Real-world implementation of precision psychiatry: Transdiagnostic risk calculator for the automatic detection of individuals at-risk of psychosis
| Autor: | Dominic Oliver, Daniel Stahl, Craig Colling, Richard Dobson, Matthew Broadbent, Helen Baldwin, Robert Stewart, Giulia Spada, Philip McGuire, Rashmi Patel, Paolo Fusar-Poli |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Psychosis
transdiagnostic medicine.medical_specialty Disease cluster Article law.invention 03 medical and health sciences 0302 clinical medicine Primary outcome law Phone London medicine Electronic Health Records Humans Psychiatry health care economics and organizations Biological Psychiatry business.industry Feasibility Usability medicine.disease Risk calculator 030227 psychiatry Outreach Psychiatry and Mental health Psychotic Disorders Calculator Implementation Feasibility Studies Precision psychiatry Implementation research business 030217 neurology & neurosurgery |
| Zdroj: | Schizophrenia Research |
| ISSN: | 0920-9964 |
| DOI: | 10.1016/j.schres.2020.05.007 |
| Popis: | Background Risk estimation models integrated into Electronic Health Records (EHRs) can deliver innovative approaches in psychiatry, but clinicians' endorsement and their real-world usability are unknown. This study aimed to investigate the real-world feasibility of implementing an individualised, transdiagnostic risk calculator to automatically screen EHRs and detect individuals at-risk for psychosis. Methods Feasibility implementation study encompassing an in-vitro phase (March 2018 to May 2018) and in-vivo phase (May 2018 to April 2019). The in-vitro phase addressed implementation barriers and embedded the risk calculator (predictors: age, gender, ethnicity, index cluster diagnosis, age*gender) into the local EHR. The in-vivo phase investigated the real-world feasibility of screening individuals accessing secondary mental healthcare at the South London and Maudsley NHS Trust. The primary outcome was adherence of clinicians to automatic EHR screening, defined by the proportion of clinicians who responded to alerts from the risk calculator, over those contacted. Results In-vitro phase: implementation barriers were identified/overcome with clinician and service user engagement, and the calculator was successfully integrated into the local EHR through the CogStack platform. In-vivo phase: 3722 individuals were automatically screened and 115 were detected. Clinician adherence was 74% without outreach and 85% with outreach. One-third of clinicians responded to the first email (37.1%) or phone calls (33.7%). Among those detected, cumulative risk of developing psychosis was 12% at six-month follow-up. Conclusion This is the first implementation study suggesting that combining precision psychiatry and EHR methods to improve detection of individuals with emerging psychosis is feasible. Future psychiatric implementation research is urgently needed. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect