An NIHR funded study, recently published in the The Lancet Psychiatry, assessed if increased liaison between primary and secondary care improves the clinical effectiveness and cost-effectiveness of detection of people with, or at high risk of developing, a first psychotic illness.
The Liaison and Education in General Practices (LEGs) study, led by Principal Investigator Dr Jesus Perez (Consultant Psyhiatrist at CAMEO Early Intervention Services, Cambridgeshire and Peter NHS Foundation Trust) was a cluster-randomised controlled trial of primary care practices in Cambridgeshire and Peterborough which included an economic assessment. Consenting practices were randomly allocated (1:1) to a 2 year low-intensity intervention (a postal campaign, consisting of biannual guidelines to help identify and refer individuals with early signs of psychosis) or a high-intensity intervention, which additionally included a specialist mental health professional who liaised with every practice and a theory-based educational package. Practices that did not consent to be randomly assigned comprised a practice-as-usual (PAU) group. It included a health economic evaluation to explore the cost-effectiveness of the high-intensity and low-intensity interventions compared with the PAU group.
A key interpretation of the findings is that “tailored and intensive liaison between primary and secondary care to detect people with early signs of psychosis and to help improve their access to mental health services can be clinically and cost effective”. The high-intensity intervention was more costly but the economic evaluation suggests that “this additional expenditure has the potential to generate subsequent savings through earlier detection and referral to specialist early intervention services”.
To access the full paper, please see the article on the Lancet Psychiatry website here
(Reference: Perez J, Jin H, Russo DA, Stochl J, Painter M, Shelley G, Jackson E, Crane C, Graffy JP, Croudace TJ, Byford S, Jones PB. Clinical effectiveness and cost-effectiveness of tailored intensive liaison between primary and secondary care to identify individuals at risk of a first psychotic illness (the LEGs study): a cluster-randomised controlled trial. The Lancet Psychiatry. 2015. http://dx.doi.org/10.1016/S2215-0366(15)00157-1).
For interest, please see Ben Kearns’ commentary on the paper entitled ‘Improved identification of people at risk of psychosis: is it value for money?’