title: 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.
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.
authors.affiliation: Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK. elizabeth.barley@kcl.ac.uk
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Barley
authors.forename: Mark
authors.initials: M
authors.lastname: Haddad
authors.forename: Rosemary
authors.initials: R
authors.lastname: Simmonds
authors.forename: Zoe
authors.initials: Z
authors.lastname: Fortune
authors.forename: Paul
authors.initials: P
authors.lastname: Walters
authors.forename: Joanna
authors.initials: J
authors.lastname: Murray
authors.forename: Diana
authors.initials: D
authors.lastname: Rose
authors.forename: André
authors.initials: A
authors.lastname: Tylee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D019090:Case Management; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications / Q000523:psychology / Q000628:therapy; D003695:Delivery of Health Care; D003863:Depression / Q000150:complications / Q000628:therapy; D005260:Female; D058006:General Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010353:Patient Education as Topic / Q000379:methods*; D018802:Patient-Centered Care; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care / Q000379:methods*; D016730:Program Development; D012648:Self Care / Q000379:methods; D006113:United Kingdom