Reducing the duration of untreated psychosis and its impact in the US: the STEP-ED study
Reducing the duration of untreated psychosis and its impact in the US: the STEP-ED study
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DOI：
10.1186/s12888-014-0335-3
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发表时间：
2014-12-04
期刊：
影响因子：
4.4
通讯作者：
Woods, Scott W.
中科院分区：
文献类型：
--
作者：
Srihari, Vinod H.;Tek, Cenk;Woods, Scott W.
背景资料：精神障碍的早期干预服务最佳连锁策略，以提供：（i）早期检测（艾德），以缩短精神病症状发作和有效治疗之间的时间（i）。e.持续时间未经治疗的精神病，DUP）;和（ii）在随后的2至5年的综合干预。在后一类中，是团队（“首发服务”或FES），整合了几种经验支持的治疗方法，并将其提供给年轻患者和护理人员。有一个迫切需要加快进入既定的FES在美国。S.尽管治疗结果有所改善，但这些FES通常在精神病发作后一年或更长时间内与患者接触。斯堪的纳维亚TIPS研究能够有效地减少DUP在一个定义的地理流域。这项研究的指导性问题是：美国能不能？S. TIPS方法对艾德的适应性大大减少了DUP并改善了现有FES的结局？方法/设计：主要目的是确定与常规检测相比，艾德是否可以减少美国的DUP。艾德将由位于康涅狄格州南部的一个FES（STEP）实施，通常的检测工作将继续在服务于大波士顿都市区的一个类似的FES（PREPR）进行。次要目的是确定DUP减少是否可以改善FES护理的表现，参与和早期结果。准实验设计将比较艾德在STEP与PREPR连续3个活动年对DUP的影响。该运动将部署3个组成部分，旨在改变STEP周围8个城镇的护理途径。社会营销方法将为公众教育活动提供信息，以实现快速有效的求助行为。专业的外展和详细介绍各种各样的护理提供者，包括那些在医疗保健，教育和司法部门，将有助于快速重定向适当的病人到STEP。最后，STEP内的性能改进措施将加快参与referreration.Discussion：STEP-艾德将测试一个艾德运动适应异质美国途径照顾，同时也提高我们对这些途径的理解和他们对早期结果的影响。
Background: Early intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i. e. Duration of Untreated Psychosis, DUP); and (ii) comprehensive intervention during the subsequent 2 to 5 years. In the latter category, are teams ('First-episode Services' or FES) that integrate several empirically supported treatments and adapt their delivery to younger patients and caregivers. There is an urgent need to hasten access to established FES in the U. S. Despite improved outcomes for those in treatment, these FES routinely engage patients a year or more after psychosis onset. The Scandinavian TIPS study was able to effectively reduce DUP in a defined geographic catchment. The guiding questions for this study are: can a U. S. adaptation of the TIPS approach to ED substantially reduce DUP and improve outcomes beyond existing FES?Methods/Design: The primary aim is to determine whether ED can reduce DUP in the US, as compared to usual detection. ED will be implemented by one FES (STEP) based in southern Connecticut, and usual detection efforts will continue at a comparable FES (PREPR) serving the greater Boston metropolitan area. The secondary aim is to determine whether DUP reduction can improve presentation, engagement and early outcomes in FES care. A quasi-experimental design will compare the impact of ED on DUP at STEP compared to PREPR over 3 successive campaign years. The campaign will deploy 3 components that seek to transform pathways to care in 8 towns surrounding STEP. Social marketing approaches will inform a public education campaign to enable rapid and effective help-seeking behavior. Professional outreach and detailing to a wide variety of care providers, including those in the healthcare, educational and judicial sectors, will facilitate rapid redirection of appropriate patients to STEP. Finally, performance improvement measures within STEP will hasten engagement upon referral.Discussion: STEP-ED will test an ED campaign adapted to heterogeneous U.S. pathways to care while also improving our understanding of these pathways and their impact on early outcomes.