REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis.
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.


OBJECTIVE
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.


METHODS
Stratified cluster randomised controlled trial, clustered at practice level.


METHODS
Birmingham, England.


METHODS
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).


CONCLUSIONS
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.
Lester
Helen
H
NPCRDC, Manchester. Helen.lester@manchester.ac.uk
Birchwood
Max
M
Freemantle
Nick
N
Michail
Maria
M
Tait
Lynda
L
D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D042241:Early Diagnosis; D004502:Education, Medical, Continuing / Q000379:methods*; D004739:England; D005194:Family Practice / Q000193:education*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy*; D012017:Referral and Consultation; D055815:Young Adult