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4228338&req=5

Figure 2: Time series plot of percentage of PND cases receiving first prescription for antidepressants.

Mentions: FigureĀ 2 summarizes monthly first prescription rates for anti-depressants. Of the 1,849 cases of PND recorded during the entire data series, 1,559 received a first prescription for antidepressants (84.32%). Rates remain high throughout the series; average prescribing rates in the six months before the intervention were 88.26%, and in the six months post-intervention were 85.33%. The ACF and PACF plots suggest a mixed model; therefore, an ARIMA 101 model was initially specified. The Ljung box Q fit statistic and ACF and PACF plots indicate the model to have removed all significant non-random variation from the data series, and both the autoregressive and moving average lags were significant.


Immediate versus sustained effects: interrupted time series analysis of a tailored intervention.

Hanbury A, Farley K, Thompson C, Wilson PM, Chambers D, Holmes H - Implement Sci (2013)

Time series plot of percentage of PND cases receiving first prescription for antidepressants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228338&req=5

Figure 2: Time series plot of percentage of PND cases receiving first prescription for antidepressants.
Mentions: FigureĀ 2 summarizes monthly first prescription rates for anti-depressants. Of the 1,849 cases of PND recorded during the entire data series, 1,559 received a first prescription for antidepressants (84.32%). Rates remain high throughout the series; average prescribing rates in the six months before the intervention were 88.26%, and in the six months post-intervention were 85.33%. The ACF and PACF plots suggest a mixed model; therefore, an ARIMA 101 model was initially specified. The Ljung box Q fit statistic and ACF and PACF plots indicate the model to have removed all significant non-random variation from the data series, and both the autoregressive and moving average lags were significant.

Bottom Line: The intervention was associated with a significant, immediate, positive effect upon percentage referral rates for psychological treatments.However, an understanding that psychological treatment can have long-term benefits was also cited.Combined with qualitative interviews, this provided insight into intervention effectiveness.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK. katherine.farley@york.ac.uk.

ABSTRACT

Background: Detailed intervention descriptions and robust evaluations that test intervention impact--and explore reasons for impact--are an essential part of progressing implementation science. Time series designs enable the impact and sustainability of intervention effects to be tested. When combined with time series designs, qualitative methods can provide insight into intervention effectiveness and help identify areas for improvement for future interventions. This paper describes the development, delivery, and evaluation of a tailored intervention designed to increase primary health care professionals' adoption of a national recommendation that women with mild to moderate postnatal depression (PND) are referred for psychological therapy as a first stage treatment.

Methods: Three factors influencing referral for psychological treatment were targeted using three related intervention components: a tailored educational meeting, a tailored educational leaflet, and changes to an electronic system data template used by health professionals during consultations for PND. Evaluation comprised time series analysis of monthly audit data on percentage referral rates and monthly first prescription rates for anti-depressants. Interviews were conducted with a sample of health professionals to explore their perceptions of the intervention components and to identify possible factors influencing intervention effectiveness.

Results: The intervention was associated with a significant, immediate, positive effect upon percentage referral rates for psychological treatments. This effect was not sustained over the ten month follow-on period. Monthly rates of anti-depressant prescriptions remained consistently high after the intervention. Qualitative interview findings suggest key messages received from the intervention concerned what appropriate antidepressant prescribing is, suggesting this to underlie the lack of impact upon prescribing rates. However, an understanding that psychological treatment can have long-term benefits was also cited. Barriers to referral identified before intervention were cited again after the intervention, suggesting the intervention had not successfully tackled the barriers targeted.

Conclusion: A time series design allowed the initial and sustained impact of our intervention to be tested. Combined with qualitative interviews, this provided insight into intervention effectiveness. Future research should test factors influencing intervention sustainability, and promote adoption of the targeted behavior and dis-adoption of competing behaviors where appropriate.

Show MeSH
Related in: MedlinePlus