Improving Clinician Recognition of Early Psychosis with an Interactive Online Cou

通过交互式在线交流提高临床医生对早期精神病的认识

• 批准号: 8743301
• 负责人: DIANA O. PERKINS
• 金额: $ 19万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-26 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8743301
• 关键词: Accident and Emergency department; Address; Alcohol or Other Drugs use; Antipsychotic Agents; Area; Awareness; Beds; Behavioral; Benchmarking; Buprenorphine; Caring; Clinical; Clinical Management; Clinical Skills; Communities; Competence; Continuing Education; Development; Diagnosis; Distress; Education; Educational workshop; Effectiveness; Evaluation; Family member; Health Personnel; Impact evaluation; Intervention; Knowledge; Legal; Legal system; Literature; North Carolina; Online Systems; Outcome; Participant; Pathway interactions; Patients; Performance; Persons; Primary Care Physician; Primary Health Care; Professional counselor; Prognostic Factor; Provider; Psychiatrist; Psychotic Disorders; Randomized; Recovery; Resources; Schizophrenia; Schools; Side; Social Workers; Staging; Student Health Services; Technology; Training; United States; Universities; Violence; Waiting Lists; Work; case-based; clinical practice; design; experience; first episode psychosis; improved; innovation; lectures; outreach; outreach program; prognostic; programs; public health relevance; secondary outcome; service intervention; skill acquisition; skills; social; stem; success; suicidal behavior; tool; treatment program

DESCRIPTION (provided by applicant): For a number of reasons treatment delay is one of the most serious deficiencies in the clinical management of schizophrenia and related psychotic disorders. Untreated psychosis is distressing, derails normal development and is associated with behavioral disturbances that may be embarrassing, aggressive or have legal consequences. In addition, duration of untreated psychosis (DUP) has emerged as an independent predictor of likelihood and extent of recovery from an initial first episode and thus may be a potentially modifiable prognostic factor. In 2005, we established the University of North Carolina Outreach and Support Intervention Services (OASIS), one of the first US clinical programs specializing in treatment of a first episode of psychosis. Findings from our local pathways to care study in first episode patients are consistent with the literature, with average delays of 18 months from onset of psychosis to initiation of antipsychotic treatment. Treatment delays in study participants mainly stemmed from a lack of awareness by the patient, persons close to the patient, community clinicians and the legal system that the subjective and behavioral difficulties were due to emerging psychosis. While both the demand- and the supply-sides of the DUP problem need to be addressed, we propose that enhancing community clinicians' awareness and skills in the evaluation of the first psychotic episode is a key step. We propose that a well-designed online continuing education course has the potential to address supply-side deficiencies effectively, with a potential for broad dissemination. We will benchmark DUP and pathways to care in patients referred to the OASIS program to inform online course development, especially to clarify the target audience, and to assess the impact of course participation on DUP for new OASIS referrals. We will develop and determine the effectiveness of the course, "Recognizing Psychosis in the Early Stages: A Window of Opportunity", to the development of clinicians' knowledge of the importance of early recognition of psychosis, competence in recognizing "warning signs" for psychosis and performance of early recognition strategies in clinical practice. Finally, we will determine if course promotion efforts impact the numbers of local community clinicians who take the online course.

描述(由申请人提供)：由于许多原因，治疗延误是精神分裂症和相关精神障碍临床管理中最严重的缺陷之一。未经治疗的精神病令人痛苦，使正常发展脱轨，并与可能令人尴尬、咄咄逼人或具有法律后果的行为障碍有关。此外，未经治疗的精神病的持续时间(DUP)已经成为从最初的第一次发作中恢复的可能性和程度的独立预测因素，因此可能是一个潜在的可修改的预后因素。2005年，我们成立了北卡罗来纳大学外展和支持干预服务(OASIS)，这是美国首批专门治疗首发精神病的临床项目之一。我们对首发患者的本地路径护理研究的结果与文献一致，从精神病发作到开始抗精神病治疗的平均延迟为18个月。研究参与者的治疗延误主要是由于患者、患者身边的人、社区临床医生和法律制度缺乏意识，即主观和行为困难是由于出现精神病。虽然DUP问题的需求方和供给方都需要解决，但我们建议提高社区临床医生在评估第一次精神病发作时的意识和技能是关键一步。我们 提出一个设计良好的在线继续教育课程有可能有效地解决供给侧的不足，具有广泛传播的潜力。我们将对OASIS计划转介的患者的DUP和护理路径进行基准，以告知在线课程开发，特别是明确目标受众，并评估课程参与对新OASIS转介的DUP的影响。我们将开发和确定“早期识别精神病：机会之窗”课程的有效性，以发展临床医生对早期识别精神病的重要性的认识，提高识别精神病“预警迹象”的能力，并在临床实践中执行早期识别策略。最后，我们将确定课程推广工作是否会影响参加在线课程的当地社区临床医生的数量。