Key Strategies for Improving Psychiatric Home-Based Care in Spain: A Modified Delphi Study.
Ana María Besoaín-Cornejo, Montserrat Gil-Girbau, Luisa Baladón Higueras and 2 others
PMID 42466610WHAT IT FOUND
Stakeholders prioritized five feasible improvements for psychiatric home care: training on referral criteria, standardized discharge protocols, feedback to referring professionals, better visit scheduling, and updated capacity information.
Staffing increases were rated important but not immediately achievable.
Key findings
01The five highest-priority improvement areas were training on referral and eligibility criteria, standardized discharge and continuity of care, feedback loops with referring professionals, scheduling and communication of visiting hours, and available updates on CRHT slots.
02Expansion of CRHT team staffing received a high score for problem significance but was deprioritized due to low scores in change agency and feasibility, as it is subject to decisions outside the institution.
03Consensus was reached in the third round, with the top five areas scoring between 3.85 and 3.52 on a 5-point scale.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Participation rates were low and declined over the three rounds, particularly among healthcare professionals, which may have influenced the stability and representativeness of the consensus. The study did not collect sociodemographic data from those who actually responded to the surveys, limiting the ability to assess non-response bias. Service users and caregivers only rated 'problem significance' and not 'change agency' or 'feasibility,' meaning the final prioritization was heavily driven by professional perspectives on what is achievable. Some professionals reported difficulty understanding the evaluation dimensions, and the invitation method differed between users (phone) and professionals (email), which may have affected engagement levels.
Declared interests
The authors declare no conflicts of interest. The study was supported by grants from the Instituto de Salud Carlos III (ISCIII), the European Union, and the National Agency for Research and Development (ANID).
The easy way to misread this
Do not interpret the deprioritization of staffing expansion as a lack of need. The study explicitly states that staffing was rated highly for problem significance but was excluded from the top five due to low feasibility and institutional constraints, not because nurses or professionals do not view it as critical.