Department of Brain Sciences, Imperial College London, London, UK
College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
BMJ Ment Health. 2023 Aug;26(1). doi: 10.1136/bmjment-2023-300716.
The components of care delivered by Early Intervention in Psychosis (EIP) services vary, but the impact on patient experience is unknown.
To investigate associations between components of care provided by EIP services in England and patient-reported outcomes.
2374 patients from EIP services in England were surveyed during the National Clinical Audit of Psychosis. Participants were asked about the care they received, and completed the 'Patient Global Impressions' Scale (rating whether their mental health had improved), and 'Friends and Family Test' (rating whether they would recommend their service). Information about service structure was obtained from service providers. We analysed associations between outcomes and components of care using multilevel regression.
The majority of participants were likely to recommend the treatment they had received (89.8%), and felt that their mental health had improved (89.0%). Participants from services where care coordinators had larger case loads were less likely to recommend their care. Participants were more likely to recommend their care if they had been offered cognitive behavioural therapy for psychosis, family therapy or targeted interventions for carers. Participants were more likely to report that their mental health had improved if they had been offered cognitive behavioural therapy for psychosis or targeted interventions for carers.
Specific components of EIP care were associated with improved patient reported outcomes. Psychosocial interventions and carer support may be particularly important in optimising outcomes for patients.
These findings emphasise the need for small case load sizes and comprehensive packages of treatment in EIP services.
早期精神病干预（EIP）服务提供的护理内容各不相同，但对患者体验的影响尚不清楚。
调查英格兰 EIP 服务提供的护理内容与患者报告结果之间的关联。
在全国精神病临床审计中，对英格兰 EIP 服务的 2374 名患者进行了调查。参与者被问及他们所接受的护理，并完成了“患者总体印象量表”（评估他们的心理健康是否有所改善）和“朋友和家人测试”（评估他们是否会推荐他们的服务）。从服务提供者那里获得有关服务结构的信息。我们使用多水平回归分析了结果与护理内容之间的关联。
大多数参与者很可能会推荐他们所接受的治疗（89.8%），并认为他们的心理健康状况有所改善（89.0%）。护理协调员的病例量较大的服务中的参与者不太可能推荐他们的护理。如果为参与者提供了针对精神病的认知行为疗法、家庭治疗或针对照顾者的针对性干预措施，他们更有可能推荐他们的护理。如果为参与者提供了针对精神病的认知行为疗法或针对照顾者的针对性干预措施，他们更有可能报告自己的心理健康状况有所改善。
EIP 护理的特定内容与改善患者报告的结果有关。心理社会干预和照顾者支持可能对优化患者的治疗效果尤为重要。
这些发现强调了 EIP 服务中需要小的病例量和综合治疗方案。
