Key Strategies for Improving Psychiatric Home-Based Care in Spain: A Modified Delphi Study.

چکیده اصلی

AIMS: This study aimed to identify and prioritize key strategies for improving a psychiatric home-based care programme, the Crisis Resolution and Home Treatment (CRHT) intervention in Catalonia, Spain. The objective was to incorporate the perspectives of service users, family caregivers and healthcare professionals to guide quality improvement efforts. METHODS: A modified Delphi method was used to reach consensus among stakeholders previously involved in a qualitative evaluation of the CRHT programme. The expert panel included 130 participants: 31 CRHT service users/caregivers and 99 healthcare professionals. Over three rounds of online surveys, participants rated 18 pre-identified improvement strategies across three dimensions: problem significance, change agency and feasibility of change. Service users and caregivers assessed only problem significance. Open-ended responses were also collected and analysed. FINDINGS: Consensus was reached in the third round, with five strategies prioritized: (1) training on CRHT referral and eligibility criteria, (2) standardized discharge and continuity of care protocols, (3) feedback loop between CRHT and referring professionals, (4) scheduling and communication of visiting hours, and (5) available updates for CRHT slots. These areas were rated highest in terms of feasibility and change agency, though not necessarily in problem significance. Notably, the same individuals who participated in the initial qualitative phase contributed to the prioritization process, ensuring continuity and relevance in stakeholder input. CONCLUSION: The study demonstrates the value of collaborative, consensus-based approaches to quality improvement in mental health care. Prioritized strategies reflect feasible and actionable areas for enhancing CRHT services. Involving service users, caregivers and professionals in both evaluation and decision-making processes strengthens the relevance, person-centredness and effectiveness of care. Implementation of these strategies is underway, with further improvements planned based on stakeholder feedback and continuous assessment.

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