Abstract
BackgroundThe early detection and referral to specialized services of young people at ultra-high risk (UHR) for psychosis may reduce the duration of untreated psychosis and, therefore, improve prognosis. General practitioners (GPs) are usually the healthcare professionals contacted first on the help-seeking pathway of these individuals.Methods/DesignThis is a cluster randomized controlled trial (cRCT) of primary care practices in Cambridgeshire and Peterborough, UK. Practices are randomly allocated into two groups in order to establish which is the most effective and cost-effective way to identify people at UHR for psychosis. One group will receive postal information about the local early intervention in psychosis service, including how to identify young people who may be in the early stages of a psychotic illness. The second group will receive the same information plus an additional, ongoing theory-based educational intervention with dedicated liaison practitioners to train clinical staff at each site. The primary outcome of this trial is count data over a 2-year period: the yield - number of UHR for psychosis referrals to a specialist early intervention in psychosis service - per primary care practice.DiscussionThere is little guidance on the essential components of effective and cost-effective educational interventions in primary mental health care. Furthermore, no study has demonstrated an effect of a theory-based intervention to help GPs identify young people at UHR for psychosis. This study protocol is underpinned by a robust scientific rationale that intends to address these limitations.Trial registrationCurrent Controlled Trials ISRCTN70185866
Highlights
The early detection and referral to specialized services of young people at ultra-high risk (UHR) for psychosis may reduce the duration of untreated psychosis and, improve prognosis
No study has demonstrated an effect of a theory-based intervention to help General practitioner (GP) identify young people at UHR for psychosis
The detection and prompt referral to early intervention services of young people who may be at ultra-high risk (UHR) for psychosis [1] is intended to reduce the duration of untreated psychosis (DUP) and improve outcomes [2]
Summary
There is little definitive guidance on the essential components of an effective educational intervention in primary mental health care. This is not an unusual phenomenon; many well designed studies with demanding training interventions in primary care mental health failed to show significant outcomes [32]. No study has demonstrated an effect of a TPB-based intervention to help GPs identify people at UHR for psychosis on objectively measured behavior or examined whether the TPB constructs mediate the effects of an intervention on this behavior This cRCT attempts to address these limitations, ensuring that the intervention is underpinned by a robust scientific rationale which enables explanation of how and why each component of the intervention has any effect. All authors provided a critical review and approved the final manuscript
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