Effectiveness and cost-effectiveness of tailored intensive liaison between-randomised controlled trial primary and secondary care to identify individuals at risk of a first psychotic illness (the LEGs study): a cluster-randomised controlled trial
Poster C46, Saturday, October 22, 11:30 am - 1:00 pm, Le Baron
Jesus Perez1, Debra A Russo1, Jan Stochl1, Huajie Jin2, Michelle Painter3, Gill Shelley3, Erica Jackson3, Carolyn Crane1, Jonathan P Graffy1, Tim J Croudace4, Sarah Byford2, Peter B Jones1; 1University of Cambridge, 2King's College London, 3Cambridgeshire and Peterborough NHS Foundation Trust, 4University of Dundee
Aim: We aimed to assess whether increased liaison between primary and secondary care improves the effectiveness and cost-effectiveness of detection of people with, or at high-risk of developing, a first psychotic illness (FEP). Methods: Our Liaison and Education in General Practices (LEGs) study was a cluster-randomised controlled trial of primary care practices in Cambridgeshire, UK. Consenting practices were randomly allocated (1:1) to a 2 year low-intensity intervention (a postal campaign) or a theory-based high-intensity intervention, which additionally included liaison with a specialist mental health professional. Practices that did not consent to be randomly assigned comprised a practice-as-usual (PAU) group. The primary outcome was number of referrals of patients with, or at high-risk of developing, a FEP to the early intervention service per practice site. Findings: 54 of 104 eligible practices provided consent. These practices were randomly allocated to interventions. High-intensity practices referred more FEP cases (mean 1·25[SD1·2] vs 0·7[0·9] for low intensity; [IRR] 1·9,95%CI 1·05–3·4,p=0·04), although the difference was not statistically significant for individuals at high-risk (0·9[1·0] vs 0·5[1·0]; 2·2,0·9–5·1,p=0·08). For high-risk and FEP combined, high-intensity practices referred both more true-positive (2·2[1·7] vs 1·1[1·7]; 2·0,1·1–3·6,p=0·02) and false-positive (2·3[2·4] vs 0·9[1·2]; 2·6,1·3–5·0,p=0·005) cases. Referral patterns did not differ between low-intensity and PAU practices. Total cost per true-positive referral was £26,785 in high-intensity practices, £27,840 in low-intensity practices, and £30,007 in PAU practices. Interpretation: This intensive intervention to improve liaison between primary and secondary care for people with early signs of psychosis was clinically and cost-effective.
Topic Area: Service System Development and Reform