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REDIRECT : cluster randomised controlled trial of GP training in first-episode psychosis
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Lester, Helen, Birchwood, M. J., Freemantle, Nick, Michail, Maria and Tait, Lynda (2009) REDIRECT : cluster randomised controlled trial of GP training in first-episode psychosis. British Journal of General Practice, 59 (563). pp. 183-190. doi:10.3399/bjgp09X420851 ISSN 0960-1643.
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Official URL: http://dx.doi.org/10.3399/bjgp09X420851
Abstract
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.
| Item Type: | Journal Article | ||||
|---|---|---|---|---|---|
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | British Journal of General Practice | ||||
| Publisher: | Royal College of General Practitioners | ||||
| ISSN: | 0960-1643 | ||||
| Official Date: | 2009 | ||||
| Dates: |
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| Volume: | 59 | ||||
| Number: | 563 | ||||
| Page Range: | pp. 183-190 | ||||
| DOI: | 10.3399/bjgp09X420851 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access |
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