title: The feasibility of implementing recovery, psychosocial and pharmacological interventions for psychosis: comparison study.
abstract: BACKGROUND
  Clinical guidelines for the treatment of people experiencing psychosis have existed for over a decade, but implementation of recommended interventions is limited. Identifying influences on implementation may help to reduce this translational gap. The Structured Assessment of Feasibility (SAFE) measure is a standardised assessment of implementation blocks and enablers. The aim of this study was to characterise and compare the implementation blocks and enablers for recommended psychosis interventions.
  
  
  METHODS
  SAFE was used to evaluate and compare three groups of interventions recommended in the 2014 NICE psychosis guideline: pharmacological (43 trials testing 5 interventions), psychosocial (65 trials testing 5 interventions), and recovery (19 trials testing 5 interventions). The 127 trial reports rated with SAFE were supplemented by published intervention manuals, research protocols, trial registrations and design papers. Differences in the number of blocks and enablers across the three interventions were tested statistically, and feasibility profiles were generated.
  
  
  RESULTS
  There was no difference between psychosocial and recovery interventions in the number of blocks or enablers to implementation. Pharmacological interventions (a) had fewer blocks than both psychosocial interventions (χ (2)(3) = 133.77, p < 0.001) and recovery interventions (χ (2)(3) = 104.67, p < 0.001) and (b) did not differ in number of enablers from recovery interventions (χ (2)(3) = 0.74, p = 0.863) but had fewer enablers than psychosocial interventions (χ (2)(3) = 28.92, p < 0.001). Potential adverse events associated with the intervention tend to be a block for pharmacological interventions, whereas complexity of the intervention was the most consistent block for recovery and psychosocial interventions.
  
  
  CONCLUSIONS
  Feasibility profiles show that pharmacological interventions are relatively easy to implement but can sometimes involve risks. Psychosocial and recovery interventions are relatively complex but tend to be more flexible and more often manualised. SAFE ratings can contribute to tackling the current implementation challenges in mental health services, by providing a reporting guideline structure for researchers to maximise the potential for implementation and by informing prioritisation decisions by clinical guideline developers and service managers.
authors.affiliation: University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands. j.a.j.van.der.krieke@umcg.nl.|Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. j.a.j.van.der.krieke@umcg.nl.
authors.forename: Lian
authors.initials: L
authors.lastname: van der Krieke
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. victoria.bird@kcl.ac.uk.
authors.forename: Victoria
authors.initials: V
authors.lastname: Bird
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. mary.leamy@kcl.ac.uk.
authors.forename: Mary
authors.initials: M
authors.lastname: Leamy
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. faye.bacon@kcl.ac.uk.
authors.forename: Faye
authors.initials: F
authors.lastname: Bacon
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. rebecca.dunn@kcl.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dunn
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. francesca.pesola@kcl.ac.uk.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pesola
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. monika.janosik@kcl.ac.uk.
authors.forename: Monika
authors.initials: M
authors.lastname: Janosik
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. clair.le_boutillier@kcl.ac.uk.
authors.forename: Clair
authors.initials: C
authors.lastname: Le Boutillier
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. julie.williams@kcl.ac.uk.
authors.forename: Julie
authors.initials: J
authors.lastname: Williams
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. mike.slade@kcl.ac.uk.
authors.forename: Mike
authors.initials: M
authors.lastname: Slade
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D011613:Psychotherapy / Q000379:methods*; D011618:Psychotic Disorders / Q000188:drug therapy / Q000628:therapy*; D013222:State Medicine; D006113:United Kingdom
chemical_list: D014150:Antipsychotic Agents