BACKGROUND: Delays in accessing care for young people with a first episode of psychosis are significantly associated with poorer treatment response and higher relapse rates. AIM: To assess the effect of an educational intervention for GPs on referral rates to early-intervention services and the duration of untreated psychosis for young people with first-episode psychosis. DESIGN OF STUDY: Stratified cluster randomised controlled trial, clustered at practice level. SETTING: Birmingham, England. METHOD: Practices with access to the three early-intervention services in three inner-city primary care trusts in Birmingham were eligible for inclusion. Intervention practices received an educational intervention addressing GP knowledge, skills, and attitudes about first-episode psychosis. The primary outcome was the difference in the number of referrals to early-intervention services between practices. Secondary outcomes were duration of untreated psychosis, time to recovery, use of the Mental Health Act, and GP consultation rate during the developing illness. RESULTS:A total of 110 of 135 eligible practices (81%) were recruited; 179 young people were referred, 97 from intervention and 82 from control practices. The relative risk of referral was not significant: 1.20 (95% confidence interval [CI] = 0.74 to 1.95; P = 0.48). No effect was observed on secondary outcomes except for 'delay in reaching early-intervention services', which was statistically significantly shorter in patients registered in intervention practices (95% CI = 83.5 to 360.5; P = 0.002). CONCLUSION:GP training on first-episode psychosis is insufficient to alter referral rates to early-intervention services or reduce the duration of untreated psychosis; however, there is a suggestion that training facilitates access to the new specialist teams for early psychosis.
RCT Entities:
BACKGROUND: Delays in accessing care for young people with a first episode of psychosis are significantly associated with poorer treatment response and higher relapse rates. AIM: To assess the effect of an educational intervention for GPs on referral rates to early-intervention services and the duration of untreated psychosis for young people with first-episode psychosis. DESIGN OF STUDY: Stratified cluster randomised controlled trial, clustered at practice level. SETTING: Birmingham, England. METHOD: Practices with access to the three early-intervention services in three inner-city primary care trusts in Birmingham were eligible for inclusion. Intervention practices received an educational intervention addressing GP knowledge, skills, and attitudes about first-episode psychosis. The primary outcome was the difference in the number of referrals to early-intervention services between practices. Secondary outcomes were duration of untreated psychosis, time to recovery, use of the Mental Health Act, and GP consultation rate during the developing illness. RESULTS: A total of 110 of 135 eligible practices (81%) were recruited; 179 young people were referred, 97 from intervention and 82 from control practices. The relative risk of referral was not significant: 1.20 (95% confidence interval [CI] = 0.74 to 1.95; P = 0.48). No effect was observed on secondary outcomes except for 'delay in reaching early-intervention services', which was statistically significantly shorter in patients registered in intervention practices (95% CI = 83.5 to 360.5; P = 0.002). CONCLUSION: GP training on first-episode psychosis is insufficient to alter referral rates to early-intervention services or reduce the duration of untreated psychosis; however, there is a suggestion that training facilitates access to the new specialist teams for early psychosis.
Authors: R Gater; B de Almeida e Sousa; G Barrientos; J Caraveo; C R Chandrashekar; M Dhadphale; D Goldberg; A H al Kathiri; M Mubbashar; K Silhan Journal: Psychol Med Date: 1991-08 Impact factor: 7.723
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Authors: Antonia F H Smelt; Gerda M van der Weele; Jeanet W Blom; Jacobijn Gussekloo; Willem J J Assendelft Journal: Br J Gen Pract Date: 2010-07 Impact factor: 5.386
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Authors: S M Cotton; K M Filia; A Ratheesh; K Pennell; S Goldstone; P D McGorry Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2016-01 Impact factor: 4.328
Authors: Wenche ten Velden Hegelstad; Inge Joa; Helene Barder; Julie Evensen; Ulrik Haahr; Jan O Johannessen; Johannes Langeveld; Ingrid Melle; Stein Opjordsmoen; Jan Ivar Røssberg; Bjørn Rishovd Rund; Erik Simonsen; Per Vaglum; Thomas McGlashan; Svein Friis; Tor K Larsen Journal: Early Interv Psychiatry Date: 2013-06-17 Impact factor: 2.732