Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Psychiatry, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2020 Dec 17;10(12):e042751. doi: 10.1136/bmjopen-2020-042751.
While nearly half of all new psychotic disorders are diagnosed in the emergency department (ED), most young people who present to the ED with psychosis do not receive timely follow-up with a psychiatrist, and even fewer with evidence-based early psychosis intervention (EPI) services. We aim to test an intervention delivered using short message service (SMS), a low-cost, low-complexity, youth-friendly approach, to improve transitions from the ED to EPI services.
This is a protocol for a pragmatic randomised, single blind, controlled trial with accompanying economic and qualitative evaluations conducted at the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. A consecutive series of 186 participants aged 16-29 referred by the ED to CAMH's EPI programme will be recruited for a trial of a two-way intervention involving reminders, psychoeducation and check-ins delivered via SMS. The primary outcome will be attendance at the first consultation appointment within 30 days of study enrolment assessed through chart reviews in the electronic health record. We will also extract routine clinical measures, including the Brief Psychiatric Rating Scale, Clinical Global Impression and Service Engagement Scale, and link with provincial health administrative data to examine system-level outcomes, including ED visits and psychiatric hospitalisations, 6 months and up to 2 years after baseline. We will perform a cost-effectiveness analysis of the primary study outcome and costs incurred, calculating an incremental cost effectiveness ratio. Web-based surveys and qualitative interviews will explore intervention user experience. Patients and families with lived experience will be engaged in all aspects of the project.
Research Ethics Board approval has been obtained. Findings will be reported in scientific journal articles and shared with key stakeholders including youth, family members, knowledge users and decision makers.
NCT04298450.
尽管近一半的新发精神障碍在急诊科（ED）得到诊断，但大多数因精神病到 ED 就诊的年轻人并未及时接受精神科医生的随访，而接受循证早期精神病干预（EPI）服务的则更少。我们旨在测试一种通过短信息服务（SMS）提供的干预措施，这是一种低成本、低复杂性、适合年轻人的方法，以改善从 ED 过渡到 EPI 服务的情况。
这是一项在加拿大多伦多成瘾和心理健康中心（CAMH）进行的实用随机、单盲、对照试验的方案，同时还进行了经济和定性评估。将连续招募 186 名年龄在 16-29 岁之间、由 ED 转介到 CAMH 的 EPI 计划的参与者，进行一项涉及通过 SMS 发送提醒、心理教育和检查的双向干预试验。主要结果将通过电子健康记录中的图表审查来评估，即在研究入组后 30 天内参加第一次咨询预约的情况。我们还将提取常规临床指标，包括简明精神病评定量表、临床总体印象量表和服务参与量表，并与省级卫生行政数据相关联，以检查 6 个月和基线后长达 2 年的系统水平结局，包括 ED 就诊和精神病住院治疗情况。我们将对主要研究结果和所产生的成本进行成本效益分析，计算增量成本效益比。基于网络的调查和定性访谈将探索干预措施的用户体验。具有实际经验的患者及其家属将参与项目的各个方面。
已获得研究伦理委员会的批准。研究结果将在科学期刊文章中报告，并与包括青年、家庭成员、知识用户和决策者在内的主要利益相关者分享。
NCT04298450。
