title: A mixed-method investigation of patient monitoring and enhanced feedback in routine practice: Barriers and facilitators.
abstract: OBJECTIVE
  To investigate the barriers and facilitators of an effective implementation of an outcome monitoring and feedback system in a UK National Health Service psychological therapy service.
  
  
  METHODS
  An outcome monitoring system was introduced in two services. Enhanced feedback was given to therapists after session 4. Qualitative and quantitative methods were used, including questionnaires for therapists and patients. Thematic analysis was carried out on written and verbal feedback from therapists. Analysis of patient outcomes for 202 episodes of therapy was compared with benchmark data of 136 episodes of therapy for which feedback was not given to therapists.
  
  
  RESULTS
  Themes influencing the feasibility and acceptability of the feedback system were the extent to which therapists integrated the measures and feedback into the therapy, availability of administrative support, information technology, and complexity of the service. There were low levels of therapist actions resulting from the feedback, including discussing the feedback in supervision and with patients.
  
  
  CONCLUSIONS
  The findings support the feasibility and acceptability of setting up a routine system in a complex service, but a number of challenges and barriers have to be overcome and therapist differences are apparent. More research on implementation and effectiveness is needed in diverse clinical settings.
authors.affiliation: a South West Yorkshire Partnership NHS Foundation Trust , UK.|b Centre for Applied Psychological and Health Research , University of Huddersfield , Huddersfield, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Lucock
authors.affiliation: c Clinical Psychology , University of Leeds , Leeds, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Halstead
authors.affiliation: a South West Yorkshire Partnership NHS Foundation Trust , UK.|b Centre for Applied Psychological and Health Research , University of Huddersfield , Huddersfield, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Leach
authors.affiliation: d Department of Psychology , Centre for Psychological Services Research, University of Sheffield , Sheffield, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Barkham
authors.affiliation: e School of Psychological Sciences, University of Manchester , Manchester, UK.
authors.forename: Samantha
authors.initials: S
authors.lastname: Tucker
authors.affiliation: a South West Yorkshire Partnership NHS Foundation Trust , UK.
authors.forename: Chloe
authors.initials: C
authors.lastname: Randal
authors.affiliation: e School of Psychological Sciences, University of Manchester , Manchester, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Middleton
authors.affiliation: a South West Yorkshire Partnership NHS Foundation Trust , UK.
authors.forename: Wajid
authors.initials: W
authors.lastname: Khan
authors.affiliation: a South West Yorkshire Partnership NHS Foundation Trust , UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Catlow
authors.affiliation: c Clinical Psychology , University of Leeds , Leeds, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Waters
authors.affiliation: d Department of Psychology , Centre for Psychological Services Research, University of Sheffield , Sheffield, UK.
authors.forename: David
authors.initials: D
authors.lastname: Saxon
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005246:Feedback; D005260:Female; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011613:Psychotherapy / Q000379:methods*; D006113:United Kingdom
keywords: feedback; implementation; outcomes monitoring; psychological therapies