A mixed-method investigation of patient monitoring and enhanced feedback in routine practice: Barriers and facilitators

Michael Lucock, Jeremy Halstead, Chris Leach, Michael Barkham, Samantha Tucker, Chloe Randal, Joanne Middleton, Wajid Khan, Hannah Catlow, Emma Waters, David Saxon

Research output: Contribution to journalArticlepeer-review

33 Citations (Scopus)


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. Method: 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.
Original languageEnglish
Pages (from-to)633-646
Number of pages14
JournalPsychotherapy Research
Issue number6
Early online date5 Oct 2015
Publication statusPublished - 2 Nov 2015


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