Changes in early psychosis service provision: a file audit.
OBJECTIVE
To measure change in services provided to young people with first-episode psychosis following the introduction of specialized early psychosis teams and staff training.


METHODS
A standardized tool was developed to audit services provided to young people with first-episode psychosis. The tool initially comprised 27 clinical indicators measuring aspects of optimal care derived from the Australian clinical guidelines for early psychosis. The first 12 months of treatment, as documented in the case records, were audited for all young people receiving their first treatment for psychosis during a 6-month period prior to the introduction of these service developments (n = 47). These subjects were compared with those who received treatment after the implementation of service development strategies (n = 70). A comparison was also made within the second group, between those receiving some treatment from a specialized early psychosis team and those being exclusively treated by other services.


RESULTS
Inter-rater reliability was achieved for 24 of the 27 indicators. Improvements were found on 10 indicators which measured psychosocial interventions, prescribing practices, family interventions and continuity of care. There was no significant deterioration on any of the indicators. Clients who attended early psychosis teams were significantly more likely to receive psychoeducation.


CONCLUSIONS
The services increased their provision of "guideline concordant" care for early psychosis. The audit proved useful to monitor performance, to demonstrate improvements in care and to identify those areas of service provision and documentation in need of improvement.
Department of Psychological Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
Joanne
J
Gorrell
Alison
A
Cornish
Chris
C
Tennant
Alan
A
Rosen
Louise
L
Nash
Diana
D
McKay
Beverley
B
Moss
D000293:Adolescent; D000328:Adult; D001315:Australia; D003266:Continuity of Patient Care / Q000592:standards; D017050:Episode of Care; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D008605:Mental Health Services / Q000592:standards* / Q000600:supply & distribution; D015588:Observer Variation; D009936:Organizational Innovation; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy*; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012114:Residential Treatment; D011795:Surveys and Questionnaires; D013997:Time Factors