SWSLHD and Bowral's Health - 73

Doubts over early intervention for psychosis - ■ Michael Woodhead 
- 6 Minutes

A major trial has prompted calls for a re-appraisal of the antipsychotic “early intervention” model for schizophrenia after it found low transition rates to psychosis and significant benefits from early intervention for psychosis. 

While Australian psychiatrists including Professor Patrick McGorry have championed early intervention for people at high risk of psychosis, a study of 288 such patients in the UK found that transition rates were only around 8% and many patients recovered without any active treatment.

The study, in the BMJ (online April 5) found that early intervention with CBT did not reduce the already low rates of transition or symptom-related distress, but it was effective in reducing the severity of psychosis.

The study authors say the lack of any effect of early intervention on transition to psychosis is disappointing, but the low transition rates are reassuring and show that young people can be given “an important and optimistic message” about their prognosis.

“Our observations also suggest that a review of the ultra high risk strategy ... is required,” they say.

The findings show it is highly premature to consider adding a “psychosis risk” category to DSM diagnostic criteria, and also put in question the ethics of using antipsychotics in young people deemed at high risk of psychosis. 

“We would suggest that antipsychotics are not delivered as a first line treatment to people meeting the criteria for being in an at-risk mental state,” they conclude.

SWSLHD and Bowral's Health - 34

E-health record failure blamed on top-down approach

• By Gemma Collins on  18 October 2011

The failure of the UK’s e-health program has been blamed on rushed implementation, failure to engage clinicians and a top-down government-driven partnership with private contractors. 

A review of the UK’s program, similar to the $500 million PCEHR planned in Australia, concluded that it was “time consuming and challenging, with as yet limited discernible benefits for clinicians and no clear advantages for patients.”

Researchers who reviewed five areas where the IT system was implemented through partners such as Cerner and iSoft, blamed the program’s ‘top down’ approach which led to an “unrealistic, politically driven timeline from the outset”, with “multiple tensions” between the creators and NHS staff.

In their review (link) the authors suggest there needs to be a clear vision and realistic timescale from the start with more “user involvement” of local clinicians and health staff in decision making.

They say a key lesson is the need to “move away from technology driven models of implementation,” and to “consider the merits of participating in the development of open source systems as opposed to the purchase of commercially developed systems.”

Large scale procurement projects were used in an effort to save money, but these often resulted in the ‘tail wagging the dog’ and programs being influenced by the particular type of software implemented.

 

  Comments

Yet another monumental waste of taxpayer funds. With all the privacy restrictions placed on the EHR by well-meaning but misguided people, it will only serve those who don't cause problems within the health system but would potentially generate a lot of wasted time and effort - if doctors had the time to actually do what is being asked. The drug dependent patients and doctor-shoppers where this initiative could be useful will just restrict their EHR access. What's the point of such a system? As in the UK, no benefits, just cost and effort. Why can't we learn from the experiences of others but be doomed to repeat them? Count me out. I'll give my patients a one-page summary where necessary.

Dr. Igor Jakubowicz | 18 October 2011 at 15:43