Recipe for untangling complex healthcare

So there he was, with the boy’s head in his hands. The boy was 12, but looked no more than 10 years old. He was deeply jaundiced and in a heroin withdrawal. It was 1981; Fergus O’Kelly was a family physician in the inner city Dublin, Ireland.



Complex interventions are best fashioned in stages, says the Medical Research Council in the U.K. They came up with a 6-step recipe for untangling complex health interventions. The recipe can help those of us who are researchers define their interventions and evaluate their implementation.

Substance use disorder treatment is a complex problem. Complex problems require complex interventions, ideally tested via randomised controlled trials.

Complex interventions are best developed in stages, using established implementation frameworks.
Starting with a historical patient case study, we explore how treatment of this challenging population group has been approached, how an evidence-based framework has informed formulation of a complex health intervention and how this has been progressed via the UK’s Medical Research Council (MRC) approach.
Read the paper in the December 2018 issue of the Irish Journal of Psychological Medicine:
Klimas, J. (2018). General practitioners tackle complex addictions: How complex interventions can assist in dealing with addiction. Irish Journal of Psychological Medicine, 35(4), 329-331. doi:10.1017/ipm.2016.30

The paper was first published online in August 2016.

The case study of the boy mentioned at the beginning was published in 1986 in this paper: RyanWJArthursYKellyMGFieldingJF (1982). Heroin abuse with hepatitis b virus associated chronic active hepatitis in a twelve-year-old child: a non-fictitious pulitzer prizeIrish Medical Journal 75166. Google Scholar

Read the full text of the case here:

Finally, if you enjoyed reading this post, you can also read more about complex problems here:

Users voices: Are drug problems too complex and dynamic for single magic bullet solutions?