Did you know this about eHealth implementation? Investigating implementation outcomes and implementation success of internet-based CBT across Europe Anne Etzelmüller Get.On Institute Hamburg VU Amsterdam

Background

Clinical Outcome Research Intervention Strategies Outcomes Evidence-based Practice e.g. Internet-based Cognitive Behavioural Therapy Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology Clinical Research “What”

Clinical Outcome Research Intervention Strategies Outcomes Evidence-based Practice e.g. Internet-based Cognitive Behavioural Therapy Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology Subgroups Clinical Research Moderators Comparisons “What”

A Conceptual Model of Implementation Intervention Strategies Outcomes Evidence-based Practice Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology “What” Implementation Research Methods Proctor, 2009

Evidence-based Practice iCBT implementation „Internet-based Cognitive Behavioural Therapy for the treatment of depression“ Intervention Strategies Implementation Strategies Outcomes Evidence-based Practice e.g. Internet-based Cognitive Behavioural Therapy System Environment Organizational Group/Learning Supervision Individual Providers/Customers Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology Differences in implemented programs Example: Guidance Country/site Self-help Guided Guided + VC Blended Denmark X Therapist by email Germany Guidance by VC Netherlands Integrated in F2F Norway No assistance Scotland, Wales Technical assistance Spanish cluster Italy and Estonia Turkey “What” Implementation Research Methods Proctor, 2009

Feasibility of implementation Intervention Strategies Implementation Strategies Outcomes Evidence-based Practice System Environment Organizational Group/Learning Supervision Individual Providers/Customers Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology Proctor, 2009

Penetration of the services Intervention Strategies Implementation Strategies Outcomes Location in healthcare system Evidence-based Practice System Environment Organizational Group/Learning Supervision Individual Providers/Customers Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology Spain Italy Denmark Germany Netherlands Norway Scotland Aragon Badalona Basque Galicia Estonia Piemonte Treviso Turkey Wales Location SC PC Self-referral X GP referral Specialist-referral Other PC = Primary Care; SC = Secondary Care Proctor, 2009

Evidence-based Practice Effectiveness Intervention Strategies Implementation Strategies Outcomes n = 4480 Patients (at least 1 session; 18% non-starters) 48% report severe symptoms 54% drop-out (sig. relation with „guidance“) 82% diagnoses made by „clinical judgement“ 44% clinical change, 15% deterioration Evidence-based Practice System Environment Organizational Group/Learning Supervision Individual Providers/Customers Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology Proctor, 2009

Evidence-based Practice Patient satisfaction Intervention Strategies Implementation Strategies Outcomes Evidence-based Practice System Environment Organizational Group/Learning Supervision Individual Providers/Customers Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology n = 1071 patients Assessed with CSQ8 72% of patients were satisfied with iCBT services Proctor, 2009

A Conceptual Model of Implementation Intervention Strategies Outcomes Evidence-based Practice e.g. Internet-based Cognitive Behavioural Therapy Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology ? “What” Implementation Research Methods Proctor, 2009

Use of the conceptual model of implementation Intervention Strategies Implementation Strategies Outcomes Evidence-based Practice e.g. Internet-based Cognitive Behavioural Therapy System Environment Organizational Group/Learning Supervision Individual Providers/Customers Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology Implementation Research Methods Proctor, 2009

A Conceptual Model of Implementation Intervention Strategies Implementation Strategies Outcomes Evidence-based Practice e.g. Internet-based Cognitive Behavioural Therapy System Environment Organizational Group/Learning Supervision Individual Providers/Customers Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology “What” “How” Implementation Research Methods

Use of the conceptual model of implementation Intervention Strategies Implementation Strategies Outcomes Evidence-based Practice e.g. Internet-based Cognitive Behavioural Therapy Implementation Outcomes Feasibility Fidelity Penetration Susceptibility Sustainability Uptake Adoption Appropriateness Service Outcomes Efficiency Safety Effectiveness Equity Patient- centeredness Timeliness Client Outcomes Satisfaction Function Symptomatology Implementation- as-usual (trial control group) process evaluation Which strategies are (routinely) used for the implementation of iCBT services in Europe and which effect do these strategies have? Implementation Research Methods